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#ILCA15: Introducing CMEs and Expanding Our Continuing Education Opportunities

ILCAConferencemainimage

*** Don’t forget: early bird deadline is 15 May! ***

You’ve told us that the continuing education opportunities are the PRIMARY reason you attend our annual conferences. Each year, we provide a wide variety of high quality, evidence-based presentations for you to learn new clinical techniques, absorb fresh methods of communicating, and prepare you for embracing new ways of thinking.

This year, in addition to providing 22.5 CERPS, we have also applied for Continuing Medical Education (CME) credits. This is exciting news, because it will, once again, allow us to greatly expand our reach and provide education to a wider variety of health care providers – those who are impacting the experiences of breastfeeding families all over the world! Now,  physicians, physician assistants, nurse practitioners, and midwives can also receive their much needed continuing education at our annual conference.

Please help us share evidence-based information about breastfeeding with these critical audiences – please invite them to #ILCA15!

To learn more about the 2015 ILCA conference or to register, click the register now button: 

RegisterNow

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Addressing Inequity: An Interview with Cathy Carothers

Copy of Journal of Human LactationHere at Lactation Matters and on ILCA’s social media, we have received many questions about last year’s Lactation Summit and the ongoing efforts to remove barriers to the International Board Certified Lactation Consultant® (IBCLC®) profession. We asked Cathy Carothers, BLA, IBCLC, FILCA, the current chair of the Lactation Consultant Equity Initiative, to catch us up on where the initiative has been and what to expect next.

Lactation Matters (LM): Last year’s Summit resulted in a powerful report highlighting some of the barriers to the IBCLC profession experienced by people around the globe. What feedback have you received from that report?

Cathy Carothers (CC): We are VERY excited and gratified by the incredible interest that has been generated as a result of the 2014 Lactation Summit. First of all, we were thrilled over the fantastic attendance, the enthusiasm, and the passion that people brought to the event, and the genuine care and concern by individuals and organizations that are committed to making the profession more accessible. As the Summary Report shows, there are definitely MANY barriers to address, and these barriers result in inequities that make it challenging, if not impossible, for many to access the lactation consultant profession. There is also still much to learn, especially in countries where English is not spoken. While it sometimes feels a little overwhelming to think about how big the needs are, we are, nonetheless very encouraged by the strong interest, and are confident that we WILL find solutions when we work together.

LM: As the result of that feedback,  I understand a much different kind of event is happening this July. Can you tell us a bit about it?

CC: Sure. One of the recommendations from the 2014 Summit articulated in the Summary Report was the profound need for training for members of our profession. This is indeed a journey and a process, and most of us are all at very different places along that path. The former summit design team felt strongly that the next step in this continuing process of discovery and action was to host a seminar to better inform members of the profession about the nature of inequity and how individuals can serve as change agents within their organizations and communities.

We asked a subgroup, exclusively comprised of members of underrepresented communities, to identify goals, speakers, and plans for this event. This subgroup has done an outstanding job identifying key learning needs and a plan for the day to move this work forward. The seminar is free, to enable as many as possible to participate within the limits of the space we have. We are also exploring recording the day to make access to the sessions available after the event for those unable to travel to D.C. The seminar is one continuing step in a larger process that will continue the listening and action planning. For example, the group is addressing other methods, beyond the seminar, to engage the larger global community, such as web-based listening and interactive sessions in the native languages of listeners.

LM: I know the original design team formed to plan the Summit has evolved to respond to what was learned in that report. Can you tell me how that group has changed?

CC: The original 2014 Lactation Summit was hosted jointly by three organizations – International Board of Lactation Consultant Examiners® (IBLCE®), International Lactation Consultant Association® (ILCA®), and Lactation Education Accreditation and Approval Review Committee (LEAARC). A design team comprised of representatives from several racial/ethnic groups and countries was formed to plan and execute an event that would facilitate listening and learn the breadth of issues impacting access to the profession.

We learned a lot! The Summit showed us that the magnitude of this work exceeds what can be accomplished by a single event or by any one organization. The needs are great. And the work is big and complex. So what began as a single event has now evolved into a much broader initiative, requiring many more individuals and organizations who are willing to work collaboratively to creatively address barriers. Some of the identified barriers can only be addressed by one or more of these three organizations. Many other barriers will best be addressed through the collaborative work of many individuals and organizations that can bring resources, solutions, and ideas to bear. For example, addressing the issue of lack of jobs for IBCLCs cannot be handled by a single organization. This will truly require a collective approach and many different strategies based on country and potential job settings!

