Archive | Cultural Issues

Racial Inequities in Breastfeeding: My Commitment to be a Mentor

By Betsy Hoffmeister, IBCLC

Recently, some of my colleagues in private practice were discussing the topic of IBCLC® mentoring. I’ve only been an IBCLC for four years, but I receive many phone calls per year from women looking for a mentor.  Some of my colleagues mentioned the uneasy sensation that they are training their own competition.  I want to add a different perspective.

iStock_000016195932SmallIn June, the two-day Inequity in Breastfeeding Support Summit in Seattle was the site of passionate discussion about barriers to breastfeeding support, for and by women of color. Women of color in the US have a lower rate of initiation and duration of breastfeeding, and women and their babies suffer higher rates of morbidity and mortality that could be mitigated by breastfeeding. There are also few IBCLCs and other breastfeeding support people who are women of color.

In the Greater Puget Sound Area, there are very few (possibly zero!) private practice lactation consultants who are also black, Latina, Asian, or Native American. I know of one Seattle-area Native American woman who just sat the exam and I can’t wait to hear her results! There are a few IBCLCs who are women of color who work for WIC or for hospitals. Why is that? There are many, many, MANY obstacles.  One obstacle cited was the barriers to entry – the bar keeps getting raised and it’s terribly expensive. Here in Washington State, for a variety of reasons, we have few to no La Leche League (LLL) Leaders who are also women of color. Since Leadership used to be the traditional route to becoming an IBCLC, lack of Leaders who are women of color is also a challenge. LLL of WA has been actively working to address this.

Conversely, what we learned from the women of color in attendance at the Summit, is that while the breastfeeding rates, especially in the African American community are very low, there are no visible black breastfeeding role models (calling Michelle Obama, we want your photos!!) Very often, women of color would feel more comfortable working with a breastfeeding helper who had similar life experiences. IBCLCs are typically compassionate, wise, lovely women – and yet, at least here in WA State, we have not walked in the shoes of the African American experience. I have come to understand and honor the desire of women to want to work with someone who not only has experience and training, is compassionate, wise and lovely, but also shares life experience and understanding. Incidentally, that’s why the following video is so important. I’m thrilled that when I first saw it, it had less than 10,000 hits and now it has more than 300,000!

One agenda item strongly suggested at the close of the Summit was for IBCLCs to seek out and mentor women of color as IBCLCs. And, if at all possible, NOT charge for it if the woman in training is low income. I don’t depend on my IBCLC income to run my household. I can afford to take on a free mentee. I don’t feel like I’d be training my competition. Right now, my clientele are mainly white, Asian, and Southeast Asian. I see the occasional Latina and very, very rarely an African American mother. If I could mentor an IBCLC-in-training who was also a woman of color, I feel like I’d be training valuable colleagues who could support women in my community who desperately need the services but are not seeking me specifically. I publicly committed at the Summit and here commit again: when I achieve my 5-year status and go through the process of becoming a mentor, I commit to actively seeking out a woman of color in my community who wishes to become a breastfeeding counselor and mentoring her through the process of becoming an IBCLC. I know I will learn much in the process and become a better helper to all mothers as a result.

sixBetsy Hoffmeister, MPA, IBCLC, has been a LLL Leader since 2002 and a private practice IBCLC since 2009. She lives in Seattle with her husband, who makes chocolate from beans, (but sadly, without sugar), her son who just became a Bar Mitzvah and her 8 year old daughter. In her spare time, Betsy reads, gardens, and is experimenting with knit and crochet breast patterns. She only recently got turned onto anti-racism and equity in breastfeeding support and is excited and passionate about helping the movement. Contact her atbetsy@betsysbabyservices.com.

