Around the globe, parents’ options and choices about feeding their infants and young children are influenced by an ever-changing patchwork of laws and policies. 

Has your work as a lactation professional brought you up close and personal with such a law or policy? And would you like to share what you’ve learned? 

If so, you may want to consider a submission to the Journal of Human Lactation’s (JHL) upcoming special issue covering this topic.

The February 2022 issue of the JHL will be dedicated to the latest information and analysis on laws and policies affecting breastfeeding and infant/young child feeding around the world.

Submissions are due 1 October 2021.

A variety of types of submissions are sought, including:

• original research
• literature reviews
• case studies
• insights into practice and policy.

The JHL has suggested a wide range of potential topics, including:

• The WHO Code. How is it applied in 2021? Which countries follow it, and which have enforceable laws? What are the outcomes of these laws? Which companies and organizations operate on the edges of the Code?
• Paid parental leave. What are the laws in your country? How have laws and policies influenced feeding standards over time, as well as affected initiation and exclusivity rates?
• Workplace lactation support. How are work environment policies for lactation implemented? What is the employer’s responsibility for making lactation rooms available for employees? How have these and similar policies affected feeding? What are state, provincial, and/or federal laws which do not include provisions for enforcement? Where do laws not even exist? What are the ramifications of each?
• Government regulations. What are the effects in your setting of the presence or absence of policies intended to increase access to IBCLC care? How can policies enacted for one region actually cause harm if implemented in other areas of the world?
• Breastfeeding in public. Are new laws needed in your setting? What are the existing laws? What are ongoing issues with complaints about public indecency?
• Education policy. Is there a need for funding to train new IBCLCs in areas with low rates of breastfeeding? Where might such funding come from?
• Funding regulations or policies for health care practices. What influence do insurance regulations and policies, as well as national healthcare practices,  in your area have on infant and young child feeding?
• Licensure of IBCLCs. What obstacles have arisen in places where human milk feeding advocates have introduced legislation to license IBCLCs? Where (and how) have these obstacles been overcome?
• Drug regulations. How do the United State’s regulations concerning Domperidone affect practice? What other global issues are there regarding drug regulation and lactation?

The JHL emphasizes that this is not an exhaustive list; other topics may also be suitable.

Wondering whether your idea is a good fit? Contact JHL Editor-in-Chief Joan E. Dodgson, Ph.D., MPH, RN, FAAN, at jlheditorinchief@gmail.com, or visit https://journals.sagepub.com/home/jhl.

Research tells us that the overwhelming majority of mothers want to breastfeed, but they don’t always reach their breastfeeding goals. Less than half of newborns begin breastfeeding in the first hour of life, and only 44% of infants are exclusively breastfed at six months.¹ One of the most significant challenges to improving breastfeeding rates worldwide is the exploitative marketing of commercial milk formulas. 

Around the globe, mothers and other parents experience barriers to lactation, from a lack of skilled support to inadequate workplace provisions. Formula companies are at the ready to exploit these wide gaps. Formula companies’ marketing efforts are aggressive, well funded, and come at families from every angle, including influencing health care providers at sponsoring events and providing branded educational materials, making false claims about the product, providing free samples to hook families (who often can’t afford to continue to purchase the expensive product), and exploiting parents’ desires to do what is best for their children.

The solution to these aggressive marketing tactics exists: the Code.

The aim of the International Code of Marketing of Breast-milk Substitutes and all subsequent relevant World Health Assembly resolutions (which together make up the Code) is to “contribute to the provision of safe and adequate nutrition for infants, by the protection and promotion of breast-feeding, and by ensuring the proper use of breast-milk substitutes, when these are necessary, on the basis of adequate information and through appropriate marketing and distribution.”²

The Code covers four product areas: breastmilk substitutes, which includes all commercial milk formulas (including follow-on formulas and growing up milks), marketed as appropriate for children up to 36 months of age; any other food or beverage marketed as appropriate for children up to 6 months of age; and feeding bottles and teats. 

It is important to understand that the Code applies to the marketing of these products, their quality, and information about their use, but does not limit sales of these products, recognizing that they may be necessary in some situations. The Code specifies no promotion of these products to the public in any form, including no samples of the products to families or health workers, no gifts or other financial inducements to families or health workers, no promotion in healthcare facilities or to health workers, no promotion of complementary foods before 6 months, no sponsorships of meetings of health professionals, and adequate and appropriate labeling. The Code states that companies have a responsibility to follow the Code independent of any legal measures to implement the Code. 

