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Promote Skilled Lactation Support: Add an IBCLC Day Frame To Your Facebook Profile

Show your pride in transforming world health through skilled lactation care. Educate your community by changing your Facebook Profile Frame to celebrate IBCLC Day!

This day – celebrated in 2020 on 4 March – is an opportunity to honor how IBCLCs transform world health by providing skilled lactation care. (Find other ways to celebrate IBCLC Day here at the ILCA website.)

Choose from any of the following options – “Proud to be an IBCLC” or “Proud to be an IBCLC” alongside hashtags celebrating the World Health Organization’s designation of the Year of the Nurse and the Midwife.

Happy IBCLC Day 2020

Happy IBCLC Day 2020 – #yearofthenurse

Happy IBCLC Day 2020 – #yearofthenurseandmidwife

How to Add a Profile Frame on Desktop 

  1. Navigate to your profile page by clicking your name on top blue bar 
  2. Hover over your profile picture 
  3. Click “Update” 
  4. Click “Add Frame” 
  5. In the search box, type “IBCLC Day” 
  6. Click on your preferred style 
  7. Use the editing box on the right to adjust the size and placement of your profile picture 
  8. On the bottom row, next to “Switch back to previous profile in”, click on the drop down menu 
  9. Choose how long you would like to keep your frame. 
  10. Click “set” 
  11. Click “Use as Profile Picture” 
  12. You’re all done! If you want, make a post about your new profile frame to your followers. 

How to Add a Profile Frame on Mobile (iOS)

  1. Navigate to your profile by tapping the person icon on the bottom of the screen
  2. Tap the photo icon on your profile picture 
  3. On the menu that pops up at the bottom of the screen, tap “Add Frame” 
  4. At the top of the screen, click on the search bar 
  5. Search “IBCLC Day” 
  6. Choose your style by tapping on it 
  7. Tap the button that says “Make Temporary” and choose “Custom” in the drop-down menu 
  8. Choose how long you would like to keep your frame. 
  9. Tap “Set” 
  10. Tap “Save” in the upper right hand corner of the screen 
  11. You’re all done! If you want, make a post about your new profile frame to your followers. 

ILCA Seeks Bylaws Changes in 2020

The ILCA Board of Directors is pleased to ask ILCA voting members (those who are currently certified as an IBCLC®) to vote on the 2020 bylaws changes.

The ILCA Board of Directors supports the proposed changes.

Voting ILCA members are encouraged to make an informed decision after thoughtful consideration of the issues, before they visit the voting site.

Vote carefully: Once your vote is cast, it cannot be changed, repeated or cancelled.

What is the balloting process?

ILCA’s balloting process allows bylaws elements to be voted on by section (instead of all-or-none).  We utilize a balloting platform to ensure one-member-one-vote.

If a dues-paid, IBCLC® ILCA member does not receive an email on 20 February 2020 containing a link to the ballot, please contact the ILCA Office at (or) 1+  919-861-5577 (or) 888-452-2478.  Our ILCA staff is eager to make sure you get a ballot, so your vote can be counted.

Where can I view the proposed changes?

This document shows the 2015 ILCA bylaws, edited with “tracked changes,” to show the proposed 2020 ILCA bylaws. It lets you compare the old version with the new. The document also summarizes all the changes and the Board’s rationale for each, section-by-section. 

Can I discuss this with my colleagues before I vote?

Please do!  This blog and other social media venues encourage dialogue about ILCA’s governance! Use the comments section below to ask questions or make comments.

Ballot Vote No. 1: Why does the ILCA Board support giving voting powers to all dues-paying members in Bylaw 3.4 Voting Rights?

ILCA members have power to vote to (1) elect Directors, (2) ratify bylaws changes, and (3) make motions at the Annual General Meeting.

Since 1985, ILCA has invited open membership to anyone who supports our mission [ILCA Mission: To advance the International Board Certified Lactation Consultant (IBCLC®) profession worldwide through leadership, advocacy, professional development, and research]. From 1985-2007, any dues-paying ILCA member could vote. In 2007 voting rights were restricted to IBCLC®-only members, to demonstrate strong ILCA advocacy for the IBCLC® credential.