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Black Mothers’ Breastfeeding Association: Narrowing the Disparity Gap

By Anjanette Davenport Hatter, BMBFA President

On May 24, 2013, Black Mothers’ Breastfeeding Association (BMBFA) held our 4th National Seminar, Innovations in Breastfeeding Support in Detroit, MI, USA. The Seminar consisted of a plenary address, keynote speaker and lecture sessions from some of the most notable experts in the field of lactation. Topics were directed toward maternal-child healthcare professionals on innovative solutions that address the cultural road blocks in breastfeeding support.

seminar presenter bmbfa founding directorThe Seminar began with Beth Eggleston MS, RD of Michigan Department of Community Health offering the plenary address where current breastfeeding rates in Michigan were shared and a lively discussion was held about why disparities exist. The information provided about Baby-Friendly Hospitals was particularly interesting as it not only described the 10 steps to achieving Baby-Friendly designation but also explored realistic strategies to eliminate barriers presented by hospital administration as well as mothers of newborns. Allison Benjamin RN, IBCLC of Harlem Hospital (retired), described her instrumental role in assisting Harlem Hospital in becoming the first Hospital in New York City to receive the distinguished Baby-Friendly designation. While breastfeeding provisions are still a work in progress, Leila Abolfazli, J.D., of Washington, DC, shared that the Affordable Care Act offers insurance coverage to breastfeeding mothers for services such as breastfeeding support, supplies and counseling. Interestingly enough, breast milk is being viewed as preventive healthcare according to Leila. BMBFA’s Founding Director, Kiddada Green, M.A.T., of Detroit, MI, shared strategies necessary to organize and sustain a breastfeeding support group using a model that has proven successful as it has expanded its reach throughout the Detroit area. Other strategies for sustaining community based breastfeeding support suggested by Sade Moonsammy-Gray, B.A. and Kathleen Logan, RN, CPNG, IBCLC of Community of Hope Family Healing and Birthing Center, Washington, D.C. included education, self-efficacy and empowerment of breastfeeding mothers while utilizing evidence based interventions. Dr. Paula Schreck of St. John Mother Nurture Project in Detroit, MI, offered valuable insight into community based breastfeeding support as she compared and contrasted the Mother Nurture Project with traditional hospital-based programs. Dr. Schreck facilitated the first Physician led outpatient breastfeeding clinic in Michigan. I can’t wait to begin planning next year’s seminar. I’m sure it will be yet another stellar opportunity to provide education and resources to breastfeeding professionals.

community partner st. john mother nurture projectI’m excited to report that BMBFA has made significant progress in our efforts to support breastfeeding mothers and healthcare professionals in our community. We have increased our breastfeeding clubs from once monthly to four times per month with various times and locations throughout the city of Detroit. This expansion has enabled us to reach a far greater target population and minimized barriers to our mothers receiving necessary support. How awesome is that!

breastfeeding club mtgAnother area of significant progress is our breastfeeding peer counselor program. We recently graduated 11 women who have completed a rigorous curriculum assisted by Health Connect One, which has enabled them to provide breastfeeding counseling to women in the Detroit area with hopes of increasing breastfeeding initiation and duration rates. Surely this will help our mothers by overcoming obstacles that may otherwise lead to breastfeeding cessation.

bmbfa bf peer counselorsWe have formed amazing relationships in the community with those who share our enthusiasm and passion in which reciprocal support is provided to breastfeeding mothers and public health professionals. These relationships include Neighborhood Service Organization Harper Gratiot Service Center, Wayne CHAP (Children Healthcare Access Program), WIN (Women Inspired Neighborhood) Network, Detroit Black Community Food Security Network, Focus Hope and First Beat. Our relationship with the St. John Mother Nurture Project has flourished as we forge our efforts to diversify Lactation Consultants (IBCLC) in the state of Michigan. The Michigan Department of Community Health awarded BMBFA a $117,000 grant to supplement our work to eliminate breastfeeding disparities.

bmbfa board.founding directorBMBFA has also received a $400,000 grant from the W.K. Kellogg Foundation. The funds will be used to strengthen organizational capacity by building management systems, expanding existing programs and developing new programs, leading to sustainable growth to improve the quality of life for vulnerable, poverty stricken children, while causing social change for the greater good.
BMBFA’s community approach to breastfeeding support has been deemed innovative due to its explicit focus on narrowing the disparity gap that exists in breastfeeding rates.  In Michigan, only 50.9 percent of black children ever receive breast milk as compared to 68.5 percent of white children. Strengthening BMBFA’s infrastructure will lead to long-term increases in breastfeeding rates and work to create a monumental social impact that restores the emotional, psychological and physical health of the Detroit community.