We are SO thankful for the vision of the three original host organizations that set the stage for this important work to begin and provided seed resources to launch it. As a result, each has begun internal conversations to consider the recommendations of the Summary Report. Some changes are already underway! The three organizations are also working as important collaborative partners in the restructured Lactation Equity Action Team to explore how we can collectively address these larger issues facing the profession. The team is also exploring ways to equip individual lactation consultants to become change agents within their communities.

I am truly excited about the continuing evolution of this important coalition! The 30th anniversary celebration of the profession is rapidly approaching. There’s no better time to celebrate our past and to work toward a future that includes our full cultural and geographic diversity! Henry Ford once said, “Coming together is a beginning; keeping together is progress; working together is success.”

LM: If someone wanted to get involved in the Lactation Equity Action Team, how would they do so? What sort of help is needed right now?

CC: We welcome anyone who would like to participate! There is clearly much work to do, and we would welcome those who wish to contribute their time and ideas. The Lactation Equity Action Team is examining a process to assure that the coalition includes a just and effective proportion of global and racial/ethnic perspectives. There are many opportunities to get involved for anyone who is interested.

  • Learn about the issues! The ILCA website Lactation Consultant Equity page has numerous opportunities to learn more. Be sure to scroll down to the bottom of the page to access the Suggested Reading List to read some outstanding articles about how inequities come about and can be addressed. Also, be sure to check out the February 2015 “Equity in Breastfeeding” issue of the Journal of Human Lactation, which has several outstanding articles about equity in our field. Then, use what you are learning to begin a systematic process of analyzing how institutional privilege and oppression manifests itself in your own organizations and develop and implement a strategic plan to rebuild the structure, based on your findings.¹
  • Stay informed and keep US informed! If you’d like to be on a mailing list to receive ongoing information about the lactation equity initiative, let us know! We also want to hear from YOU if you have suggestions about solutions that will address the many identified barriers.
  • Attend the Equity Action Seminar. Join us in Washington, D.C. on 21 July 2o15 for the Equity Action Seminar. If you are not able to come to Washington, D.C., check out a recording that will be made available free of charge. Pass the information along to other lactation consultants in your community, and consider implementing action steps within your hospital or organization to address issues of equity within your own community.
  • Contribute. Consider making a monetary donation to Monetary Investment for Lactation Consultant Certification (MILCC) (click here to visit MILCC). This nonprofit organization provides scholarships for IBCLC exam fees for those who are simply unable to pay the costs. Spread the word both to those who are seeking financial assistance, as well as those who are in a position to contribute. It’s a wonderful way to make a tangible difference in reducing the cost barrier.
  • Volunteer. There will be many opportunities for volunteers to participate. For instance, we will be looking for individuals who would like to work with small groups to address potential solutions for the identified barriers. Also, if you live in a country where English is not the primary language, we are considering a process to engage ideas to enhance our understanding of the issues of access. Let us know if you would be willing to convene a web meeting in your country to identify additional barriers and potential solutions.
  • Share your ideas. Use this blog or go to our online feedback form to share your ideas and thoughts about next steps and what you would be willing to work on.

LM: Where do you expect the newly formed group to go from here?

CC: Forward! The process is continuing to unfold and evolve with each passing month as we learn more about the issues and the needs. There is still much to learn and much work to do in addressing the identified barriers. We want our efforts to result in a measurable improvement in areas identified as needing change. We’ll be identifying broader goals for the initiative, conducting strategy planning, and identifying the collaborative process that will enable this work to grow.

¹ Good-Mojab C. Pandora’s box is already open: answering the ongoing call to dismantle institutional oppression in the field of breastfeeding. J Hum Lact. 2015;31(1):32-35.

Cathy Carothers, BLA, IBCLC, FILCA is Co-Founder and Co-Director of Every Mother, Inc., a non-profit 501(c)3 organization dedicated to providing counseling and lactation training and resources for health professionals and the families they serve. She is also the current chair of the Lactation Consultant Equity Initiative.

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Gathering More Voices: The Other Perspectives Crossing Cultural and Geographic Lines Panel at the 2014 Lactation Summit

Cross-Cultural PanelThe 2014 Lactation Summit was designed to listen and learn from the missing voices of the profession so that strategies for dismantling institutional oppression within the profession can be developed.

Much was learned from the 2014 Summit, but there is still listening to be done. Over the next few weeks, Lactation Matters will be breaking out the Summit findings from each community that spoke at the Summit. Our goal is two-fold: to shine a brighter light on the concerns raised in each session, and to solicit other voices who were not present at the Summit.

