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JHL Cover Photo Contest!

JHL (3)

Every year, the Journal of Human Lactation (JHL) hosts a photo contest for the coveted cover spot on each edition. The JHL 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. The annual photo contest is your opportunity to contribute to the journal and highlight your community. We’ve invited the JHL staff to tell us more about how you can join in the contest.

The four photos on JHL’s cover are changed annually. JHL is your journal, and we want to feature your photos! The four photos portray the broad field of human lactation, from the IBCLC helping new mothers (picture the caring professional with a breastfeeding mother, teaching a class, etc.) along with the harder science of lactation (picture test tubes of milk, microscope slides, etc.). Please send us your photos! We are looking for shots representing a range of backgrounds, contexts, and cultures.

Guidelines:

  • Keep photo clear with minimal background interference
  • Photos should be jpeg files: 300ppi .jpg; at least 2100 pixels wide x 1500 pixels high
  • Email photos to: jhlphotocontest@gmail.com
  • We may not be able to respond to each message separately, but as confirmation of your submission, you should receive an auto response message
  • Include your name (assuming you are the photographer) and full contact information with preferably a second email address

Rules:

  • Deadline – October 15, 2014: NO EXCEPTIONS
  • If a recognizable person features in the photo (e.g., the face of a mother/baby/clinician etc.) you must have a photo consent form.
  • If your photo is a contender for publication, we will require subjects to sign a specific consent form, so only send photos if you know you can obtain permission from the subject.
  • As the photographer you will need to sign non exclusive copyright – in other words, you allow JHL to use the photo, but you are free to use it elsewhere as you choose.
  • If we believe the photo is a potential winner, we will contact you again before the deadline to talk to you and ensure we have the correct forms.

Questions? Email jhlphotocontest@gmail.com

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Keep Infant Formula Marketing Out Of Healthcare Facilities: Action Day

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Guest Post by Jodine Chase

In 2012 Jennie Bever Babendure, PhD, IBCLC, a mother, IBCLC in private practice and breastfeeding research scientist, became an overnight advocate for the protection of mothers and children from predatory marketing practices. It happened after she learned that the representative for the World Health Organization (WHO) in the Americas, the Pan American Health Organization, had accepted $150,000 from infant food manufacturers Nestlé.

Jennie spearheaded a social media campaign that drew global attention to the need for all who work in maternal and infant health to speak out about predatory marketing practices that erode breastfeeding.

[editor’s note: We often hear confusion at Lactation Matters between the marketing of infant breastmilk substitutes and the availability of these substitutes for families who, for whatever reason, need them. Jennie’s work, and that of others who uphold the WHO’s  International Code of Marketing of Breastmilk Substitutesfocuses exclusively on marketing. To learn more about the impact of predatory marketing on families, check out this piece by Norma Escobar here or this video from Public Citizen here.]

Shortly after Jennie’s campaign drew attention to Nestlé’s involvement in funding health campaigns in the Americas, IBFAN Latin America denounced Nestlé’s sponsorship of the hiring of 15,000 women to give nutritional advice on infant feeding in Mexico. The IBFAN action comes on the heels of a successful move in the US to curb infant formula advertising in hospitals by banning the distribution of infant formula giveaways to new moms.

The success of these efforts, such as those in New York City and the state of Massachusetts, means moms in those states are no longer exposed to formula gift packs in hospitals. A 2012 survey by Best for Babes found the practice is declining, and a 2013 survey by Public Citizen and Ban the Bags has found top-ranked hospitals in the US no longer distribute infant food product manufacturer gift bags.

Public Citizens says 75 percent of hospitals in the US still distribute formula gift packs. And many mothers are finding they are targeted before they even get into the hospital to give birth. Advertising that targets pregnant women by offering prenatal education in conjunction with formula giveaways at doctor’s offices and ultrasound clinics is on the rise. 

Jennie learned this first hand during her second and third pregnancies. I interviewed her as she prepares to join families who are responding to Public Citizen’s call for a Day of Action to end infant formula advertising in hospitals and health clinics. After the interview, learn more about the Day of Action and about efforts worldwide to support breastfeeding families by reducing predatory marketing.

Jodine Chase: As an IBCLC who has worked as an advocate to end predatory marketing, you are very aware of the tactics that infant food product companies employ to increase their market share. But you’re also a mother expecting your third child. During this pregnancy what marketing tactics were you personally exposed to?

At 10 weeks into this pregnancy, my husband and I went in for our first prenatal visit. A medical assistant handed us a “gift bag” when she ushered us into the exam room. While we were waiting to see the nurse practitioner, my husband opened the bag and started pulling things out. Along with information from the obstetrician on diet and scheduling our visits, there was a small makeup bag from Abbott containing samples of their Prenatal vitamins along with an invitation to join the Similac Strong Moms website, as well as a portable cooler bag from Mead-Johnson with the label “Powdered Formula for Nursing Moms,” with a can of powdered Enfamil newborn formula.

Breastmilk substitutes Jennie received during pregnancy

Breastmilk substitutes Jennie received during pregnancy

The Enfamil package also contained 2 Breastfeeding Guides: the “New Mother’s Breastfeeding Essentials” with a label from the American Academy of Pediatrics and “Breastfeeding: The Best Start for You and Your Baby” produced by Enfamil. My husband was perusing these guides with the bottles of formula on his lap when the medical assistant re-entered the room. When he asked her how giving formula to new moms was supposed to support breastfeeding, she gave a wry smile and said, “Yeah, that is a little strange, isn’t it?” When he further queried how these things ended up in the bags, she said, “Well, the reps bring us lunch along with boxes of these samples, and we put whatever they give us in the gift bags for moms.”

We had our next visit at another office of the same practice. On the front counter was an

Breastmilk substitutes at Jennie's OB's office

Breastmilk substitutes at Jennie’s OB’s office

11×14 gift basket filled with every type of formula Enfamil makes, wrapped up in cellophane with a bow on top. Looking at this, my 7 year old son asked me “Mom, what is that doing there? Aren’t they supposed to help moms breastfeed?”

2) Was it easy for you to see how the ad campaigns are designed to undermine breastfeeding?

This one is tougher, as the formula companies have gotten very slick at marketing themselves as supporters of new moms. They’re so slick that they’ve obviously got many healthcare providers convinced that they are only providing free samples to help, not to hurt breastfeeding.