Undeniably, demographics of ILCA membership and the pathways of entry into our profession as a whole show significant race, income, and geographic-based barriers. ILCA’s Strategic Plan seeks to increase diversity by creating meaningful, accessible entry into the profession, and our professional association.

Right now, those who are seeking IBCLC® certification and knowledge do not have a professional “home.” The burden falls to the individual to cobble together education and training that will be acceptable to meet pathway requirements of the International Board of Lactation Consultant Examiners® (IBLCE®). ILCA values all members.

Further, extending voting powers to all dues-paying members allows those that have retired to continue to be advocates for the profession. We believe it is essential to honor retirees’ institutional knowledge and their dedication to ILCA and the profession, while continuing to move our mission forward. ILCA’s role has always been:

  • Serve current IBCLCs®
  • Engage and help others who believe in our work
  • Promote the value, growth, and awareness of our profession throughout all stages of your career

Inclusion will propel this profession into growth and sustainability. To address the challenges of current members, and generations of IBCLCs® to come, there must be an invited and equitable voice by those in our association. Inclusion assumes full acceptance; in a membership organization, that includes voting rights.

The ILCA Board supports this amendment to giving voting rights to all dues-paying members as means to build membership, increase diversity, and enhance equity.

Ballot Vote No. 2: Why does the ILCA Board support changes to Directors’ qualifications in Bylaw 5.2 Qualifications?

In previous years, there have been questions about when a Director meets the two (2) year ILCA membership mark. To alleviate confusion about membership validity, the revised bylaws require each Director be an ILCA member in good standing who has completed two (2) years of ILCA membership immediately prior to the date that nominations are called and be an IBCLC®.

The ILCA Board supports this amendment because it provides greater specificity for the two (2) year ILCA membership requirement.

Ballot Vote No. 3: Why does the ILCA Board support shortening the period for identifying Director positions to be filled by election in Bylaw 6.3 Directors?

New Directors start in July each year and the balloting period begins the following March. If the Director positions to be filled by election had to be identified by the Board six (6) months prior to the balloting period, the identification would need to take place by October and there often is not enough time for the Board to determine what is needed.

The ILCA Board supports this amendment to three (3) months prior to the balloting period because the change in timing allows new Directors to become acclimated each year before new positions need to be identified.

Ballot Vote No. 4: Why does the ILCA Board support removing chair of the Nominations Committee from the outgoing President’s responsibilities in Bylaw 6.7 Appointment of President?

The ILCA President serves for a two-year term and at the end of their term, the outgoing President serves as chair of the Nominations Committee for an additional two (2) years. This task and time frame extend beyond the responsibilities of the President. This function is covered in the ILCA Policies and Procedures as an operational task, not a governing task.

The Board supports changes that appropriately utilize the President’s time and contributions.

Ballot Vote No. 5: Why does the ILCA Board support the outgoing President serving as an ex-officio Board member for one year in proposed Bylaw 6.8 Immediate Past President?

Ex-officio Board members are valued for their knowledge, expertise, and experience. The immediate past President’s connections to the wider community can enhance the ILCA Board’s work.

The Board supports this amendment to the outgoing President’s duties to aid with the transition of knowledge and support.

Ballot Vote No. 6: Why does the ILCA Board support all these other little edits in Bylaws 6.5 Nominations Committee and 10.2 Voting Privileges?

Any bylaw amendment, no matter how small and non-controversial, requires member vote to ratify.  There are several such changes that we have “saved up” over the years, awaiting the next bylaws vote, which is now, in 2020.

The ILCA Board supports changes that will correct typographical errors and provide consistency of language.

I have a question, and a few comments!

Excellent!  Please contact ILCA directly or use the comments section below to tell us what you think or to seek more information before you vote (if you are a current ILCA voting member).

Thank you for your membership, and for helping to build a better ILCA!


Mudiwah A. Kadeshe, President           

Tova Ovits, Secretary


Ten Things IBCLCs Need to Know About the Gut Microbiome

New understanding of how human milk affects the gut microbiome is helping to explain exactly how the benefits of human milk are achieved.

We hear a lot these days about the gut microbiome—and with good reason. Evidence suggests that the bacteria in our gut influence virtually every aspect of our functioning, from our stress and anxiety responses, to our metabolism and appetite, to the robustness of our immune system, to even our experience of gender and mating. And when our gut microbiome is out of balance, research suggests negative consequences can result: depression and anxiety, obesity, irritable bowel syndrome, Alzheimer’s Disease, and asthma have all been linked to microbiome disruption.