We are looking forward to following our passion and doing incredible work in our community as we continue to answer the US Surgeon General’s Call to Action to Support Breastfeeding. Please visit our website at bmbfa.org to learn more about our breastfeeding programs and services. Also follow us on Facebook and Twitter!

Anjanette Davenport HatterAnjanette Davenport Hatter is the President of the Board of Director’s for Black Mothers’ Breastfeeding Association. Mrs. Davenport Hatter has dedicated her time to eliminate breastfeeding disparities for African American families. She understands how breast-milk decreases the risk factors for developing chronic diseases and has worked extensively with organizations such as Gift of Life MOTTEP, National Kidney Foundation, Children’s Hospital of Michigan and as a member of Alpha Kappa Alpha Sorority Inc. Her tireless efforts in working to improve health outcomes in her community has led to her nominations for the WEGO Health Activist  Award and the National Advisory Council on Maternal, Infant and Fetal Nutrition-Breastfeeding  Promotion. Mrs. Davenport Hatter holds Master’s Degree in Social Work from Wayne State University. She is a dedicated wife, mother and social worker.

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How IBCLCs Can Make an Impact Through Social Media

Written by Robin Kaplan, M.Ed., IBCLC

With 93% of adults born after 1982 (the Millennial Generation) communicating online and nearly 3 out of 4 using social networking websites, such as Facebook and Twitter, breastfeeding promotion and support has been taken to an entirely new level. In the Journal of Human Lactation article, Establishing an Online and Social Media Presence for Your IBCLC Practice, authors Amber D. McCann and Jeanette E. McCulloch, present findings that encourage all of us in the breastfeeding community to step into the minds of these Millennial mothers and engage with them about breastfeeding in their preferred medium.

Why does breastfeeding promotion and support need a social media presence?

While health care providers continue to be the first choice for most people with health concerns, 80% of US Internet users have sought health advice online.  Plus, 44% of US women spend more time online after a new baby is born.  We live in an amazing time where we can find answers online in an instant when we used to have to wait until our doctor’s office opened the next morning.  The scary side of this is that there is so much misinformation online about breastfeeding and how easy it is for mothers to access this incorrect advice. Even formula companies have breastfeeding advice sections on their websites… this is NOT where new mothers should be receiving their evidence-based breastfeeding information and support….right next to a Enfamil advertisement!

Also, with breastfeeding being such a HOT TOPIC in the news, mothers are often bombarded with this negative press.  It goes viral in an instant!  The Time Magazine article, ‘Are You Mom Enough‘ and Mayor Bloomberg’s initiative to ban the formula bags in all New York City hospitals flooded the Internet and social media networks in record time.  Negative comments about breastfeeding were abundant!  While Best for Babes and Kellymom are doing all they can to turn this bad breastfeeding press into something positive, they need our help to further provide breastfeeding education and support online.

So where are these Millennial mothers and what are they doing online?

The four most dominant social media platforms are Facebook, Twitter, blogs, and Pinterest. What these platforms have in common is that they ALL promote engagement among Internet users.  This is not like reading a book for information, which is a one-sided conversation.  Using social media allows you the ability to comment, ask questions, and agree/disagree with the author and other commenters.  It’s a conversation.  When a mother posts a question on a Facebook page, she is actively seeking advice from her peers or an ‘expert.’  When a mom reads a blog article, she is looking to make connections with the author to help make sense of her world and often seek advice on a particular topic.  Twitter is all about conversation and engagement and Pinterest is now a hub for articles and driving more traffic to websites than Facebook.  We may not live in a village anymore, but the Internet is revitalizing the village mentality.  It’s all about the need for support and belonging.

