Author Archive | lactationmatters

Fighting Cross-Marketing of “Follow-up” Milks

Families often do not know the difference between infant formula and toddler milks. According to UNICEF and the World Health Organization (WHO), advertising and promotion of toddler or follow-up milks is a way to circumvent the protections provided by the International Code of Marketing of Breast-milk Substitutes (International Code).

These toddler or follow-up milks are often labelled nearly identically to infant formula intended for infants birth – six months, but are in some countries not subject to the same marketing restrictions.

According to the World Health Organization: “Products that function as breastmilk substitutes should not be promoted. A breastmilk substitute should be understood to include any milks . . . that are specifically marketed for feeding infants and young children up to the age of 36 months (including follow-up formula and growing-up milks).” 

These are just two of the reasons why ILCA volunteer Maryse Arendt attended the Codex meeting in Dusseldorf, Germany, where follow-up formulas, cross-promotion, and the International Code were being discussed.

Following the six day meeting, Maryse reported that important progress was made following significant discussions, negotiations, and compromises. As ILCA’s representative to Codex, she worked alongside the handful of other lactation-supportive NGO and breastfeeding-friendly country representatives. 

Codex Alimentarius is a set of internationally recognized standards and guidelines for food, food production, and food safety. Since 1963, Codex has existed to protect the health of consumers and ensure fair practices in international food trade.

Progress at Codex often happens in small steps and over multiple years of effort and negotiation. Previously, the Codex standard defined follow-on milks as not being breastmilk substitutes. This is significant as it allowed formula companies to label follow-on milks in similar packaging (often in stages, such stage 1, 2, and 3) and then market the toddler drinks without the protections of the International Code.

The new Codex draft under discussion now names the product a “drink for young children” or a “drink for young children with added nutrients,” without requiring it to be exempted from the International Code. This is important because countries that are already or want to define the product as a breastmilk substitute can do so, without threat of violations of World Trade Organization agreements. The text has still to undergo different Codex steps before being final in 2022.

Up next: a discussion to include a reference to the International Code and WHA resolutions in the preamble, which was deferred to next year. The United States was the biggest opponent to strengthening references to the Code in Codex.

Thank you to Maryse for your significant efforts. 

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Call for Papers: State of the Science August 2020 Issue

Guest post by Journal of Human Lactation Editor in Chief, Joan Dodgson, PhD, MPH, RN, FAAN

The aim of state of the science literature reviews that Journal of Human Lactation (JHL) features in our August issue is to provide an up-to-date picture of what is well established in a particular aspect of lactation and to suggest possible areas that need further research. These reviews are critical analyses of the body of research about a specific narrowly defined topic, written by researchers who have the breadth and depth of knowledge along with the research skills to distill a body of work for the rest of us. It is important that the authors’ analysis within state of the science articles addresses a number of very important questions:

  • Why is this an important area within lactation?
  • What assumptions are being made in the existing literature?
  • How rigorous are the study designs within this body of literature?
  • Who is and who is not being studied (and why)?
  • What do we know, what are we fairly certain about, and what do we not know about this topic?
  • Where or what are the disparities?
  • What are next steps in moving this knowledgebase forward? 

We consider state of the science analysis a type of research because it requires much more depth of analysis than a synthesis of existing literature. Therefore, all components of a research paper (i.e., background, study aim, methods [design, sample, data collection, data analysis] results, discussion and limitations) are required in the state of the science papers.

  • First, a brief Background about the topic of study that includes the significance of this topic is needed. 
  • A clearly written Study Aim that describes the area to be critically analyzed is essential or the reader will be unable to determine if the authors have adequately addressed the issue. 
  • The methods section begins with the Design section statement, in which a design statement is required. A number of ways to conduct an analytical review of the literature (i.e., the design) exist, any of which would be appropriate for a state of the science paper. We have previously published state of the science papers that used the methods of systematic reviews, meta-analyses, scoping reviews, integrated and qualitative synthesis; however, other methodologies also could be used. 
  • In this type of research, the articles reviewed are the Sample, which need to be described using inclusion and exclusion criteria. This section also provides a description of how the literature review was done, including the databases searched, search strategy and search terms. To do an adequate review a minimum of 4 databases need be searched. In addition to the health science databases, many topics relevant to lactation also require a search of humanities (JSTOR) and social science (PsycINFO, social science abstracts & others) literature. It might be helpful to readers if a table of the search strategy was included. Additionally, a PRISMA diagram is required.
  • The Data Collection section must include how data from each article was abstracted (e.g., using matrices), when and by whom. This section also needs to include which variables were extracted with clear definitions, keeping in mind that breastfeeding variables frequently are ill defined or defined differently by various authors.
  • The Data Analysis section clearly describes to the reader how variables were analyzed (e.g., descriptive statistics, etc.) and compared. 
  • It is likely that most of the Results will be presented in the form of tables and/or figures. 
  • It is in the Discussion section that the authors will need to distill the meanings within their findings, discuss the gaps in the existing body of literature and identify areas for future research. 
  • A Limitation section is required
  • Conclusions need to be generalized statements 