The market for commercial milk formulas is huge, estimated at US$70.6 billion in 2019³, with an estimated US$16 billion in profits.⁴ What these companies spend on formula marketing FAR outpaces what countries spend on breastfeeding support: One analysis of just the six largest commercial milk formula companies estimated they spent US$7 billion on marketing in 2015 (US$17 billion if spending on sales staff and administrations is included).⁵ This spending dwarfs the estimated $653 million annual cost to scale up breastfeeding counselling interventions in 34 countries to meet breastfeeding goals, which would save the lives of 820,000 children and add US$300 billion to the economy annually.⁶ 

However, the existence of the Code is not enough. It must be implemented with legal measures, including steps for monitoring and enforcement in every country. As of April 2020, 136 of 194 countries had enacted legal measures with provisions to implement the Code but only 25 of these countries had measures substantially aligned with the Code; 58 countries still have no legal measures at all.⁷

As we celebrate the 40th anniversary of the enactment of the Code, we are reflecting both upon the gains the Code has made possible, but also upon the work yet to be accomplished by this important protection.

This is why ILCA:

• Calls on governments to enact, enforce, and monitor the Code, or strengthen legal measures already in place.
• Supports existing efforts, like NetCode, to provide resources and support for monitoring and enactment of the Code.
• Calls on all ILCA members to fulfill their obligations under the Code, and supports members with education and information to do so.
• Calls on other health care professional organizations to honor and uphold the Code, including educating health workers and ending the practice of allowing Code-violating corporations to sponsor events.
• Continues to follow the Code in evaluating advertising and sponsorship in the Journal of Human Lactation and at our annual conference, serving as a model to other health care professional organizations.

These efforts are critical to ensuring that formula companies do not continue to put profits before the health of mothers, infants, and young children.

References

1: SEVENTY-FOURTH WORLD HEALTH ASSEMBLY A74/14 Provisional agenda item 16 Committing to implementation of the Global Strategy for Women’s, Children’s and Adolescents’ Health (2016-2030), Report by the Director-General. (2021). https://apps.who.int/gb/ebwha/pdf_files/WHA74/A74_14-en.pdf

2: International Code of Marketing of Breast-milk Substitutes. (n.d.). https://www.who.int/nutrition/publications/code_english.pdf

3, 6: Rollins, N. C., Bhandari, N., Hajeebhoy, N., Horton, S., Lutter, C. K., Martines, J. C., Piwoz, E. G., Richter, L. M., & Victora, C. G. (2016). Why invest, and what it will take to improve breastfeeding practices? The Lancet, 387(10017), 491–504. https://doi.org/10.1016/s0140-6736(15)01044-2

4, 5: Don’t Push It: Why the formula milk industry must clean up its act. (2018). Resource Centre. https://resourcecentre.savethechildren.net/node/13218/pdf/dont-push-it.pdf

7: Marketing of breast milk substitutes: national implementation of the international code, status report 2020. (2020). Www.who.int. https://www.who.int/publications/i/item/9789240006010

Image credit: UNICEF

How would it change your practice if you learned that just about everything you think you know about the lingual frenulum is wrong?  

New research to be presented at the International Lactation Consultant Association’s Annual Conference in Texas in July suggests exactly that, with serious implications for lactation professionals’ work.

As a Pediatric ENT Consultant at Starship Children’s Hospital in New Zealand, Nikki Mills, BHB, MBChB, FRACS, Dip Paeds, IBCLC, sees a lot of baby’s tongues. And, she is often asked to perform frenotomies.

Over time, Mills began to have more questions than answers about the procedure.

Why did some of her patients seem to get great benefit from the procedure, breastfeeding more successfully afterward, while others saw no benefit at all?

“As a surgeon who was being asked to divide frenulums in babies, I really wanted to know what it was that I was cutting,” Mills says. “I wanted to understand exactly what tissues I was dealing with and what they did.

“I believed that understanding should be the basis for deciding when a frenulum should be cut—and when it should not,” Mills continues. “For me, it was a fundamental question.”  

But when she went looking for research to answer her questions, Mills came up empty handed.

“No one had ever looked at the anatomy and function of the lingual frenulum in detail,” she says.

She decided it was high time someone did.

So she scaled back her clinical practice and spent the next four years researching.

As part of her investigation, she dissected fresh neonatal cadavers to better understand the anatomy and function of the lingual frenulum.

What she discovered was out of sync with everything she had been taught.