By providing booklets about breastfeeding, breastfeeding support phone numbers and saying “breastfeeding is best” at every turn, they make it look like they’re really out to help moms, and only step in when needed. But how can you support breastfeeding by giving moms cans of formula?

The formula companies are very aware that putting formula into a mom’s hands makes it more likely she will use it. Having a physician or hospital give the formula samples to moms makes it look like a health recommendation.

In my second pregnancy I received 8 cans of formula by mail and over 200 advertisements/coupons for formula. I definitely didn’t need my healthcare providers to hand me more of this in the guise of breastfeeding support.

3) Did you ever find the tactics influencing or swaying you personally?

No, but I was very lucky. I delivered my first baby with a midwifery practice that was affiliated with a Baby-Friendly Hospital, and was not given any formula marketing material by healthcare providers or the hospital. Perhaps that is why receiving such a huge amount of these materials so early in my 2nd and 3rd pregnancies really shocked me.

Like many new moms, I really struggled with breastfeeding my first, who was a little early and had lost some weight. If I had been handed samples of formula by my midwife or hospital, I might have considered using it.

4) What do you see that a woman expecting her first baby may not have noticed? What do you want pregnant women to know about these practices?

Despite what formula companies would have you believe, the research shows that mothers who are given samples of formula by their healthcare providers are more likely to give supplementary formula to their breastfed babies, more likely to buy the brand of formula given in the sample, and more likely to introduce solid foods (which are often also made by formula companies) earlier than recommended.

There is nothing altruistic about these samples the formula companies provide, they are a wise investment in future sales. Yes, some moms and babies may need or want to supplement, but the formula marketing is aimed at all moms, setting them up to expect to need formula and doubt their abilities to breastfeed before they even start.

The only way for us to stop this from happening is to speak up. With enough pressure from consumers (us!!), the hospitals and healthcare facilities will get the message.

5) What will you be doing on Public Citizen’s Day of Action?

I have already signed Public Citizen’s petition. Since I can’t be there to help deliver the petition in person, I will be posting pictures of myself and my sons on social media asking healthcare facilities to stop acting as marketing arms for the formula companies. My older son is already very aware of these tactics, and I’m proud that he is learning to be skeptical of marketing campaigns. My hope is that by the time he has children, formula marketing in healthcare facilities will be a thing of the past!

Day of Action

Public Citizen, a nonprofit organization dedicated to championing citizens interests in the face of corporate abuse, is calling on infant formula makers to stop using hospitals and healthcare providers as marketing tools.

A Day of Action takes place on May 21st, both on social media and at Mead Johnson’s Chicago headquarters. Mothers holding hand-made signs with messages like “no ads in hospitals,” “keep ads out of my doctor’s office” and “follow the WHO Code” will be posting their pictures and videos on social media. They’ll be sharing on the Facebook event page as well as on Twitter and Instagram with the hashtag #NoFormulaAds. And thousands of people have signed the petition for Public Citizen to delivery to Enfamil maker Mead Johnson. The petition currently sits at over 17,000 signatures, with more rolling in each day.

Marketing of Breastmilk Substitutes Worldwide

The Public Citizen campaign focuses on changing practices in the United States. The marketing of infant formula impacts families worldwide. To learn more about efforts around the world, check out the links here.

IBFAN Africa
IBFAN Afrique (French Speaking West Africa)
IBFAN Arab World
IBFAN Asia
IBFAN América Latina y el Caribe
IBFAN Europe
Baby Milk Action/IBFAN UK
INFACT Canada/IBFAN North America
NABA – USA

This is, no doubt, an incomplete list. Share your local efforts in the comments and we’ll be sure to add them to this post.

Jodine Chase owns a public relations firm that specializes in news analysis for a select clientele. She is the curator of Human Milk News and with her husband has parented eleven children and stepchildren. She has three grandchildren and two more on the way, and she wants infant food product companies to stop targeting her daughter Rose and her unborn granddaughter (photo) with unethical marketing campaigns. She joined the Best for Babes Foundation board in 2014 to support the BfB C.A.R.E.-WHO Alliance, and she helps run INFACT Canada ‘s Facebook page. She is a founding member of the Breastfeeding Action Committee of Edmonton (BACE).

photo credits:

image of Jodine’s daughter Rose holding sign, courtesy Jodine Chase
images of breastmilk substitutes received during pregnancy, courtesy Jennie Bever Babendure

Do you have a story to share about your efforts to enforce and/or enact the WHO International Code of Marketing of Breastmilk Substitutes in your country? Would you like to share it at Lactation Matters? Please e-mail us at media at ilca dot org.

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New Research: Direct Correlation Between Labor Pain Medications and Breastfeeding

New Research_ Direct Correlation Between

Jennifer Lind, PharmD, MPH is an Epidemic Intelligence Service Officer assigned to the Nutrition Branch in the Division of Nutrition, Physical Activity and Obesity at the CDC. Dr. Lind’s research is focused on research and surveillance issues related to infant and young child feeding practices. Before joining the CDC, Dr. Lind worked as a community pharmacist which led to her deep commitment to public health and fostered her interest in chronic diseases. Dr. Lind and her colleagues recently published a ground breaking study in the Journal of Human Lactation that demonstrates an association between use of labor pain medications and a delay in the onset of lactation (DOL) (defined as milk coming in >3 days after delivery).

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Jennifer Lind, PharmD, MPH

Dr. Lind was recently interviewed by Marie Hemming, IBCLC, a member of the International Lactation Consultant Association® (ILCA®) Medialert Team.

Marie Hemming: What led you to study the effect of labor medications on the onset of lactation?

Dr. Lind: As a pharmacist, labor pain medications are of interest to me and there is very little research done on the association between labor medications and how it can potentially affect the onset of lactation. So many women (estimate of 83%) use labor pain medications and we know that a delay in the onset of lactation (DOL) can lead to shorter breastfeeding durations.

MH: Please summarize the results.

DL: Mainly, in all of the groups of labor pain medications and delivery method, we found that mothers who received labor pain medications were 2-3 times more likely to report DOL compared to mothers who did not use labor pain medications and delivered vaginally.

MH: Are there other studies that demonstrate this association?

DL: This information is relatively new. There are 2 other studies, but they are greater than 10 years old. This current study is the most recent data on the topic.

MH: What do you think are the public health implications of these study results?

DL: This research adds to the body of literature on the topic, which can help inform clinicians and women as they make decisions regarding labor and delivery.