State of the science articles are the most up-to-date evaluations about the topic analyzed, as textbooks are always out of date, making state of the science articles invaluable resources for researchers, educators and clinicians. It is of great importance that experts in the field publish state of the science papers, which is why we are posting this call for papers. We ask that, if you feel this is something you could do, you consider submitting one for upcoming state of the 2020 science issue (manuscripts due 20 January 20).

Find JHL Author Directions here.

For examples of state of the science articles, see our August 2019 issue.

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Understanding ILCA’s Advocacy Strategy

At ILCA, all of our advocacy work is defined by our overarching goal: sustainable policy change so that more children survive and thrive through breastfeeding/chestfeeding and so that skilled lactation care is valued globally.

The advocacy strategy was shared with our community by advocacy advisor Michele Griswold at the recent All General Meeting at the ILCA conference in Atlanta, Georgia:

Read on for a summary of key elements of ILCA’s advocacy strategy:

Our overarching goals

At ILCA, all of our advocacy work is defined by our overarching goal: sustainable policy change so that more children survive and thrive through breastfeeding/chestfeeding and skilled lactation care is valued globally.

Of course, ILCA’s advocacy strategy is also informed by our vision: World health transformed through breastfeeding and skilled lactation care.

Target areas in breastfeeding and skilled lactation care

This leads to a two-pronged advocacy approach targeting two critical issues: breastfeeding and skilled lactation care.

For the next three to five years, ILCA has identified six target areas in the two areas of breastfeeding and skilled lactation care.

For breastfeeding, ILCA advocates for breastfeeding/chestfeeding families by calling upon governments, regional and local decision makers to:

  • Implement BFHI
  • Implement the Code
  • Family Friendly Policies

For skilled lactation professionals, ILCA advocates for:

  • Worldwide recognition of skilled lactation professionals as allied health providers
  • Capacity building at the local, regional, and national levels
  • Funding to achieve the above

ILCA represents you when it matters most

To help achieve these goals, ILCA has long had representation at the global level to represent you at the global level. [Editor’s note: We will continue to keep you up-to-date on these key meetings via email and social media at #ILCArepresents]

Engagement is key to advocacy success

How will ILCA reach these goals? Michele captured ILCA’s focus on effective organizing through engagement:

“The heart of advocacy work is relationships. Ongoing engagement with you, our members and partners, and key stakeholders is going to be key to achieving our advocacy goals. We as lactation professionals all over the world are linked to one another through the work we do every day in our communities.”

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New Resource: Advocacy Toolkit

The evidence is now stronger than ever: breastfeeding is critically important for women and children in both high- and low-income countries.

Increasing the rates of breastfeeding worldwide will help countries to meet the Sustainable Development Goals (SDGs)—including Goal 5 on gender equality and women’s empowerment. Breastfeeding is a woman’s right and empowers women as mothers, giving women the means to nourish their infants and protect them from illness, even during emergencies and times of crisis.

However, lack of adequate support for women to breastfeed is an issue in every country. Women who wish to breastfeed should have the right to do so—whenever and wherever they choose—with the full support of their families, communities, employers, and governments.

The Global Breastfeeding Collective (the Collective) is pleased to share a new resource: the Breastfeeding Advocacy Toolkit. Led by UNICEF and WHO, the Collective is a partnership of more than 20 international organizations – including ILCA – committed to increasing investment and driving policy change to support breastfeeding worldwide. The toolkit is intended for all stakeholders seeking information and tools to protect, promote, and support breastfeeding. The toolkit aims to build awareness of the Collective’s seven policy actions and provide access to resources that stakeholders can use in the development of initiatives to support these policy actions globally, nationally, and sub-nationally. Resources in the toolkit include guidebooks, policy briefs, educational videos, and case studies. Where possible, resources have been provided in multiple languages, and the toolkit will be updated periodically to include new, relevant tools as they become available.