“What I found was very different from what has been the popular understanding of the lingual frenulum,” she says. “It’s challenging because when I present my research, it makes everyone who thinks they understood the lingual frenulum rethink and reframe what they thought.

“We have started to think of any lingual frenulum as a tongue tie,” Mills continues. “We’ve created a situation where normal anatomy is called an anomaly.”

At the ILCA conference, she will explain her published research in detail, as well as its implications for evaluating and treating breastfeeding problems.

In addition, she will present research she has recently published on the effect of positioning on babies who are having difficulty with swallowing and breathing during breastfeeding.

Mills placed breastfeeding parents and their infants inside MRI machines, capturing dynamic MRI images of what happens during sucking and swallowing.

Because most previous research has been done with bottle-feeding infants, these MRI studies represent a leap forward in understanding what happens during breastfeeding.

“We wanted to understand and define the impact of different breastfeeding positions on tongue position and dynamic airway collapse with the tissues above the voice box, and also with milk flow,” she explains. “What happens when the baby is positioned in different ways?

“When a baby is having trouble breathing, breastfeeding is often the first thing to go,” she continues. “Parents are told they must bottle feed. I wanted to know, what can be done to modify positioning to create a greater possibility of supporting safe breastfeeding in at least some of those babies?”

Mills will present these findings, along with tips for how IBCLCs can apply them when working with babies with Laryngomalacia and other challenges.

From her unique perspective as a clinician and a researcher, Mills will discuss:

• How the field of lactation support is getting it wrong when it comes to the lingual frenulum.
• Why assessing lingual frenulum in isolation is a costly mistake.
• How her new data inform decisions about when frenotomy is indicated and when it is not.
• The results of her dynamic MRI studies of babies feeding at the breast, the first of their kind, and implications for using positioning to help babies with sucking and swallowing difficulties.

This year’s conference will be hybrid, offering both online and in-person options in Houston, Texas, US. To learn more about the #ILCA21 conference, offered both virtually and in person, visit here.

The perspective of each IBCLC is unique. Your viewpoint is shaped by whether you practice in the community, in a health-care facility, or as a researcher. In your region of the world, you may hold a different vantage point based on the cultural needs and practices of the families that you serve. And yet there are common threads we all hold as providers and for the breastfeeding mothers and chestfeeding parents we serve. 

The ILCA board is where we weave together all of these perspectives to inform the best possible support for you, the lactation profession, and the global breastfeeding community.

Board nominations are now open. We welcome you to take a moment to consider who in your community can best represent your unique needs while holding the vision for our diverse global profession. Our goal is to ensure a board that can truly capture all the threads that make up the lactation consultant field.

Candidates must self-nominate. Required qualifications include:

• Membership in good standing for two years (immediately prior to the date nominations are called)
• IBCLC in good standing
• Strong interest in the growth and development of ILCA
• Demonstrated leadership

Learn about all of the qualifications and time commitment here in the job description and complete the application here.

Questions about your membership status or the application process? Contact our helpful support staff at info@ilca.org.

The deadline for applications has been extended to 7 June 2021, 23:59 New York EDT; 8 June 2021 5:59 Geneva CEST / 13:59 Sydney AEST.

Our nominations task force, led by Past President Mudiwah Kadeshe, MSN, RN, LNC, IBCLC, looks forward to learning more about you.

What do you do when your job is to help breastfeeding families in your local area—but your local area comprises three states, two countries, and two languages?

If you’re Elsa Quintana, you become an expert in collaboration—in envisioning it, in building it, and in funding it.

Quintana, BA, IBCLC, BCJ, works at the intersection of three locales—far west Texas (United States), extreme southern New Mexico (United States), and Ciudad Juarez, Chihuahua (Mexico). 

She navigates three state governments, two national governments, and two languages in her job of facilitating lactation care for families across multiple borders.

At this year’s International Lactation Consultant Association’s conference, Quintana will share tips and strategies for harnessing the power of collaboration, no matter your setting.

“We are unique in that we have two countries and three states that are all about five minutes from each other,” Quintana says. “But we have all found a way to pull together and it truly works. At the conference, I want to share our story because I believe it has lessons that can be used in many other places. I’m hoping to inspire people to see what’s possible where they are.”

Quintana served for many years as the State Coordinator for the WIC Breastfeeding Peer Counselor Program in New Mexico, where she and her program have received awards and recognition locally, nationally, and internationally for their efforts to increase breastfeeding rates in the state.