What does the gut biome have to do with breastfeeding? A lot, as it turns out. A webinar hosted by ILCA, Jarold “Tom” Johnston, DNP, CNM, IBCLC, explores that connection. Here, based on Johnston’s talk, are the 10 things lactation consultants need to know about the maternal-infant gut microbiome.

1. The microbiomes of baby and birthing parent are inextricably linked.

When a person gives birth, they pass their microbiome to their baby—first through exposure to their normal flora in the birth canal and then through their milk during breast- or chestfeeding.

2. Communication is a two-way street.

The milk ejection reflex is a muscular contraction that pushes milk out to the baby. But did you know that once the milk ejection reflex slows, muscles relax and pull baby’s saliva back in? Lactocytes respond to saliva exposure by producing particular macrophages. If the baby has been exposed to an infection, at the next feeding, he will get leukocytes and antibodies to fight that specific infection.

3. Colostrum is not really food.

You read that correctly! Babies get very few calories at the breast during the first 48 hours, because the calories in colostrum are not intended for digestion. They come from immune cells, designed to populate the immune system. Rather than thinking of colostrum as calories, think of it as an immune system transfer.

4. Breastmilk sugars are more than food.  

Human Milk Oligosaccharides (HMOs) play a key role in developing the infant’s gut microbiome. Human milk contains more than 100 types of HMOs. (In contrast, cows’ milk contains only two.) Each HMO has a specific benefit for the infant’s gut microbiome. Some are prebiotics, acting to increase good bacteria in the gut. Others block the attachment of invading viruses and bacteria like RSV and e.coli by providing harmless “decoy” attachment sites. Another type coats the baby’s gastrointestinal tract, preventing pathogens from sticking.  But none of them are digested by baby as carbohydrates until the baby is more than four months old.

5. A breasted baby’s gut microbiome is optimized for nutrition delivery.

The breastfed infant’s gut contains a specialized group of bacteria known as the phosphotransferase system. This system transports lactose and makes it available for use. Breastfed babies have higher levels of phosphotransferase then formula-fed babies. This means breastfed babies can access the maximum amount of energy available in their breastmilk. This ensures a constant source of carbohydrate for the developing, glucose-dependent brain.

Breastfed babies have higher numbers of gut bacteria that produce Vitamin A, B Vitamins, Vitamin K-2, and more. When they drink breastmilk, it feeds the bacteria colonies in their gut that make these micronutrients. Are you ever asked whether breastmilk contains enough iron, Vitamin K, or other nutrients? That question is misleading! Babies actually do not “get” these important micronutrients from the breastmilk they drink; what they get from breastmilk are the ingredients to feed a microbiome that can synthesize these micronutrients.

6. There are “bonus” calories in breastmilk.

Epithelial cells in human milk (formerly thought to be dead) are actually alive, active, and functional. They form clusters (called mammospheres) in the baby’s gut and continue to make more milk! This means that for every calorie of breastmilk a baby takes in, he gets bonus calories as the epithelial cells continue to generate milk inside his gut.

7. Exclusively breastfed babies have “less mature” gut microbiomes, and that is a good thing.

At birth, babies have very different proportions of specific bacteria in their gut microbiome compared to their birthing parent’s. Over the first 12 months of life, the baby’s microbiome shifts to strongly resemble the birthing parent’s. However, this shift is accelerated by the introduction of formula or the feeding of solid foods. As soon as the baby ingests anything other than human milk, the gut microbiome changes rapidly, and it does not go back. This may explain why formula fed infants experience more auto-immune and infectious illness.

8. Birth interventions affect the microbiome.

Cesarean section birth reduces microorganism exposure. While infants born via vaginal birth show 135 of their mother’s 187 bacteria strains after birth, infants born via surgical delivery show only 55. Antibiotics given to Group Beta-Strep-positive parents during birth also have an effect, since they wipe out good flora in the birth canal. Exactly how these interventions affect long-term health is not yet clear, but continuing to think carefully about birth interventions is key.