Please be sure to check out the Breastfeeding Advocacy Toolkit and consider sharing with your networks! The toolkit is intended to be interactive, and we welcome your input. Should you have any questions or suggestions regarding the toolkit, please contact breastfeeding@unicef.org.

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ILCA Seeks Advocacy Advisor

ILCA would like to thank Michele Griswold, PhD, MPH, RN, IBCLC, for her service as the ILCA Advocacy Advisor to the Board of Directors. During her time in this new role for ILCA, she has helped to shape this position and has created a vision and strategy that will help advance breastfeeding worldwide and elevate the role of skilled lactation care. While we are deeply sad to see her go, we are thrilled to see her in her new position as Assistant Professor in the Department of Public Health at Southern Connecticut State University.

ILCA is seeking an Advocacy Advisor to the Board of Directors to lead the organization’s strategic advocacy plan.

Advocacy is a core tenet of ILCA’s mission and vision.  Additionally, ILCA’s values of knowledge, diversity and equity serve as the basis for ILCA’s equity-focused evidence based advocacy strategic framework.

The person serving in the Advocacy Advisor role will be responsible for helping to operationalize ILCA’s leadership and participation on policies and actions including, but not limited to, Baby Friendly Hospital Initiative, The Code of Marketing of Breast Milk Substitutes, family-friendly policies, workplace initiatives, capacity-building of IBCLCs and skilled lactation professionals globally and promoting recognition of IBCLCs and other skilled support professionals as critical members of the health care team.

This is a leadership position that will report to ILCA’s Executive Director.

Core Responsibilities include:

  • Design and implement strategic planning for ILCA’s advocacy agenda
  • Oversee ILCA’s Global Advocacy Committee including United Nations liaisons
  • Build global expertise teams surrounding ILCA’s advocacy issues
  • Be a liaison between ILCA and ILCA’s global partnerships with WHO, UNICEF, WABA
  • Represent ILCA to the Global Breastfeeding Collective, NetCode, Codex Alimentarus and others
  • Represent ILCA at key strategic meetings globally

Required Qualifications:

  • Experience with advocacy at the local, regional, state, global level
  • Demonstrated commitment to ILCA values of knowledge, diversity, equity
  • Familiarity with core documents related to breastfeeding advocacy i.e. human rights, and the Code
  • Leadership experience
  • Strong English writing skills

Preferred Qualifications:

  • Demonstrated leadership within ILCA as an organization as evidenced by prior/current volunteer service
  • Ability to communicate in more than one language
  • A strong network of global professional alliances
  • Excellent presentation skills
  • Critical thinker
  • IBCLC
  • Grant writing skills and experience/education in program planning, implementation, management, evaluation. Successful grant funding a plus!

This position may be remote. The successful candidate should have reliable access to internet etc. It is envisioned that the candidate will commit approximately 10-20 hrs/week which may vary with travel commitments. Salary is hourly and commensurate with experience.

To apply:

Please send cover letter, resume/CV addressed to executivedirector@ilca.org, salary requirements, one letter of recommendation and the names and contact details of two additional recommenders who we may contact.

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Three Research Takeaways: Supporting Lactating Women Who Experienced Childhood Sexual Abuse

How can new research inform how lactation consultants support women who are breastfeeding and who have experienced childhood sexual abuse?

The Journal of Human Lactation article, Breastfeeding in Women Having Experienced Childhood Sexual Abuse, aims to “investigate experiences with breastfeeding in women with a history of [Childhood Sexual Abuse (CSA)].”

Find three key takeaways we have put together here:

Learn more by accessing the full article here. Access to JHL is free for ILCA members.

New! Earn CERPs by reading this and other select JHL articles in our Independent Study Modules, free for ILCA members. Members, access your free continuing education here. Learn more about ILCA membership here.

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Celebrating Black Breastfeeding Week 2019

The International Lactation Consultant Association® (ILCA®) is proud to celebrate Black Breastfeeding Week (25 August – 31 August). 