More studies need to be done looking at this association to evaluate why this association exists.

Finally, we need to explore if by providing additional lactation support to women who receive labor pain medications, we are able to improve breastfeeding outcomes and prevent the shorter breastfeeding duration that we know exists in women who have DOL.

MH: How can these data be used by pregnant women?

DL: Women can use these data when they are talking to their health care providers about labor pain medications as part of the decision making process. The research can help them make an informed decision with the knowledge that there may be a risk of experiencing breastfeeding difficulties if they use labor pain medications. Women can also be prepared with appropriate community support mechanisms in case they do experience a delay in the onset of lactation after they are discharged from the hospital. Everyone is very excited about the information because it addresses a gap in this field which is great for clinicians who work in labor and delivery and help mothers enhance natural breast feeding.

MH: Studies show it can take up to 17 years to translate research into practice. How do you think we can disseminate this information more quickly to pregnant women and their caregivers?

DL: This study is available online at the Journal of Human Lactation now. We hope to reach as many families and clinicians as possible so that this can go into the clinical decision making process that mothers and their caregivers make.

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Help Your U.S. Clients Understand Their Rights in the Workplace

In the United States, Sunday marks Mother’s Day. The United States Breastfeeding Committee (USBC) honors this day through an annual campaign. This year, the USBC is focused on getting the word out about the federal “Break Time for Nursing Mothers” law and what it means for breastfeeding employees, as well as issuing a call to action about the Supporting Working Moms Act, which would expand the law to millions of additional workers. Today, Dr. Kathleen Marinelli of the USBC is guest blogging at Lactation Matters to ensure our community is aware of the U.S. federal requirements and ways to support policy that can improve breastfeeding outcomes for U.S. families.

Help Your Clients Understand Their Rights in the Workplace

With more than half of women with infants employed, simple workplace accommodations are critical for breastfeeding success. By helping moms understand their rights as a breastfeeding employee and plan for their return to work, lactation care providers can support a successful transition so that working moms are supported to reach their personal breastfeeding goals.

The federal “Break Time for Nursing Mothers” law requires employers to provide break time and a private place for hourly paid employees to pump breast milk during the work day. The United States Breastfeeding Committee’s Online Guide: What You Need to Know About the “Break Time for Nursing Mothers” Law compiles key information to ensure every family and provider has access to accurate and understandable information on this law.

Key Facts about the “Break Time for Nursing Mothers” Law:

  • Who is covered: The law applies to nonexempt (hourly) employees covered by the Fair Labor Standards Act.
  • Space: Employers are required to provide a place that is not a bathroom. It must be completely private so that no one can see inside. Employers are not required to create a permanent dedicated space for breastfeeding employees. As long as the space is available each time the employee needs it, the employer is meeting the space requirements.
  • Time: The law requires employers to provide “reasonable” break time, recognizing that how often and how much time it takes to pump is different for every mother. Employees should consider all the steps necessary to pump, including the time it will take to gather pumping supplies, get to the space, pump, clean up, and return to their workspace. Employers must provide time and space each time the employee needs it throughout her work day.
  • Enforcement: The U.S. Department of Labor’s Wage and Hour Division (WHD) is responsible for enforcing the “Break Time for Nursing Mothers” law. If an employer refuses to comply, employees can file a complaint by calling the toll-free WHD number 1-800-487-9243.
  • Small Businesses: All employers, regardless of their size or number of employees, must comply with the “Break Time for Nursing Mothers” law. Following a complaint from a breastfeeding employee, businesses with fewer than 50 employees may be able to apply for an undue hardship exemption. To receive an exemption for that employee, the employer must prove that providing these accommodations would cause “significant difficulty or expense when considered in relation to the size, financial resources, nature, or structure of the employer’s business.” Until they are granted an exemption by the Department of Labor, they must comply with the law.
  • State laws: Employees who are not covered by the “Break Time” law may be covered be a state law. Contact your state breastfeeding coalition for help understanding the breastfeeding laws where you serve.

The “Break Time for Nursing Mothers” law was an important victory for families, but breastfeeding success shouldn’t depend on a mother’s job type. The Supporting Working Moms Act would expand the existing federal law to cover approximately 12 million additional salaried employees, including elementary and secondary school teachers. We can all help make this happen! Use USBC’s easy action tool to ask your legislators to cosponsor the Supporting Working Moms Act with just a few clicks. Twelve million employees are counting on us! As Surgeon General Regina Benjamin advised us, “Everyone can help make breastfeeding easier.”

We know that workplace lactation support is a “win-win”, benefiting families, employers, and the economy, yet one of the major causes for the drop-off in breastfeeding rates is the lack of effective, reasonable workplace accommodations when mothers return to work. Employers that provide lactation support experience an impressive return on investment, including lower health care costs, absenteeism, and turnover rates, with improved morale, job satisfaction, and productivity. The retention rate for employees of companies with lactation support programs is 94%, while the national average is only 59%!

Breastfeeding and working is not only possible, it’s good for business. Find additional information and resources in USBC’s Online Guide: What You Need to Know About the “Break Time for Nursing Mothers” Law and help spread the word about this valuable new resource with your clients by sharing this link: www.usbreastfeeding.org/workplace-law.

Mothers, babies and employers everywhere will be glad you did!!

Important links and information:

Editor’s note:

This post addresses the need for workplace accommodations for breastfeeding mothers who return to work in the U.S. Workplace accommodations are critical for any breastfeeding parent who has returned to work, regardless of the country of their workplace.

Workplace accommodations are, of course, most critical in countries where paid leave is not readily accessible. A comprehensive comparison of maternity leaves around the globe can be found here and is also discussed in the chapter “Breastfeeding and Maternal Employment” of the Core Curriculum For Lactation Consultant Practice.

How do family leave and workplace accommodations impact breastfeeding rates in your country?

Marinellii-head-shotDr. Kathleen Marinelli is the Chair of the United States Breastfeeding Committee, an independent nonprofit coalition of almost 50 nationally influential professional, educational, and governmental organizations, that share a common mission to improve the Nation’s health by working collaboratively to protect, promote, and support breastfeeding, where she represents the Academy of Breastfeeding Medicine. She is also a Neonatologist and Breastfeeding Medicine Physician at Connecticut Children’s Medical Center, in the Connecticut Human Milk Research Center, and Associate Professor of Pediatrics at the University of Connecticut School of Medicine.