She currently contracts with the New Mexico Department of Health to teach a bilingual 100-hour certification course for community health workers.

Working within the Binational Breastfeeding Coalition (BBC), Quintana worked on a three-year grant project called Breastfeeding on the Border.

The project brought together WIC peer counselors, community health workers, and professionals across borders to better serve lactating families.

Breastfeeding on the Border successfully established community lactation support groups, which connected resources and built networks within communities. The result is sustainable, community-driven supports that are culturally informed and not susceptible to rises and falls in government funding.

In addition, Quintana helped create a unique presentation series called “Look Who’s Talking.” These talks brought renown speakers such as Kathleen Kendall Tackett and Laurel Wilson to share information with BBC, whose membership includes lactation professionals, nurses, social workers, pediatricians, therapists, dentists, and others. The speakers presented to packed rooms, while even more attendees watched online.

The Look Who’s Talking presentations and other education efforts under the project shared one simple goal: to get a variety of professionals who serve childbearing families all on the same page about lactation basics.

“That way, the same message is being delivered in many settings across the communities,” Quintana notes.

Bringing together diverse professionals from different states and different countries around the same goal may sound like a huge task, but Quintana says it comes down to perseverance and believing in your mission.

“Every time I talk to other lactation professionals, they ask, ‘How in the world do you guys do it?’” Quintana says. “They are especially surprised that we have been able to fund some of our initiatives, like the high-level speakers we’ve brought in.

“The keys are developing good contacts, networking, and looking for shared goals,” she continues. “Maybe you’re looking for ways to provide lactation support, and another organization in your community is talking about adolescent pregnancy. How can you share resources? You are always looking to partner and invite.

“It can be done, and you can do it,” she encourages. “When you have a passion to help families, you don’t see bridges and interstate lines and borders. You just see a parent who needs help.”  

From her unique perspective, Quintana will share tips on:

• Networking and finding shared goals
• Finding your setting’s unique opportunities
• Understanding your audience’s needs
• Collaborating to find funding
• Navigating bureaucracy
• Not getting discouraged

This year’s conference will be hybrid, offering both online and in-person options in Houston, Texas, US. To learn more about the #ILCA21 conference, offered both virtually and in person, visit ilca.org/conference.

The Journal of Human Lactation (JHL) is soliciting manuscripts for their February 2022 special issue on a wide variety of topics pertaining to laws and policies related to infant and young child feeding. 

Submissions can include original research, literature reviews, case studies, and insights into practice and policy. Examples of topics include, but are not limited to, the following:

• The International Code of Marketing of Breast-milk Substitutes: Describe how it is applied in 2021; which countries follow it; which countries have laws that are actually enforceable and how that is done with outcomes; how they are actually enforced when this does happen (in your own country and/or compared to other countries); describe companies/organizations that operate on the “edges” of the International Code (i.e. breast pump companies that are not code compliant; non-profit foundations that were founded by executives from and funded by profits from Code non-compliant companies that fund Infant and Young Child Feeding-related research).
• Paid parental leave: Describe the laws in your country and how changes in policy/law have influenced infant and young child feeding standards over time; describe how changes in policy/law have influenced breastfeeding initiation and exclusivity rates.
• Workplace lactation support: Implementation of work environment policy for working lactating mothers; employers’ responsibility to make lactation room(s) available for employees or any similar policies and how has that affected Infant and Young Child Feeding; consider state, provincial and/or federal laws concerning workplace lactation support that do not include means of enforcement or where they do not even exist and the ramifications.
• Government regulations: Lack of, or conversely presence of policy intended to increase access to the care of an International Board Certified Lactation Consultant^® (IBCLC^®) care; consider how governmental guidance specific to one country or region that may be implemented in other parts of the world can actually cause harm.
• Breastfeeding in public: Consider whether laws are needed based on current policies and laws; write about the existing laws; on-going issues with complaints about public indecency.
• Education policy: Discuss whether funding (and where it might come from) should be provided to assist persons working with childbearing/childrearing families in communities with low rates of breastfeeding (i.e., exclusive to 6 months; duration to one year or more) to become IBCLCs; examples of model programs; how to create model programs.
• Funding regulations or policies for health care practices: The influence of insurance regulations/policies/national health care practices influence infant and young child feeding practices in your location.
• Licensure of IBCLCs: Obstacles that have arisen in states/provinces where human milk feeding advocates have introduced legislation to license IBCLCs; places obstacles to licensure have been overcome; how this was accomplished. 
• Drug regulations: In the US there are regulations concerning the use of Domperidone; how this affects practice; other issues globally pertaining to drug regulations and lactation.