9. What about special situations?

Many of the mechanisms of microbiome transfer rely on birth and direct feeding. What about parents who exclusively pump, rely on donor milk, or induce lactation for an adopted baby? Exclusive pumping and the use of donor milk both impact the microbiome to some extent. Pasteurization of donor milk inactivates some of the living organisms in human milk, and exclusive pumping does not allow for the two-way communication discussed earlier where baby’s saliva is taken into the breast and informs lactocytes of the baby’s specific infection exposure. However, as you address parents’ concerns, what the science tells us now is that receiving human milk is more important than how it is the baby receives the milk.

10. Microbiome science is only a baby itself.

According to Johnston, it is important to remember that our understanding of the gut microbiome is just getting started. There is a long way to go, and much more to learn. However, for those of us who work with lactating families, the exciting news is: Understanding how the unique components of human milk interact with the infant’s gut organisms is helping us begin to understand how those benefits occur—they operate through the microbiome.

Want to learn more? ILCA members, access the entire webinar here. Not a member yet? Learn more about how you can access this and other continuing education at ILCA here.


Six Tips For Preparing To Breastfeed

Your baby has not yet arrived, but you know you plan to breast- or chestfeed. What are the best ways to prepare? Below, International Board Certified Lactation Consultants® (IBCLCs®) share six top tips on how to get ready for the journey ahead. Taking these steps now will maximize your chances of meeting your breastfeeding goals.

Spend time with someone who is breastfeeding.

There is no substitute for seeing the process up close and personal before your baby arrives. “Go and see and be around other nursing mothers,” advises Roxanna Farnsworth, IBCLC. Look in your circle of friends and family for parents with nursing babies who may be willing to share their experience. Or, seek out a local mother-to-mother breastfeeding group—they welcome pregnant and prospective parents, and you will see lots of babies breastfeeding.

Know what normal looks like.

Misconceptions about infant feeding and sleep are common. If you expect your baby to sleep long stretches and eat every three hours, you may panic when he or she does not conform to this idea. You may worry that your baby is not getting enough milk or that there is some other problem. Healthy newborn babies nurse a lot, and unpredictably. It is important to know what to expect. “Focus on learning about what normal newborn breastfeeding behaviors are!” says Lynette Beard, IBCLC. “They are very different from that beautiful five-month-old you may have seen breastfeeding.”

Engage your partner.

Research shows that the messages we get from those close to us dramatically impact our confidence in our ability to breastfeed. If you have a partner, take the time before your baby arrives to seek their support. “Talk to your partner about what breastfeeding means to you and what you think might be helpful from them (and not),” suggests Farnsworth. “Often the partner (if one is involved) says or does things that hurt the breastfeeding person without realizing it. In my class, we practice how the partner can share and show love by asking what the mom needs in the moment (versus giving advice or dismissive comments).”

Learn the basics.

While birth classes may be your major focus leading up to your baby’s arrival, set aside some time to educate yourself about breastfeeding. Gaining knowledge will boost your confidence. “My advice? Take a prenatal breastfeeding class and set up a prenatal consult with an IBCLC if you can,” Bryna Sampey, IBCLC, says. One key skill to learn: hand expression. “Learn and practice hand expression so you can get good at it by the time you need it,” Sampey adds. “It is really beneficial.”

Protect the first hours.

Once your baby is in your arms, plan for breastfeeding to be your only priority for the first hours of life. As tempting as it is to invite friends and family to hold and admire the new arrival, this is a critical time for privacy. “Ask about your hospital or birth center’s policy on skin-to-skin and the hours [immediately] after birth,” recommends Chasta Carson Hite, IBCLC. “Plan for uninterrupted skin-to-skin and breastfeeding for a minimum of one to two hours or longer if needed. Prepare your family that you will be limiting visitors during this time.”

Set up support.

Most importantly, have your lactation support team in place before you need them. Locate the names and phone numbers of local support group leaders and IBCLCs, and keep this information handy. “Having contact information of a lactation consultant and breastfeeding support in your community [will] support your personal breastfeeding goals, so you can have your best experience possible,” says Angie Hilliard, IBCLC. Preparing and educating yourself is key, but knowing you are not alone on this journey is the best peace of mind.

Find an IBCLC to help with your questions about lactation and employment or your other breastfeeding questions.

An International Board Certified Lactation Consultant® (IBCLC®) is a healthcare professional who specializes in the clinical management of breastfeeding. 