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Open Letter: Barriers To The IBCLC Profession

The following is an open letter sent to International Lactation Consultant Association® (ILCA®) president Elizabeth Brooks. Lactation Matters is sharing this letter with the goal of sparking conversation before, during, and after the Lactation Summit (hosted by Lactation Education, Accreditation and Approval Review Committee (LEAARC), ILCA, and International Board of Lactation Consultant Examiners®(IBLCE®). We welcome your open and honest dialogue about barriers to the International Board Certified Lactation Consultant® (IBCLC®) profession in the comments and in your own community.

In her IBCLC Day address, Elizabeth Brooks, ILCA president, acknowledged the inequities to entering the profession. I thanked Elizabeth informally, and after a long discussion with her, decided to write this open letter for public consideration.

On IBCLC day, I opened my Facebook feed to find a sea of messages posted by Facebook friends thanking the IBCLCs who had inspired them or helped them on their path through the difficulties of breastfeeding. While I have also been inspired by many IBCLCs, instead of joining in the congratulations and well wishing, I felt a wave of regret for those people who do not have equal access to the field and who, despite their talents and experience, may never become IBCLCs.

In Europe, where I live, the number of practicing IBCLCs is very low. The new IBLCE exam prerequisites have made access to the profession very difficult (especially for non-health care professionals). Even those private practice IBCLCs and health care professionals who have the qualification have difficulty actually practicing with it.

Europe has an aging population. A review of health care education in the UK shows a distinct lack of maternal and infant health courses, and I think this is common across Europe. Because of a predicted decline in births, most resources are directed towards mental health nursing and aged care. Despite access to free or subsidized health care for a large number of Europeans, that health care does not include lactation support. Even when lactation support is identified as needed, the IBCLC credential is not recognized as the standard for delivering that care.

Here in Europe and in other parts of the world we need help promoting a qualification that is difficult to promote. The IBCLC qualification is known as the ‘gold standard,’ but unlike gold (which has a predictable mass), the prerequisites have changed consistently throughout its 30 years of existence. When people ask me to explain exactly what an IBCLC is and what an IBCLC has studied I begin with a “well, it depends . . ..”

We (breastfeeding advocates, providers and supporters) need a clear idea of what the profession is and what we want it to be. Currently the qualification is used predominantly as an add-on to existing health care professions. Non-health care professionals are following a precarious path through ‘patched together’ education; 14 health-science subjects from different faculties and institutions, 90 hours of lactation specific education from independent sources and a various assortment of practical hours with varying degrees of supervision.

Unlike other professions with a clearly outlined study path, navigating the IBCLC exam prerequisites requires skills and experience unrelated to those necessary for success at completing the required courses and practical hours – the system currently privileges those with prior tertiary education, familiarity with education institutions, independent study skills and, for those of us in Europe, internet access, and the economic means to affront unsubsidized private education.

Each country in Europe has an existing health care education system which is not organized along the same lines as the courses outlined in the Health Sciences Education Guide. The difficulties in finding courses that satisfy the specified requirements are forcing many of us to spend our ‘lactation education dollars’ in the US rather than within our own education systems, due to bureaucratic difficulties such as course names, length and content. This is an unfortunate loss of resources as our own education systems are often subsidized or free but don’t necessarily offer individual courses with the same division of content.

My hope is that IBLCE will recognize the resources that we do have instead of requiring a standard list of courses, which we do not have. Such a recognition could then help us open dialogue with our own institutions. We could ask for permission to access to the pre-existing courses that we require by emphasizing the need to train professionals within existing institutions, in turn promoting recognition of the qualification in our own countries. This could be a tangible way to demonstrate to our governments, education systems and health care systems the need for lactation education and professionally trained providers. In the interim, we also need help in simplifying access to the exam and assistance in sourcing universally available online courses that are accepted by IBLCE.

In opening opportunities for new IBCLC candidates, we should also focus on creating opportunities for those less advantaged and those from marginalized communities in order to increase diversity within the profession. Currently, the practical hours component of the prerequisites privileges health care professionals already in practice and those who can afford, and are eligible to, volunteer with mother-to-mother support counseling organizations.

This constitutes a barrier to those who do not have a health care degree, and those who are not mothers (including men), those who do not parent in a certain way, or who cannot afford to volunteer. Other analogous professions, including counseling, nursing, and midwifery, do not have these kinds of restrictions and as a result have a wider diversity of practitioners. We should be turning our gaze to the entry points of both the education and practical requirements and consider how to remove barriers to entry in order to create a system that truly welcomes candidates of all ages, genders, race, abilities, and sexual orientations.

The African American community is pioneering work in this area, creating systems that build on WIC peer-counsellor programs enabling IBCLC candidates to build on their existing experience under the guidance of qualified mentors. In Europe we do not have programs such as WIC (nor easy access to mentors nor academic programs) and there are growing numbers of independent peer counsellors, volunteer and professional, doulas, breastfeeding counsellors and lactation educators who are unable to use their experience towards the IBCLC exam.

These individuals could be encouraged to participate in a structured and supervised support network that could enrich and enlarge the small but significant pool of candidates who acquire experience via volunteer mother support organizations such as La Leche League International (LLLI). The mother support organizations recognised by IBLCE are not accessible to all, nor provide support to all. LLL has recently widened their application requirements to include men who have breastfed, a change in policy from two years ago when they refused the application of Trevor MacDonald. This is a positive step towards inclusion by the association which has a history of difficult relations with working mothers, single mothers and women in same-sex relations – factors that limit this organization (the world’s largest mother support organization) as an equitable entry point to the profession. I hope that other entry points for non-health care professionals will be recognized or created.

Lastly, there are many people with skills and experience from within underserved communities that could be serving communities worldwide, including indigenous, marginalized ethnicities, rapidly increasing migrant populations, the diversely abled and the LGBTIQ population. Our access to the exam is limited for the same reasons that our communities are underserved. Nearly three-quarters of the world’s IBCLCs reside in America (or serve in the American military) and even there many communities are unrepresented in the profession and underserved.

In lieu of statistics, we can look at the way the profession is described, the images used in breastfeeding literature, and the gendered language used by IBLCE and throughout the breastfeeding field generally. I think it is safe to say that the lactation profession is practiced predominantly by white, English speaking, middle-class, heterosexual, partnered, cisgender women. I know there are a few exceptions to that and I take my hat off to sole earners or primary breadwinners, people of color, LGBTIQ people, men, and those with linguistic challenges who have managed to enter and gain employment within the profession.