This year’s theme is “The World Is Yours: Imagine. Innovate. Liberate.” 

Black Breastfeeding Week consists of a series of online and face-to-face activities. Check out their website and social media profiles (including their Facebook page here) for updates. You can also find resources for bringing creativity and inspiration to your local breastfeeding community, like this Hackathon Toolkit.

In the United States, you can also look for a local event many of which include “Baby Lift Up,” the signature event for Black Breastfeeding Week. “Each year, black families gather  . . . in predetermined locations to lift up their babies (of all ages!) in unison in a show of solidarity and support for black children living healthy and thriving lives.”

Check out these past Lactation Matters posts for answers to your questions about why Black Breastfeeding Week exists or other resources for celebrating #BBW19.

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Access FREE Articles from Journal of Human Lactation #WBW2019

World Breastfeeding Week (WBW) is an annual celebration of the role of breastfeeding in our homes, our communities, and the world.  As a part of our 2019 theme, Empower Parents, Enable Breastfeeding, we are proud to announce that Journal of Human Lactation (JHL) is making available 5 essential articles to everyone – FREE* through 31 August 2019.

The Journal of Human Lactation is essential for building our knowledge as IBCLCs. We believe knowledge guides our practice, strengthens our value, and supports our role in transforming world health.

Read the following JHL articles—free through 31 August 2019!

  1. Breastfeeding Support Interventions by International Board Certified Lactation Consultants: A Systemic Review and Meta-Analysis by Ellen M. Chetwynd, Heather M. Wasser, and Charles Poole
  2. Effectiveness of the IBCLC: Have we Made an Impact on the Care of Breastfeeding Families Over the Past Decade? by Barbara Haase, Emily Brennan, and Carol L. Wagner
  3. Current Trends in Research on Human Milk Exchange for Infant Feeding by Aunchalee E. L. Palmquist, Maryanne T. Perrin, Diana Cassar-Uhl, Karleen D. Gribble, Angela B. Bond, and Tanya Cassidy
  4. Critical Review of Theory Use in Breastfeeding Interventions by Yeon K. Bai, Soyoung Lee, and Kaitlin Overgaard
  5. An Integrated Analysis of Maternal-Infant Sleep, Breastfeeding, and Sudden Infant Death Syndrome Research Supporting a Balanced Discourse by Kathleen A. Marinelli, Helen L. Ball, James J. McKenna, and Peter S. Blair

Journal of Human Lactation is the official journal of ILCA. It is a quarterly, peer-reviewed journal publishing original research, insights in practice and policy, commentaries, and case reports relating to research and practice in human lactation and breastfeeding. JHL is relevant to lactation professionals in clinical practice, public health, research, and a broad range of fields related to the trans-disciplinary field of human lactation.

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Happy World Breastfeeding Week 2019!

Happy World Breastfeeding Week! International Lactation Consultant Association® (ILCA®) is excited to join World Alliance for Breastfeeding Action (WABA) and other organizations and individuals the world over in celebrating #WBW2019. The theme of World Breastfeeding Week (WBW) 2019 is Empower Parents, Enable Breastfeeding. ILCA will feature resources throughout the week of 1-7 August to help you make the most of this important week.

Are you ready to celebrate #WBW2019? Check out this must-do list to be sure:

Visit the #WBW2019 website for general information and downloadable promotional materials, including the campaign objectives, logo, poster, action folder and other materials. These materials are available in many languages and contain information on the theme, relevant facts and figures, case studies, and suggested ways to take action.

Share your commitment to breastfeeding advocacy and education. Organizing your own WBW event? Then pledge your event to be placed on the Pledge Map. Use the #WBW2019 Media Kit that contains information about the annual WBW campaign as well as the 2019 Press Release for your events. Join the online social media movement by participating in WABA interaction, polls, and activities such as the upcoming #AskMeAnything session through their Facebook, and Twitter pages. Don’t forget to view the Social Media Kit that is frequently updated with visuals, infographics, GIFs, sample posts, and relevant hashtags.

Look for information and action steps throughout WBW on ILCA’s social media, including Facebook, Twitter, and Instagram, where you’ll find articles, images, action steps, and more to help with your successful WBW 2019 observance. Find graphics to download and share here on the ILCA website here.

For the most up-to-date information about WBW 2019 and to download promotional materials, please visit our website here.

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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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