The submission deadline is 1 October 2021.

For more information, please visit the JHL journal homepage here.

Please send email inquiries about specific ideas for manuscripts for this special issue to the Editor in Chief at jhleditorinchief@gmail.com.

If an IBCLC^® you knew helped a client with a history of breast cancer induce lactation for an adopted infant, wouldn’t you want to hear the story?

How about if a friend had been involved in a study measuring COVID-19 antibodies in human milk during the newborn phase? Definitely a great story to hear!

Case studies—stories—of others’ successes and challenges have so much to teach.

Now, you can access the full text of five new case studies here free of charge in a collection recently released by the Journal of Human Lactation. The case studies will remain open access through 15 June.

Topics include:

Maternal Transfer of Cetirizine Into Human Milk. A study in which levels of the drug found in the common allergy medication Zyrtec were measured in human milk, filling a previous gap in data.

Severe Lactational Mastitis With Complicated Wound Infection Caused by Streptococcus pyogenes. Management of a severe case of mastitis at two weeks postpartum has a positive outcome, with the pair nursing successfully into toddlerhood.

Induction of Lactation After Adoption in a Muslim Mother With History of Breast Cancer: A Case Study. Details the protocols used to successfully induce lactation and discusses the benefits to both parent and baby.

Induced Lactation in a Mother Through Surrogacy With Complete Androgen Insensitivity Syndrome (CAIS). A mother through surrogacy, with XY karyotype and CAIS, is able to partially breastfeed, supporting the concept of helping more nontraditional parents with lactation.

Early Identification of IgA Anti-SARSCoV-2 in Milk of Mother With COVID-19 Infection. Do mothers with Covid-19 infection produce milk that has antibodies that could protect their nursling? This case study suggests the answer is yes.

Each case study in the collection gives detailed information about the issue, history, management, and outcome.

Want to read more great content from the Journal of Human Lactation? ILCA members can access the full Journal of Human Lactation for free! Join online today.

Let potential clients know that your Hospital-Based Facility or Community-Based Agency recognizes the role of the International Board Certified Lactation Consultant^® (IBCLC^®) in protecting, promoting and supporting breastfeeding by applying for the IBCLC Care Award.

The IBCLC Care Awards are promoted to new families and the general public which means your facility can enjoy the benefits of positive public relations in your community, including:

• Enhanced attractiveness to potential patients
• Competitive edge in recruiting lactation consultants, nurses, midwives, mother support counselors and other medical staff
• General good will in the community by providing excellent care in helping new families reach their breastfeeding goals

Visit the IBCLC Care Directory to see which Hospital-Based Facilities are already benefiting from the IBCLC Care Award program!

Hospital-Based Facilities and Community-Based Health Agencies that staff currently certified IBCLCs can apply online to become a recognized IBCLC Care Award facility. Learn more about the qualifications and complete the online application here.

Applications will be accepted online starting January 2021 through 5 March 2021. Please contact us at admin@ilca.org if you have any questions.

The award was created by International Board of Lactation Consultant Examiners^® (IBLCE^®) and International Lactation Consultant Association (ILCA). Learn more and apply here.

It would be difficult to think of a year when being an International Board Certified Lactation Consultant^® (IBCLC^®) has been so challenging—or so important.

In 2021, birthing and lactating families all over the world have faced unprecedented hurdles as they’ve brought their babies into the world amid the COVID-19 pandemic. They have needed the help of IBCLCs like never before, to navigate obstacles none of us could have imagined.

At the same time, IBCLCs have had to dive deeper into their own creativity to find ways to connect with and support families, amid lockdowns, quarantines, and social distancing. And you have risen to the challenge, innovating, persevering, and caring like never before.

On 3 March 2021, we welcome your community to celebrate YOU by thanking IBCLCs.

We hope you will also take this opportunity to celebrate the IBCLCs that have made a difference in your life, through mentorship, community, or support.

Show your IBCLC pride! Starting now, use our IBCLC Day frame on your Facebook image to help build recognition for your profession.

Find the IBCLC Day frame here.

Find IBCLC Day images for you and your community to share here.

We have also welcomed code-compliant organizations that would like to provide special offers to IBCLCs for #happyIBCLCday to do so on our event page. Feel free to check out what they have shared with you here. We also hope that you will share with us what you are doing in your local community to celebrate!

#happyIBCLCday