These were the thoughts that cast the cloud over the IBCLC for me, a cloud that lifted upon reading Elizabeth Brooks’ address, opening a much needed dialogue on barriers to the profession. The discussion that followed with her and others was, in the end, a cause for celebration of IBCLC day. I am currently an IBCLC exam candidate and believe strongly in creating a profession that is as equitable as it is professional. I am much looking forward to continuing this discussion at the Lactation Summit in Phoenix in July, where I will be an eager participant.

profile 02.14 edited II croppedAlice Farrow is an Australian who has lived most of her adult life in Italy where she is currently a single parent of two bilingual and bicultural children. A member of the LGBTIQ community and mother of a diversely abled breastfeeder (a daughter born with a cleft lip and palate), she writes on issues of inclusion and special needs in breastfeeding  support through her two websites www.languageofinclusion.com and www.cleftlipandpalatebreastfeeding.com.

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Q & A with Sherry Payne, MSN, RN, CNE, IBCLC: An Innovator In Lactation Equity

Screen Shot 2014-04-16 at 12.54.48 PMSherry Payne, MSN, RN, CNE, IBCLC, is the Executive Director of Uzazi Village, a nonprofit organization devoted to decreasing pregnancy related health disparities in the urban core of Kansas City. She is also the facilitator of the upcoming 2014 Lactation Summit: Addressing Inequities within the Lactation Consultant Profession. Ms. Payne speaks frequently around the country to professional audiences on topics related to lactation and birth disparities (including the upcoming 2014 ILCA Conference). One of the many barriers that aspiring IBCLCs of color face is acquiring clinical hours. The Uzazi Village Lactation Consultant Mentorship Program is an innovative solution, connecting aspiring International Board Certified Lactation Consultants® (IBCLC®) from the Kansas City community to the Uzazi Village Breastfeeding Clinic, which provides free services to area families.

Ms. Payne was recently interviewed by Marie Hemming, IBCLC, a member of the International Lactation Consultant Association® (ILCA®) Medialert Team.

Marie Hemming: Why did you start the Lactation Consultant Mentorship Program?

Sherry Payne: I started this program with the idea that we needed more IBCLCs of Color. I am currently the only IBCLC of Color practicing in my city (though I am the third African-American IBCLC to be certified in my community). This has become a top priority for Uzazi Village – making accessible pathways for lactation educators and peer counselors to become board certified professionals, and then linking those professionals to families in our community who need those services. We already had our free Breastfeeding Clinic up and running two days a week and four volunteer IBCLCs to run it. It was not too difficult to add the mentorship program to it. Three of our IBCLCs qualify to be mentors and there were always plenty of women at our door inquiring about how to become a Lactation Consultant. The research tells us that recruiting and diversifying the ranks of IBCLCs should be a part of the strategy for overcoming disparities in lactation in the African-American community. That’s what we are attempting to do.

MH: Tell us about the Breastfeeding Clinic and how it serves families in Kansas City.

SP: Clients are referred from community-based prenatal clinics and local hospitals that serve low income breastfeeding women who otherwise would not be able to access the lactation support they need. I talk to the local lactation consultants, nurse midwives, pediatricians, doulas and other care providers about our clinic. We receive referrals from Women, Infants, and Children (WIC) and home visiting programs such as Healthy Start and Nurse Family Partnership. We have three to five moms in clinic and home visits each day and we spend an average of two hours with each client on everything from sore nipples, to milk supply issues, to relactation and weaning. We also offer two breastfeeding support groups: La Leche League on Troost, and the Chocolate Milk Café. Our support groups and breastfeeding classes also draw local women into the clinic.

MH: How does the Mentorship Program work?

SP: The interns need to accumulate 300 or 500 hours and we ask that they work at the Breastfeeding Clinic a minimum of one day per week every other week. If they come to every clinic it will take them four to six months or it may take them as long as 10 months to get their hours if they come less often. They are also encouraged to take the WHO/UNICEF Breastfeeding course which is offered every quarter. The interns pay a fee for the program on a sliding scale depending on income.

The program is just starting out, however, we have our first intern beginning in May 2014, with two other candidates seeking placement. We are currently working on getting hospital placement for our interns to do part of their hours. We are also in talks with a local community college to package all the required courses to create a one-stop shopping curriculum for our interns. We hope to be able to simplify things by having classes and clinical experiences all in one program.

MH: What are some of the other barriers that aspiring IBCLCs of Color experience? How is Uzazi Village helping to break down those barriers?

SP: Barriers for aspiring IBCLCs include accessing the educational components, finding mentors, and completing the hours. Women of Color will of course be much less likely to find mentors that look like them, and normative culture mentors may be uncomfortable bringing a Woman of Color into their practice. (I am actually experiencing the same difficulty in my midwifery training.) Many aspiring IBCLCs of Color are found in the ranks of WIC Peer Counselors, but there is no clear cut pathway to move them into the ranks of IBCLCs. It is the presence of these types of barriers that compelled me to create a program at Uzazi Village. International Board of Lactation Consultant Examiners® (IBLCE®) requirements often presuppose educational attainment that peer counselors may not possess, leaving them stranded at the bottom of the professional and economic rungs.

MH: You were invited to Washington DC by the United States Breastfeeding Committee to discuss continuity of care with advocates from around the country. If you could change one thing about our healthcare system to improve breastfeeding outcomes, what would it be?

SP: The Affordable Care Act makes provision for reimbursement for lactation professionals. I would like to see reimbursement for ALL levels of breastfeeding support professionals – direct compensation for the work we do, particularly WIC Peer Counselors. We need our WIC Peer Counselors in our communities. Lactation consultants are most often isolated in hospitals and accessing them is difficult, if not impossible, following hospital discharge. Private practice IBCLCs are cost prohibitive to access among the women we regularly see. Peer counselors have had the greatest impact on increasing breastfeeding rates in our community – they do most of the front-line work and yet they receive the least amount of recognition and pay. I would like to see Peer Counselors and Certified Lactation Counselors compensated by insurance companies for the valuable service and support they offer. This does not take anything away from the board certified professional, but enhances and refines his or her role. We need all levels of expertise.

MH: Of all of the things that you have done, are there one or two things that stand out as being most effective in helping the moms that come to Uzazi Village?

