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Ensuring Health for All: ILCA President, Mudiwah Kadeshe, shares at Women Deliver

How do we make sure that the world knows about the impact and value of skilled lactation care? By educating the community at the world’s largest gathering on the health, rights, and well-being of women and girls. ILCA president Mudiwah Kadeshe recently presented at a side event at Women Deliver. Also in attendance at the conference was board member Iona Macnab. Together, they attended all of the lactation-related events and may have even been spotted adding some breastfeeding imagery to a community-created mural. Following is Kadeshe’s presentation.

My name is Mudiwah Kadeshe and I am the president of the International Lactation Consultant Association, or ILCA. ILCA is the member association for International Board Certified Lactation Consultants® (IBCLC®) and other healthcare professionals who care for breastfeeding families. ILCA membership is open to all who support and promote breastfeeding.

I have the unique opportunity to work with a variety of providers who support breastfeeding. I direct a lactation program that brings together comprehensive lactation services – from peer educators, Certified Lactation Counselors, and IBCLCs, to a pediatric breastfeeding medicine specialist. Each of us has our own scope of practice and are essential to this work. I get to see the impact that comprehensive, community-based lactation support can have in a low-resource community.

I work in Washington, DC, in the United States, but ILCA represents more than 5000 members in 80 countries around the world. Globally, our members support women in the prenatal period, immediately following birth, when they have sore, painful breasts, or have other special needs, such as cleft lips/palates. IBCLCs also educate families and other health care providers and advocate for breastfeeding worldwide.

Women Deliver calls for action to ensure health for all by implementing comprehensive health services that are person centered and focus on women and girls. They call for meeting the needs of women and girls’ reproductive health across the entire life course.

We believe that breastfeeding and lactation is a critical part of the continuum of reproductive health, but is too often left out of the discussions around access to a full range of reproductive health care. Integrating breastfeeding and skilled lactation care into a person-centered comprehensive health system is critical to achieving many of the Sustainable Development Goals.

Imagine how increased breastfeeding rates worldwide could impact the goal of eliminating poverty. For example, a 2015 study from a large cohort in Brazil demonstrated that adults who had been breastfed as children had higher levels of education and income later in life.

Of course, increased breastfeeding rates can help end hunger for the youngest members of the global community.

Breastfeeding improves health of women and children across the lifespan and is part of a nurturing care package. Evidence from the 2016 Lancet series indicates:

  • 820,000 lives of children saved, but children are not the only beneficiaries of breastfeeding
  • 20,000 cases of breast cancer prevented
  • With adequate scaling up of breastfeeding to recommended rates, more than $300 billion USD could be saved each year in health care costs associated with not breastfeeding

Supporting women in breastfeeding also increases gender equality, or as Jennifer would say, gender equity…

…and reduces inequalities.

All while supporting sustainable cities and communities.

However, families are facing barriers worldwide. Globally, the majority of women initiate breastfeeding but many stop before they intend to. Only 40 percent of children are breastfed exclusively for the first six months of life. The target for exclusive breastfeeding is 70 percent. This gap is due, in part, to a lack of access to quality lactation health services.

There is ample evidence to include breastfeeding and skilled lactation care in an integrated health care system as part of quality health services.

In my experience in my community, comprehensive support is what helps families reach their goals. But don’t just take my word for it. The research supports my experience.

A 2015 meta-analysis reviewed almost 200 studies to look at effective interventions on breastfeeding initiation, exclusivity and continued breastfeeding in 5 settings-health systems and services, home and family environment, community environment, work environment, policy environment, AND they looked at the combination of these together. The authors concluded that no one setting is adequate.

The greatest impact on exclusive breastfeeding and lactation duration was demonstrated when breastfeeding families received counseling and education concurrently across settings: health systems, home and family and the community environment.

What do quality lactation services look like? High quality care is defined by WHO as “care that is safe, effective, people-centred, timely, efficient, equitable and integrated.”

According to the World Health Organization’s Guidelines on Counseling Women to Improve Breastfeeding Practices, comprehensive breastfeeding counseling should include:

  • all pregnant women and women with young children,
  • should be provided antenatally and postnatally up to 24 months or longer,
  • should be provided face-to-face and possibly by telephone or remotely,
  • should provide a continuum of care by trained HCPs, community lay/peer counselors,
  • and should anticipate and address important challenges and context.

Also, person-centred care should be:

  • Country-led,
  • Equity-focused,
  • and Participatory

If we know that lactation provides health for all, and lactation support improves outcomes, what are the barriers we need to overcome?

One of ILCA’s core values speaks directly to the issue of access to quality lactation care for families globally.

Today, families are not receiving comprehensive lactation care for a number of reasons. First, the health care system lacks capacity in knowledge. Second, communities are lacking capacity in higher level skills, including lack of access to IBCLCs. Additionally, unethical marketing practices by baby milk companies target vulnerable populations, undermining families’ goals and global health outcomes. Moreover, we need to scale up the number of providers available around the globe. However, there are issues of access to the profession. ILCA worked with those underrepresented in the field worldwide and identified challenges to entering the field, including language barriers, financial issues, and a lack of qualified mentors.

What can we take away from this? As I have seen in my own community, investment in building capacity of health care systems, including professionals and community lay and peer counselors will strengthen decisions that families make about breastfeeding.

Investing in diversification of skilled lactation professionals will help ensure quality comprehensive, person-centered care to families globally.

And, most importantly, families’ decisions to breastfeed should not be undermined by inequitable access to quality, comprehensive, person-centered breastfeeding and skilled lactation care.

Lactation and breastfeeding are a critical part of the reproductive continuum.

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