How can an IBCLC use social media effectively, without feeling like it is a waste of his/her time?

  • Creating a social media plan can be extremely helpful or you might find yourself being led down the time-sucking social media rabbit hole.  As McCann and McCulloch suggest, create a plan that is appropriate for the size of your business or organization.
  • Decide who your target audience is and the purpose of your engagement.
  • Choose a social media platform or two that you feel is manageable and decide how much time you plan to dedicate to it a week.
  • Spend some time just watching and listening.  You will figure out pretty easily what your audience is looking for.
  • Keep in mind that social media is all about sharing information. While you don’t want to give away everything you know, the more information you benevolently share online, the more appreciative your audience will be and encouraged to return to your platform in the future.  You may have the chance to influence the greater masses with your positive messages about breastfeeding!

What about ethical concerns and client/patient confidentiality?

McCann and McCulloch stress the importance of upholding our Code of Professional Conduct, Scope of Practice, and Standards of Practice.  The authors state that while these documents ‘do not contain a specific social media policy, IBCLCs may want to review the American Medical Association’s Policy on Professionalism in the Use of Social Media’.

As an avid blogger and social media user, I have a phrase that I use very regularly when I receive a comment or question that takes information from general breastfeeding advice to specific for one mom and baby and it goes something like this…. “It definitely sounds like you have some very important questions that would be best answered in a private conversation with an IBCLC.  If you would like to discuss this further, please contact me at …..”   This lets the mother know that I would love to help her, but this is not the appropriate place to discuss private, personal information and I want to protect her privacy.

So, even if you feel like you are not Internet savvy and social media gives you hives, all you have to do is start off slowly.  Lurk a little on these social media platforms and just listen to what mothers are saying and asking for.  Check out the Lactation Matters article, Great Breastfeeding Blogs to Read, and start sharing these articles on a social media platform.  Begin a conversation on a Business Facebook page and see where it takes you.  My guess is that you quickly see your calling to offer breastfeeding-supportive and evidence-based guidance to our Millennial mothers.  And you never know… you might just have a ton of fun, as well!

Robin Kaplan received training to be a Certified Lactation Educator and an International Board Certified Lactation Consultant from UCSD. She holds a Masters in Education from UCLA, a multiple-subjects teacher credential from UCLA, and a BA in Psychology from Washington University in St. Louis, MO. In 2009, Robin started her own business, the San Diego Breastfeeding Center, where she offers in-home breastfeeding consultations, free weekly support groups, breastfeeding classes, and online support through her business blog.  In addition to her private practice, Robin was the founding Co-editor of theInternational Lactation Consultant Association’s (ILCA)blog, Lactation Matters, and a regular contributor toILCA’s E-Globe newsletter.  She also is the host/producer of The Boob Group online radio show and the Director of Marketing for NaturalKidz.com.  Robin lives in her native San Diego, where she enjoys cooking, hiking, trying new trendy restaurants, and traveling with her family.

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A Closer Look at Cultural Issues Surrounding Breastfeeding

By Emma Pickett, IBCLC

As lactation consultants, we’ve been reading about breastmilk for a long time. It makes a nice contrast from the science of oligosaccharides to learn about the importance of goat meat soup to a lactating mother in Somalia or about the huge variety of cultures worldwide that emphasizes the importance of a mother avoiding ‘cold’ foods postpartum to seek spiritual balance. When it comes to reading about different cultural practices surrounding breastfeeding, there’s a lot that is simply fascinating.