SP: The Chocolate Milk Café, which is a mother-to-mother support group for African-American women, has been groundbreaking. It is designed to meet the needs of our urban moms and has been one of our most successful programs. At Chocolate Milk Café, mothers can attend with their babies and have a safe environment in which to discuss their breastfeeding issues. We are starting to replicate this model around the country.

MH: You are breaking new ground with your work at Uzazi Village, is there someone who has influenced you or mentored you in your own career as a lactation consultant & natural birth educator?

SP: Lots of people have invested in my success over the years, but my primary mentor in lactation has been Charlene Burnett, BSN, RN, IBCLC. She mentored me when I was an L & D nurse, but I worked at a different hospital. She received special permission from her hospital to mentor me 500 hours in a year. I could not have done this without her. She is one of my LC volunteers and she is the Director of Lactation Services at Uzazi Village. We have named a scholarship after her: the Charlene L. M. Burnett IBCLC Scholarship, set aside for a candidate of color in the greater metropolitan area of Kansas, Missouri who has met all requirements to sit for the IBLCE exam. It is our small way of thanking her for all that she has invested in Uzazi Village.

MH: What advice would you give to others hoping to increase access to lactation services for women of Color?

SP: Be creative, assess your community assets and find a way to connect what you have to what women need. When I’m considering a project large or small, I always call to mind the words of the late tennis great, Arthur Ashe: “Start where you are, use what you have, do what you can.” Finally, if you are not a woman of color yourself, join your efforts to someone who is. Allies are important to the cause, but they must take their lead from someone who is a member of a community of color. At Uzazi Village, we counsel many allies around the state and around the country to place women of color in central roles when doing outreaches to communities of color. On our website, you’ll find the success stories (Uzazi Champions) of those we have worked with to improve lactation rates in other communities of color.

Marie Hemming, IBCLC is the mom of three breastfed children (now 20, 16 & 15 years of age). She developed and taught a 20-hour breastfeeding class at the Florida School of Traditional Midwifery. She is currently volunteering as an IBCLC and lay community counselor at Birthline of San Diego, serving families living in poverty.

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IBCLC Day 2014: Honoring the Ways IBCLCs Help Families

IBCLCs, get ready to give thanks – and accept gratitude.IBLCDaySocialMedia-Final-A

Every day, I hear from people who are grateful for the IBCLCs in their community. Families who were able to reach their breastfeeding goals. Health care providers who see the vital role the IBCLC plays on a baby’s team. Community leaders who value how breastfeeding improves their citizens’ health and well being.

This year, IBCLC Day is designed to deepen the connections we have to families, health care providers, and our community by taking a moment to share that gratitude.

ILCA has created a series of images – designed to be shared on social media – that invite the community to share their reflections on the impact of IBCLCs. (Check out a sample one at the top of this post!) We also hope that families and others will take this opportunity to thank the IBCLCs in their lives by sharing these reflections on social media.

On March 5th – IBCLC Day 2014 – please watch on the blog, Facebook page, and in your e-mail for ways that you can encourage sharing.

Want to take action today? On the ILCA website, you’ll find a flyer all about how your community can participate. Please print and post wherever families, health care providers, or anyone who cares about breastfeeding might see it – like your local baby store, community center, or health care center.

Know an organization who would like to help us celebrate IBCLC day with a blog post to encourage sharing? Contact us at LactationMatters {at} gmail {dot} com.

We know that in the past, IBCLC Day has focused on local events. While we don’t have some of the materials as in year’s past (like cake art) others will still be available (like thank you certificates and e-cards). We hope that you’ll continue to organize those in your community! You can also purchase IBCLC merch at the ILCA store here as thank you gifts! We encourage you to take this opportunity to come together and share your gratitude for your local breastfeeding community.

You can also take March 5th as an opportunity to share gratitude for your IBCLC colleagues. Stop by the ILCA Facebook page and share a “thank you” with your mentor, your practice partner, or an IBCLC that you collaborated with sometime this year. Or send an e-card (you’ll find those and everything else you need for IBCLC Day here). The more gratitude, the better!

In the words of the U.S. poet and author Maya Angelou: “When we give cheerfully and accept gratefully, everyone is blessed.”

Photo credit for image: courtesy of the Indiana Black Breastfeeding Coalition. Anne Schollenberger Photography.

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Transitions At Lactation Matters

by Amber McCann, IBCLC

This week marks an exciting transition at Lactation Matters. After almost two years, I will be stepping down as the editor of ILCA’s blog. As you may have heard, Jeanette McCulloch, IBCLC, will be taking on the role of ILCA’s media coordinator. Jeanette and I have worked closely together for a number of years to help educate and inspire our lactation colleagues to embrace using online communications with the families they serve. I am confident that Jeanette will confidently take ILCA forward as they seek to effectively communicate why IBCLCs are essential to new families. I talked with Jeanette about her passion for this work and her vision for the organization’s online presence.

McCulloch Speakers Headshot Cropped

Amber: Tell us a little about how you became to be an IBCLC and what led you to use your skills in communications and PR in our field?

Jeanette: I became an IBCLC like so many of us – after lots of breastfeeding challenges of my own. My experience of transitioning to parenting gives me lots of empathy for what many new mothers face. I had a satisfying but demanding PR job and a much-cherished high needs baby, born after years of fertility treatment. She would later be diagnosed as tongue-tied (by a speech pathologist when she was three) but all I knew is that in order to gain weight, she needed to nurse (and be held) round-the-clock. After one day of day care, I knew this wasn’t going to work for either of us.

I left my beloved job and found more flexible work where I could often bring my daughter along. I truly found my tribe as I supported a community of doulas. While there, I saw – daily – the powerful interplay between birth, breastfeeding, postpartum support, and perinatal mood disorders. I saw how much mothers need a community of support, especially when our mothers, sisters, and aunts are so far-flung. I helped to build a lactation program that coordinated care between doulas and IBCLCs and offered a warmline, a clinic, and home visits.

What I missed, though, was using my PR skills. In my previous role, I did what is known as “public interest” PR. I missed the craft of using communications to shape public policy. In my work at BirthSwell, I am so grateful to be able to bring the two together – using communications to help spread accurate, empowering information about birth and breastfeeding.

Amber: What are your hopes as you take on this new position?