An IBCLC can reassure you when breastfeeding and lactation are going well, and provide information and support to help prevent and manage common concerns. Learn more and find an IBCLC in your community here.


How Can You Improve Outcomes By Supporting A Family’s Breastfeeding Self-Efficacy?

Self-efficacy—most of us have heard the term. Similar to self-confidence, self-efficacy is the feeling you have when you see yourself as capable of accomplishing a goal, and you are pretty certain that you can succeed.

You probably know intuitively that your client’s self-efficacy about breast- or chestfeeding is an important component of their success. But there’s numerical evidence to show that it may be even more important than we thought.

A 2017 study in the Journal of Human Lactation suggests that a person’s confidence in their breastfeeding success can have a marked impact on their actual success—and that the right interventions can significantly increase that all-important sense of self-assurance.

In the first investigation of its kind on this topic, Interventions to Improve Breastfeeding Self-Efficacy and Resultant Breastfeeding Rates: A Systematic Review and Meta-Analysis looked at the data from 11 previously published studies. Each had measured Breastfeeding Self-Efficacy (BSE), a numerical score indicating confidence, before and after breastfeeding interventions. Studies had then compared changes in BSE to breastfeeding rates at particular points postpartum.

Researchers grouped the data from the 11 studies’ control groups and intervention groups to compare results.

Overall, intervention groups had Breastfeeding Self-Efficacy scores 4.86 points higher than control groups.

But that’s not all. Researchers found that for every 1-point increase in the mean BSE score between groups, the odds of exclusive breastfeeding went up by 10 percent.

“We wanted to ask, ‘Is BSE a theory that means something for breastfeeding outcomes?” says Meredith (Merilee) Brockway, PhD, RN, IBCLC, a post-doctoral researcher at the University of Manitoba and the study’s lead author. “And the answer is yes. If we can improve a person’s BSE, we will see significantly improved breastfeeding rates.”

What is BSE?

About 20 years ago, researchers in human lactation created the term “Breastfeeding Self-Efficacy,” or BSE, to describe an individual’s degree of confidence in their ability to successfully nurse their child. A scale (the Breastfeeding Self-Efficacy Scale) was created to measure it, and was later refined to the Breastfeeding Self-Efficacy Scale Short Form, or BSES-SF. The concept has been used in many studies. However, until Brockway’s study, no one had measured whether BSE could be changed—or whether changing it enhanced breastfeeding success.

What Shapes BSE?

Some people enter their lactation journey full of confidence, some full of doubt. Most are somewhere in the middle. What creates the difference? Factors fall into four domains.

  • Previous accomplishments. Has this person breast- or chestfed before? What was that experience like?
  • Vicarious experience. Who else’s lactation journey have they seen? How did it go?
  • Verbal persuasion. Messages about the likelihood of success from important others in the person’s social sphere, like friends, family, and physicians, are key.
  • Physiological/affective status. How is the person feeling, physically and mentally? A traumatic birth, fatigue, depression, or anxiety can all effect BSE.

What Does this Mean for You?

Since BSE is an important predictor of success, how can lactation support professionals apply this concept in their work with families? Brockway has several suggestions.

Keep BSE on your radar. Remember that confidence in one’s ability, not just actual factors affecting ability, determines success.

Assess your client’s BSE. Ask questions in each of the four domains,” Brockway suggests. “What are their previous experiences? Vicarious experiences? What messages are they receiving from important others? What are they experiencing, mentally and physically, that might be impacting their confidence? If you notice red flags in a category, recognize that this client may have lower confidence in their ability to succeed, and that’s where you can augment your work for this family.”

Maintain continuity of care. Some studies the meta-analysis intervened in the hospital, others in the community, and others in both locations—with overwhelming evidence that interventions need to extend over both settings. When interventions only took place in the hospital, BSE scores only increased an average of 0.16 points. When they took place in the community after discharge, scores went up 0.84 points. But when an intervention spanned both settings, BSE jumped 5.37 points. “If you just end the work in the hospital, it is not fine,” Brockway says. “The person goes home and is on their own, and what are they to do? There has to be a transition where they keep contact. It’s very important.”