Photo by mrcharley via Flickr Creative Commons

There’s a fabulous article by a breastfeeding mum named Ruth Kamnitzer which I would encourage you to read. In it, she talks about her experiences as a Canadian mother moving to Mongolia. She describes how feeding in public becomes a very different experience when complete strangers bend down to kiss your baby’s cheek – while he is feeding! Then, as he pops off in surprise, the giver of the kiss gets a face full of milk and everybody laughs. Try and picture that scene taking place in your local mall!

We enjoy reading about the fact that Japanese kindergarten admission forms might ask matter-of-factly whether a child has weaned from the breast. Or, that in Korea, an IBCLC declaring a baby to be beautiful would be going against the cultural practice of not commenting that a baby is healthy, fat or beautiful for fear of making the mischievous Gods jealous.

But once we’ve satisfied that natural boob and baby-obsessed curiosity, how do we balance our desire for evidence-based practice with some of the cultural messages that may seem harder to support?

Cultural practices fit into only 3 categories: beneficial, harmless or harmful.

Many Muslim families wish to practice the sunnah of ‘tahneek’. A softened date is sometimes rubbed on the baby’s palate before the first feed so the baby will enter ‘a sweet world’. Traditionally, if a date cannot be found, anything sweet will do. An IBCLC might guide a family towards a clean finger dipped in glucose water rather than the boiled hard candy from uncle’s pocket.

Other beliefs are more of a struggle. One study of 120 cultures showed that 50 withheld the infant from the breast for 48 hours or more due to the belief that colostrum was “dirty”, “old”, or “not real milk”. In central Karnataka in India, 35% of infants were still not breastfeeding at 48 hours, yet at 1 month 94% were. A mother who may be reluctant to give colostrum feeds in a western hospital may be passionately committed to exclusive breastfeeding later on.

Some of us can be a little smug when it comes to looking at cultural practices from around the world. We may feel uncomfortable when we hear of the lives of women in Kenya who are strongly instructed to avoid breastfeeding after quarrels to prevent “bad blood” entering the milk and affecting baby. This may mean breastfeeding is paused or a mother’s rights are infringed by family members or neighbors , yet she doesn’t speak up for fear of conflict. Several cultures – traditional groups in Papua New Guinea and the Gogo tribe of Tanzania among them – emphasize the need for the woman to be celibate during breastfeeding. A mother may be torn between her desire to breastfeed – in an environment when food after weaning may not be plentiful – and her desire to satisfy her husband. A husband who is often not expected to also remain celibate.

Those descriptions may be hard to hear but I have no doubt there are women pitying the cultural constraints put upon many woman living in Western industrialized cultures. These poor mothers are still often expected to be separated from their healthy babies after birth. Their baby may sleep in a separate area of a large building (“the hospital nursery”) because culture says “that’s best”. These poor mothers feel obliged to feed according to the clock and feel like failures if their babies feed more frequently. The babies in this culture are often weaned prematurely because the breast is over-sexualized and it’s deemed inappropriate for older children to feed at the breast. Many of us live in a culture that values privacy, scientific “measurement”, control, infant independence. It’s hard to imagine a set of cultural norms more incompatible with breastfeeding.

Is any of this really any less harmful in the long-term than avoiding colostrum feeding?

As an IBCLC, how do you educate yourself about the cultural issues within your community?

With a background of teaching in inner-city London, Emma Pickett, IBCLC came to breastfeeding support after she had her first child in 2004. She trained as a breastfeeding counselor with the UK-based charity the Association of Breastfeeding Mothers (ABM). Now sitting on their central committee, Emma continues to volunteer on the National Breastfeeding Helpline and the ABM’s own helpline as well as running three support groups in North London. Emma qualified as an IBCLC in 2011 and has a private practice alongside her voluntary work. Her work focuses on how breastfeeding impacts on a woman’s sexuality and relationships but also crucially how the sexualization of Western society affects the initiation and continuation of breastfeeding. She is keen to encourage open dialogue in an area which even breastfeeding supporters sometimes shy away from. You can her discuss Breastfeeding and Sexuality on a recent episode of The Boob Group

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