Jeanette: I am so excited to be in this new role. I think there is a huge potential for ILCA to connect in a new way to its members and the broader breastfeeding community. The good news is that ILCA has a strong community base – all thanks to the efforts of the past social media team. Bloggers Robin Kaplan and Decalie Brown launched a powerful tool in Lactation Matters, with Amber McCann really building and sustaining an audience there. Maryanne Perrin’s work on social media has resulted in a strong community on Facebook and Twitter, with a combined audience of more than 12,000 followers. And we shouldn’t forget the work of Doraine Bailey, who edited our e-Globe for a number of years and kept members informed of all of the wonderful work of ILCA.

The next level for ILCA is to begin to really engage with that base – to get into conversations that deepen relationships and opportunities. But building relationships is time and resource intensive. That’s why I’m excited to be building a team of volunteers that will be engaging with the ILCA audience on a daily basis.

Amber: What do you see as the biggest challenge for ILCA in regards to communications and how do you envision tackling it?

Jeanette: Social media is a powerful tool for listening to *and* engaging with our community. When organizations first start to truly hear the “buzz” out there, there’s usually some good news – and a few tough truths. With every group I work with, I think the hardest moments have been when we’ve had to take that look in the mirror and learn what’s being said out there. And see it as opportunity.

I’m starting this work at a time of change for the IBCLCs; where the growth of competing service providers is colliding with a scarcity of available funding; where undeveloped regions of the world are desperately working to establish breastfeeding as a cultural norm; and where the move toward cultural, racial, and economic diversity in our profession is being actively pursued. There’s also the real challenge of helping families and others sort through the different kinds of breastfeeding helpers, without being divisive and while recognizing the need for care in underserved communities.

I know there’s no way I can do this alone – which is why I am so excited to be pulling together a team. A team that will be building relationships and tapping into the resources of the larger community. My goal is to work with the team to make sure ILCA is bringing the voice of its membership to the conversations about breastfeeding support today.

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Dr. Miriam Labbok – Global Breastfeeding Leader & APHA Lifetime Achievement Award Winner!

By Maryanne Perrin, MBA

labbokThere is no doubt that it will take a global village to improve breastfeeding rates and ensure that every child gets the optimal nutrition and immunity to start life. Our global village needs fearless leaders to advance the breastfeeding cause, and Dr. Miriam Labbok is one such visionary, which is why we were delighted to see the announcement last week that she had received the American Public Health Association’s Lifetime Achievement Award.  ILCA is proud to claim Dr. Labbok as a fellow IBCLC, and even more proud of the decades of impact she has had on breastfeeding outcomes. In case you aren’t familiar with Dr. Labbok’s work (which is hard to imagine!) here is a brief summary of her many contributions:

  • Dr. Labbok, MD, MPH, FACPM, FABM, IBCLC, is currently a professor at the University of North Carolina Gillings School of Global Public Health. She also serves as the Director of the Carolina Global Breastfeeding Institute, which offers a comprehensive program of research, service to the greater community, and education related to breastfeeding and optimal reproductive health.
  • From 2001 to 2005 she served as UNICEF’s Senior Advisor, Infant and Young Child Feeding and Care.
  • From 1996 to 2001 she served as Chief, Nutrition and Maternal Health Division for the Agency of International Development (USAID).
  • From 1992 to 1996 she served as the Director of the World Health Organization’s Collaborating Center on Breastfeeding.
  • A Pubmed search of “Labbok + breastfeeding” generates over 75 published papers on topics ranging from infant feeding practices in international communities, to the impact of the Ten Steps in maternity hospitals, to IBCLCs experience with health insurance coverage of breastfeeding support services.

Dr. Labbok’s lifetime of work has had an immeasurable impact on improving global health. Congratulations on the much deserved APHA Lifetime Achievement Award!

MaryannePerrin3-2Maryanne Perrin loves all things related to food: growing it, cooking it, eating it, and now studying about it at the molecular and cellular level.  She has a BS in Industrial Engineering from Purdue University and an MBA from the University of North Carolina, Chapel Hill, and enjoyed a variety of career paths (information technology, management consulting, stay-at-home-mom, entrepreneur) before returning to school to obtain a PhD in Nutrition Science. She was quickly captivated by the amazing story of human milk and is focusing her research on understanding the nutritive and immunoprotective value of donor milk beyond one year postpartum.  When she’s not studying or helping ILCA with social media, she likes playing in the woods with her husband, three kids, and the family dog.  

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A Response from the International Chiropractic Pediatric Association

Lactation Matters received the following response from Dr. Joel Alcantara, the Research Director of the International Chiropractic Pediatric Association in response to remarks from Dr. Howard Chilton in the September issue of ILCA’s e-Globe. In the issue, Dr. Chilton, one of the plenary speakers at this year’s ILCA Conference in Melbourne, Australia, responded to questions about the use of chiropractic care for colicky infants. He said,

“I find too often when I am asked to manage the colicky and unsettled baby that they have already been seen by a chiropractor and have had some form of cranial or spinal treatment. This type of management is unproven, has no basis in science and is potentially dangerous, both of itself and from the delay in the application of sound medical and nursing procedures for this complaint. The movement of chiropractors into the management of paediatric, and especially neonatal conditions, is very
troubling.

The parents of young children are highly vulnerable when their children are perceived to be unwell and, combined with their reasonable wish to avoid medications, are easily mislead by the anecdotal claims of such pseudoscience. As I heard someone remark recently: “the collective noun for ‘anecdote’ is not ‘evidence’.” I wish I’d thought of it!

However when one is marketing what is in effect the placebo effect one is certainly motivated to be sympathetic and kind and to give extra attention and time to the concerns of the parent. It is this benefit that derives from the chiropractor in this field, and perhaps it is in this area that conventional medicine can improve.”

Lactation Matters always welcomes discourse such as this as we seek to develop evidence based practice and we thank the International Chiropractic Pediatric Association for reaching out to us to publish their comments.

