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Honoring Black Breastfeeding Week 2020: Health Equity and Access

Please join ILCA in celebrating Black Breastfeeding Week! Traditionally held in the last week of August, Black Breastfeeding Week was initially created to address racial disparities in breastfeeding. This year’s theme – Revive, Restore, Reclaim – is being celebrated virtually this year due to COVID-19. 

A lack of access to culturally matched skilled lactation providers is one of the barriers that Black families face while working towards their breastfeeding and chestfeeding goals. In a recent address to more than 1500 participants around the globe, ILCA’s immediate past president, Mudiwah Kadeshe, shared the impacts of inequities in breastfeeding and a model for creating change.

Watch her presentation here:

Here is a transcript of her presentation:

Breastfeeding is a public health imperative. You cannot separate it from health equity.

As France [Begin, Senior Advisor, Early Childhood Nutrition at UNICEF] shared with us earlier, we know the cost of not breastfeeding is enormous.

And yet, we also know that while most mothers around the globe start breastfeeding, those who are economically or socially vulnerable are most likely to struggle with breastfeeding.

In high resource countries, low income families and those with less education are less likely to breastfeed than their high income counterparts.

And even where breastfeeding is more prevalent, in low- and middle-income countries, still less than 40 percent of infants under six months are exclusively breastfed.

Inequities in breastfeeding occur not just around income and education, but around other identities, including race, religion, sexual orientation, gender identity, and ability.

Inequities in lactation result because of the systems that perpetuate barriers to access in health care, including skilled breastfeeding care.

In both my global work with ILCA and locally with the Washington DC Breastfeeding Coalition, I have seen that addressing these barriers is possible. But it will take all of us.

How can we deliver skilled breastfeeding support both locally and around the globe? I know that International Board Certified Lactation Consultants, or IBCLCs, play an essential role, because the clinical skills these providers bring are particularly helpful in special circumstances, like small or sick newborns.

IBCLCs are just one of the many kinds of providers that can and do work together to ensure support for those critical first 1,000 days of life. I want to share with you one model of bringing together different providers of skilled breastfeeding care for addressing barriers – my work as a part of the DC Breastfeeding Coalition.

Our model has three essential components: knowledge, partnerships, and funding.

Equity starts with knowledge of the community’s needs. Washington DC is truly a tale of two cities. On either side of the river, you see very different communities, each with very different breastfeeding outcomes.

Working closely with the community, The DC Breastfeeding Coalition saw that one reason for those disparities was a lack of access to skilled breastfeeding support. Together, we established the East of the River Lactation Support Center to break down that barrier.

At our Center, we wrap care around the mother, from before birth until weaning. We ensure that the mother and child receive consistent care from trained, integrated, and collaborative teams of skilled breastfeeding care providers.

Breastfeeding education begins during pregnancy, provided by a community based peer educator. Peer educators continue to provide care at the hospital and after birth, and are full members of the health care team. As peers from the community, they are skilled at teaching breastfeeding, and they are experts in the culture of the families they serve.

Lactation care continues in the clinic. Routine questions are answered by a peer educator or Certified Lactation Counselor, who supports the normal course of breastfeeding.

More complex issues are referred to an IBCLC or a breastfeeding medicine specialist. Throughout care, this team works together.

Partnerships are critical to our success. Our peer educators go where the breastfeeding mothers are, including into the local public schools, providing support to breastfeeding students in the classroom. 

Our team also provides care to one of the most marginalized populations, the deaf community, through our breastfeeding support for the students and employees of Gallaudet University.

We work with employers, conferring awards to those who create a supportive environment for their breastfeeding employees.

We facilitate a Lactation Certification Preparation Course for individuals from underrepresented groups to prepare them for the IBCLC exam.

Funding programs that generate positive results is critical. The Coalition is supported through grant funding. What you value is what you measure!  The DC Breastfeeding Coalition developed a custom database to collect demographic data and breastfeeding rates. 

We are in the early phases of data analysis, and know first hand that these efforts are most needed in the communities with the fewest available resources. 

And, we are also looking towards ways that, over time, our program can become self-sustaining. But we know it will take time to get there. 

In the meantime, models of skilled breastfeeding support, like the DC Breastfeeding Coalition’s efforts at East of the River, need sufficient and sustained financial support if they are to continue.

We know that breastfeeding prevents malnutrition, ensures food security, even in times of crisis, and plays a role in breaking the cycle of poverty. And, we know that skilled breastfeeding support – in all its forms – plays a critical role in improving breastfeeding outcomes.

Together, we can ensure that all families have access to the breastfeeding support they need to achieve the equitable health they deserve.

To view the entire webinar or to hear this presentation in Arabic, French, Russian, or Spanish, click here.

To learn more about Black Breastfeeding Week (BBW) celebrations, visit the BBW website here.

Mudiwah A. Kadeshe has more than 25 years of experience in women’s health nursing. Informed by her own birth experiences, she entered the profession wanting to support women in their birthing choices and became a certified childbirth educator and an International Board Certified Lactation Consultant to increase her ability to reach families. Mudiwah established and directed a lactation resource center at a tertiary

care medical system hospital that facilitated more than 3000 deliveries per year. She currently is a community based lactation consultant in one of the most poverty stricken wards in Washington, D.C. and oversees the peer counselor services through the Children’s National East of the River Lactation Support Center. She is currently the Vice President, Program Manager, and lead facilitator for grant-based projects for D.C. Breastfeeding Coalition.

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