Addressing Inequity: An Interview with Cathy Carothers

Here at Lactation Matters and on ILCA’s social media, we have received many questions about last year’s Lactation Summit and the ongoing efforts to remove barriers to the International Board Certified Lactation Consultant® (IBCLC®) profession. We asked Cathy Carothers, BLA, IBCLC, FILCA, the current chair of the Lactation Consultant Equity Initiative, to catch us up on where the initiative has been and what to expect next.

Lactation Matters (LM): Last year’s Summit resulted in a powerful report highlighting some of the barriers to the IBCLC profession experienced by people around the globe. What feedback have you received from that report?

Cathy Carothers (CC): We are VERY excited and gratified by the incredible interest that has been generated as a result of the 2014 Lactation Summit. First of all, we were thrilled over the fantastic attendance, the enthusiasm, and the passion that people brought to the event, and the genuine care and concern by individuals and organizations that are committed to making the profession more accessible. As the Summary Report shows, there are definitely MANY barriers to address, and these barriers result in inequities that make it challenging, if not impossible, for many to access the lactation consultant profession. There is also still much to learn, especially in countries where English is not spoken. While it sometimes feels a little overwhelming to think about how big the needs are, we are, nonetheless very encouraged by the strong interest, and are confident that we WILL find solutions when we work together.

LM: As the result of that feedback,  I understand a much different kind of event is happening this July. Can you tell us a bit about it?

CC: Sure. One of the recommendations from the 2014 Summit articulated in the Summary Report was the profound need for training for members of our profession. This is indeed a journey and a process, and most of us are all at very different places along that path. The former summit design team felt strongly that the next step in this continuing process of discovery and action was to host a seminar to better inform members of the profession about the nature of inequity and how individuals can serve as change agents within their organizations and communities.

We asked a subgroup, exclusively comprised of members of underrepresented communities, to identify goals, speakers, and plans for this event. This subgroup has done an outstanding job identifying key learning needs and a plan for the day to move this work forward. The seminar is free, to enable as many as possible to participate within the limits of the space we have. We are also exploring recording the day to make access to the sessions available after the event for those unable to travel to D.C. The seminar is one continuing step in a larger process that will continue the listening and action planning. For example, the group is addressing other methods, beyond the seminar, to engage the larger global community, such as web-based listening and interactive sessions in the native languages of listeners.

LM: I know the original design team formed to plan the Summit has evolved to respond to what was learned in that report. Can you tell me how that group has changed?

CC: The original 2014 Lactation Summit was hosted jointly by three organizations – International Board of Lactation Consultant Examiners® (IBLCE®), International Lactation Consultant Association® (ILCA®), and Lactation Education Accreditation and Approval Review Committee (LEAARC). A design team comprised of representatives from several racial/ethnic groups and countries was formed to plan and execute an event that would facilitate listening and learn the breadth of issues impacting access to the profession.

We learned a lot! The Summit showed us that the magnitude of this work exceeds what can be accomplished by a single event or by any one organization. The needs are great. And the work is big and complex. So what began as a single event has now evolved into a much broader initiative, requiring many more individuals and organizations who are willing to work collaboratively to creatively address barriers. Some of the identified barriers can only be addressed by one or more of these three organizations. Many other barriers will best be addressed through the collaborative work of many individuals and organizations that can bring resources, solutions, and ideas to bear. For example, addressing the issue of lack of jobs for IBCLCs cannot be handled by a single organization. This will truly require a collective approach and many different strategies based on country and potential job settings!

We are SO thankful for the vision of the three original host organizations that set the stage for this important work to begin and provided seed resources to launch it. As a result, each has begun internal conversations to consider the recommendations of the Summary Report. Some changes are already underway! The three organizations are also working as important collaborative partners in the restructured Lactation Equity Action Team to explore how we can collectively address these larger issues facing the profession. The team is also exploring ways to equip individual lactation consultants to become change agents within their communities.

I am truly excited about the continuing evolution of this important coalition! The 30th anniversary celebration of the profession is rapidly approaching. There’s no better time to celebrate our past and to work toward a future that includes our full cultural and geographic diversity! Henry Ford once said, “Coming together is a beginning; keeping together is progress; working together is success.”

LM: If someone wanted to get involved in the Lactation Equity Action Team, how would they do so? What sort of help is needed right now?

CC: We welcome anyone who would like to participate! There is clearly much work to do, and we would welcome those who wish to contribute their time and ideas. The Lactation Equity Action Team is examining a process to assure that the coalition includes a just and effective proportion of global and racial/ethnic perspectives. There are many opportunities to get involved for anyone who is interested.

• Learn about the issues! The ILCA website Lactation Consultant Equity page has numerous opportunities to learn more. Be sure to scroll down to the bottom of the page to access the Suggested Reading List to read some outstanding articles about how inequities come about and can be addressed. Also, be sure to check out the February 2015 “Equity in Breastfeeding” issue of the Journal of Human Lactation, which has several outstanding articles about equity in our field. Then, use what you are learning to begin a systematic process of analyzing how institutional privilege and oppression manifests itself in your own organizations and develop and implement a strategic plan to rebuild the structure, based on your findings.¹
• Stay informed and keep US informed! If you’d like to be on a mailing list to receive ongoing information about the lactation equity initiative, let us know! We also want to hear from YOU if you have suggestions about solutions that will address the many identified barriers.
• Attend the Equity Action Seminar. Join us in Washington, D.C. on 21 July 2o15 for the Equity Action Seminar. If you are not able to come to Washington, D.C., check out a recording that will be made available free of charge. Pass the information along to other lactation consultants in your community, and consider implementing action steps within your hospital or organization to address issues of equity within your own community.
• Contribute. Consider making a monetary donation to Monetary Investment for Lactation Consultant Certification (MILCC) (click here to visit MILCC). This nonprofit organization provides scholarships for IBCLC exam fees for those who are simply unable to pay the costs. Spread the word both to those who are seeking financial assistance, as well as those who are in a position to contribute. It’s a wonderful way to make a tangible difference in reducing the cost barrier.
• Volunteer. There will be many opportunities for volunteers to participate. For instance, we will be looking for individuals who would like to work with small groups to address potential solutions for the identified barriers. Also, if you live in a country where English is not the primary language, we are considering a process to engage ideas to enhance our understanding of the issues of access. Let us know if you would be willing to convene a web meeting in your country to identify additional barriers and potential solutions.
• Share your ideas. Use this blog or go to our online feedback form to share your ideas and thoughts about next steps and what you would be willing to work on.

LM: Where do you expect the newly formed group to go from here?

CC: Forward! The process is continuing to unfold and evolve with each passing month as we learn more about the issues and the needs. There is still much to learn and much work to do in addressing the identified barriers. We want our efforts to result in a measurable improvement in areas identified as needing change. We’ll be identifying broader goals for the initiative, conducting strategy planning, and identifying the collaborative process that will enable this work to grow.

¹ Good-Mojab C. Pandora’s box is already open: answering the ongoing call to dismantle institutional oppression in the field of breastfeeding. J Hum Lact. 2015;31(1):32-35.

Cathy Carothers, BLA, IBCLC, FILCA is Co-Founder and Co-Director of Every Mother, Inc., a non-profit 501(c)3 organization dedicated to providing counseling and lactation training and resources for health professionals and the families they serve. She is also the current chair of the Lactation Consultant Equity Initiative.