By Joel Alcantara, Research Director of the International Chiropractic Pediatric Association

ICPA Logo (1)We thank the ILCA for the opportunity to respond to comments made by Howard Chilton, MBBS, MRCP(UK), DCH on the subject of chiropractic care for infants with colic. In this era of evidence-informed medicine, Dr Chilton is obviously ill informed on chiropractic for colicky infants and colic medications. A recent systematic review of the literature on chiropractic and infantile colic by Alcantara and colleagues1 found 26 published articles in peer-reviewed journals consisting of three clinical trials, two survey studies, six case reports, two case series, and four cohort studies. Overall, the published literature supports chiropractic for colicky infants. In terms of comparative effectiveness research, it should interest Dr Chilton that a clinical trial has compared chiropractic versus Dimethicone, a very popular medication prescribed for infants with colic. The study demonstrated that chiropractic care was more effective in relieving infantile colic.2 This is not surprising to those familiar with the scientific literature on drug prescriptions for colic that finds “little scientific evidence to support the use of Simethicone, Dicyclomine hydrochloride, Cimetropium bromide, lactase, additional fiber or behavioral interventions.”3

Chiropractic is a vitalistic, holistic and patient-centered approach to patient care. Chiropractic is a caring profession where mutual trust, understanding and acceptance is of paramount importance in our approach with patients, adult or children. As chiropractors, we acknowledge and embrace the non-specific effects of the clinical encounter – what Dr Chilton refers to as the placebo effect. With all due respect, perhaps Dr Chilton should not be so arrogant and judgmental and embrace the placebo effect since colic medications such as dimethicone or semithicone have been demonstrated to be no better than placebo.4,5  Even more pressing, safety concerns have been raised with a number of these colic medications.6,7

A systematic review of the scientific literature on adverse events associated with pediatric spinal manipulation found only 10 documented adverse events attributed to pediatric chiropractic in a span of over 100 years of chiropractic practice.8 Our own practice-based research network studies point to the safety of pediatric chiropractic with prevalence of adverse events at less than 1% and risk estimates placed at <1000 adverse events per 1 million children followed under chiropractic care for 1 year.9,10 Dr Chilton should be more concerned about the practice of “off-label” prescribing for infants and children in his profession. The first study to examine the extent of this practice of prescribing medication for children without the safety, efficacy, and quality assurance that is required of medications was performed in the UK. The study found that 70% of children received either an unlicensed or off-label drug prescription, with approximately one-third of drug prescriptions being unlicensed or off-label.10,11 Subsequent studies have confirmed the popularity of this practice in pediatric medicine with documented adverse events that is unmatched in frequency and severity by chiropractic or other alternative forms of pediatric care.

The practice paradigm of the 21st century is integrative care that is embraced by lactation professionals, chiropractors, nurses, and other healthcare professionals. It is characterized by mutual respect and shared managementthat emphasizes wellness and healing of the entire person (bio-psycho-socio-spiritual dimensions), drawing upon the best of both conventional and alternative therapies.13 Antiquated attitudes expressed by Dr Chilton have no place in the care of infants and children in the 21st century.

References

  1. Alcantara J, Alcantara JD, Alcantara J. The chiropractic care of infants with colic: a systematic review of the literature. Explore (NY). 2011;7(3):168-74.
  2. Wiberg JM, Nordsteen J, Nilsson N. The short-term effect of spinal manipulation in the treatment of infantile colic: a randomized controlled clinical trial with a blinded observer. J Manipulative Physiol Ther. 1999;22(8):517-22.
  3. Hall B, Chesters J, Robinson A. Infantile colic: a systematic review of medical and conventional therapies. J Paediatr Child Health 2012 Feb;48(2):128-37
  4. Metcalf TJ, Irons TG, Sher LD, Young PC. Simethicone in the treatment of infant colic: a randomized, placebo-controlled, multicenter trial. Pediatrics 1994; 94(1): 29-34
  5. Danielson B, Hwang CP. Treatment of infantile colic with surface active substance (simethicone). Acta Paediatr Scan 1985;74(3):446-50.
  6. Crotteau CA, Wright ST, Eglash A. Clinical inquiries. What is the best treatment for infants with colic? J Fam Pract 2006;55(7):634-6.
  7. Lucassen PL, Assendelft WJ, Gubbels JW, van Eijk JT, van Geldrop WJ, Neven AK. Effectiveness of treatments for infantile colic: systematic review. BMJ 1998;316(7144):1563-9.
  8. Vohra S, Johnston BC, Cramer K, Humphreys K. Adverse events associated with pediatric spinal manipulation: a systematic review. Pediatrics. 2007;119(1):e275-83
  9. Alcantara J, Ohm J, Kunz D. The safety and effectiveness of pediatric chiropractic: a survey of chiropractors and parents in a practice-based research network. Explore (NY). 2009;5(5):290-5.
  10. Alcantara J, Ohm J, Kunz D. A practice-based prospective study on the incidence and prevalence of adverse events associated with pediatric chiropractic spinal manipulative therapy. J Ped Matern & Fam Health – Chiropr [Submitted for Publication]
  11. Choonara I, Sharon C. Unlicensed and off-label drug use in children. Implications for safety. Drug Safety 2002; 25 (1):1-5
  12. Turner S, Gill  A, Nunn T,et al. Use of ‘off-label’ and unlicensed drugs in paediatric intensive care unit. Lancet 1996;347:549-50
  13. Bell IR, Caspi O, Schwartz GE, et al. Integrative medicine and systemic outcomes research: issues in the emergence of a new model for primary health care. Arch Intern Med 2002;162: 133-40.

alcantara_joelDr. Joel Alcantara, I.C.P.A. Research Director, spearheads the profession’s largest and most successful Practiced Based Research Network (PBRN) and continuously oversees numerous projects relevant to evidenced based family chiropractic care. He is instrumental in involving members of the International Chiropractic Pediatric Association in publishing the research so necessary in the profession. His commitment to publishing is establishing recognition and validity to the necessity, safety and effectiveness of chiropractic care for pregnant women and children.

Dr. Alcantara was born in the Philippines and grew up in Calgary, Alberta. Prior to attending Chiropractic College, he was trained in Chemistry-Biochemistry and Cellular, Molecular and Microbial Biology at the University of Calgary. Upon graduating from Palmer College of Chiropractic West in 1995, he was given a full-time faculty appointment at his alma mater in the Research Department. In the two years prior to his position with the I.C.P.A. , he held the rank of Assistant Professor at Life Chiropractic College West. During his tenure at both chiropractic colleges, he has taught an array of subjects from Chiropractic Pediatrics, Physical Diagnosis, Research Methods, Public Health and various chiropractic clinical courses. He has published widely in scientific journals and in the popular chiropractic media and has co-authored several chapters in various chiropractic textbooks. Dr. Alcantara is completing his Master of Public Health degree at San Jose State University with a specialty in Community Health Education.

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