Understand How BSE Creates Success. From previous work on the concept of self-efficacy in general, we get a glimpse into why a person with higher BSE is more likely to meet their breast- or chestfeeding goals. It turns out that self-efficacy is what allows us to navigate obstacles that come up on the path to our goal. And since almost no one’s lactation journey is obstacle-free, that ability is critical to sustained success.

“When you build up someone’s BSE, you empower them,” Brockway concludes. “When you increase their self-efficacy, you launch them—you give them the eventual ability to operate successfully long-term on their own. So when that person hits an obstacle—sore nipples, a growth spurt, a sleep regression—they don’t think, ‘I’m failing at this.’ They think, ‘Okay, this is good. I can get through this, and I’m still doing well.”

Want to learn more?

ILCA members, did you know that you can earn CERPs by studying select journal articles? Learn how to get continuing education credit from this article here.

Not a member yet?

Get the clinical skills you need. ILCA members can earn up to 18 continuing education credits through membership. Learn more here.


IBCLC Care Awards: Applications Now Open

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 13 January 2020 through 14 February 2020. Please contact us at 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.


Top 10 JHL Posts of 2019

On topics ranging from addressing disparities to trends in research on human milk exchange, our community tapped into the top-accessed resources of Journal of Human Lactation (JHL) nearly 180,000 times last year.

As we wrap up 2019, we compiled this list of the year’s top ten most accessed JHL articles. Planning on using research to guide your practice? Your ILCA membership ensures a full year’s access to the next year’s content, along with online, on-demand searchable access to the full database of JHL research to find the evidence you need. Not a member or time for you to renew? Click here to join or renew your membership now.

#10 Critical Review of Theory Use in Breastfeeding Interventions

Yeon K. Bai, Soyoung Lee, Kaitlin Overgaard

#9 A Critical Review of Instruments Measuring Breastfeeding Attitudes, Knowledge, and Social Support

Corrine S. Casal, Ann Lei, Sera L. Young, Emily L. Tuthill

#8 Does Truthful Advertising Ever Pass “The Smell Test” in a Peer-Reviewed Journal?

Elizabeth C. Brooks

#7 Reflexivity in Qualitative Research

Joan E. Dodgson

#6 Current Trends in Research on Human Milk Exchange for Infant Feeding

Aunchalee E. L. Palmquist, Maryanne T. Perrin, Diana Cassar-Uhl, Karleen D. Gribble, Angela B. Bond, Tanya Cassidy

#5 Breastfeeding Support Interventions by International Board Certified Lactation Consultants: A Systemic Review and Meta-Analysis

Ellen M. Chetwynd, Heather M. Wasser, Charles Poole

#4 An Integrated Analysis of Maternal-Infant Sleep, Breastfeeding, and Sudden Infant Death Syndrome Research Supporting a Balanced Discourse

Kathleen A. Marinelli, Helen L. Ball, James J. McKenna, Peter S. Blair

#3 Feasibility and Acceptability of Metformin to Augment Low Milk Supply: A Pilot Randomized Controlled Trial

Laurie Nommsen-Rivers, Amy Thompson, Sarah Riddle, Laura Ward, Erin Wagner, Eileen King

#2 Breastfeeding in the Community: Sharing Stories on Implementations That Work

Sheree Holmes Keitt, Harumi Reis-Reilly, Nikia Fuller-Sankofa, Margaret Carr

#1 Breastfeeding in the Community: Addressing Disparities Through Policy, Systems, and Environmental Changes Interventions

Harumi Reis-Reilly, Nikia Fuller-Sankofa, Calondra Tibbs

Editors Note: As originally posted, some authors were listed in the incorrect order. This post was edited on 16 January 2020 to list the authors in order as published in the Journal of Human Lactation.


Fighting Cross-Marketing of “Follow-up” Milks

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

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

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

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

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

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

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

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

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

Thank you to Maryse for your significant efforts. 


Call for Papers: State of the Science August 2020 Issue

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

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

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

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

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

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

Find JHL Author Directions here.

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


Understanding ILCA’s Advocacy Strategy

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

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

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

Our overarching goals

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

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

Target areas in breastfeeding and skilled lactation care

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

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

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

  • Implement BFHI
  • Implement the Code
  • Family Friendly Policies

For skilled lactation professionals, ILCA advocates for:

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

ILCA represents you when it matters most

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

Engagement is key to advocacy success

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

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


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