The 2014 Summit was the result of a year-long planning effort by a 22-member design team made up of diverse representatives from seven countries of the world. It was hosted jointly by International Board of Lactation Consultant Examiners® (IBLCE®), International Lactation Consultant Association® (ILCA®), and Lactation Education Accreditation and Approval Review Committee (LEAARC).

The design team recommended a structure to hear from 26 individuals representing the following categories:

  • African Americans in the U.S.
  • Hispanics in the U.S.
  • Native Americans in the U.S.
  • North and South America
  • Asia Pacific
  • Russia and Europe
  • Communities that cross geographic and ethnic lines (males, lay breastfeeding support groups, those working in remote regions of the world, and the LGBTQI community)

While there are specific barriers unique to various racial, ethnic, geographic, and other groups, several general themes emerged that were common to many of the groups. These findings will help guide future discussions and action plans needed to dismantle institutional oppression.

The following is a summary of the assessments made by individuals representing the panel on Other Perspectives Crossing Cultural and Geographic Lines. Read our other posts on the assessments made by individuals representing the panels on African Americans in the U.S., Native Americans in the U.S., Hispanics in the U.S., North and South America, Asia Pacific, and Europe and Russia. To access information on all of the panels presented, read a complete summary of the report here.

In future posts, we will be highlighting the assessments made by other communities in the order they were presented in the Summary Report.

We hope that, after reading, you will consider sharing your comments, ideas, and suggested solutions. Please click here to offer your input.

Other Perspectives Crossing Cultural and Geographic Lines

A general panel addressed other important perspectives that are not unique to particular cultural, racial, and ethnic groups or countries/regions of the world.

LGBTQI Community
The lesbian, gay, bisexual, transgender, queer, questioning, intersex (LGBTQI) community is present in all communities of the world. However, acceptance is far from universal and affects how “out” or visible LGBTQI people can be. Non-acceptance such as social stigma and the lack of recognition, legal rights and protection, etc. can lead people to hide their sexual orientation (and relationship or family make-up) and/or their gender identity, due to fear of repercussions, including violence.

The diverse members of the LGBTQI community may have intersectional identities, so they will suffer discrimination in different and layered ways. For example, gay and lesbian members of the community may suffer less discrimination than transgender and bisexual individuals. LGBTQI people of color face complex layers of discrimination. Transgender people of color have been described in the literature as the most oppressed group in the United States.

Legislation still restricts activities of LGBTQI people worldwide. For example, one U.S. state (Arizona) recently proposed legislation that, if passed, would have allowed businesses to refuse to serve people from the LGBTQI community. Rampant discrimination, often under the guise of religious beliefs, has resulted in high stress levels, higher rates of breast and ovarian cancer, substandard health care, and refusal to be provided health care. Many families report they do not want to receive lactation care from a LGBTQI provider. Lack of knowledge among members of the profession about the needs and issues of the LGBTQI community are a confounding factor, making it more difficult to provide mentorship opportunities. Lactation texts and exam preparation materials barely acknowledge the existence of LGBTQI people.

Lay Breastfeeding Support Counselors
Although the lactation profession had its earliest beginnings in the lay breastfeeding support movement, the profession has taken on more clinical approaches through the years. Individuals representing the lay breastfeeding support field identified difficulties for peer support counselors to access mentors and afford clinical education opportunities. Several reported that the U.S. Special Supplemental Nutrition Program for Women, Infants and Children (WIC), which supports a robust peer support program nationwide, does not encourage advancement of peer counselors to IBCLC positions, and many local WIC agencies do not provide positions or funding for peer counselors who become IBCLCs. Many also reported that they do not feel “wanted” by the lactation profession. They desperately seek recognition and support.

Remote Regions of the World
Many aspiring lactation consultants live in remote regions of the world and find it extremely challenging to access education, clinical experience, and resources. Transportation can be challenging and costly. Lack of community resources often means that few IBCLCs are available.

Male Lactation Consultants
Men comprise an extremely small proportion of the total numbers of IBCLCs worldwide. Major barriers include lack of acceptance among primarily female supervisors and directors, lack of male-friendly environments in health clinics and hospitals, and a feeling that males are not welcomed in the mostly female lactation consultant profession. For example, most lay breastfeeding support organizations completely exclude males. Even when infants are born, health providers tend to ignore the father, focusing most of the care and attention to the mother. The sense of feeling “invisible” causes many men to feel the lactation consultant profession is not for them.

We welcome your comments, ideas, and suggested solutions. Please click here to offer your input.

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Gathering More Voices: The Europe and Russia Panel at the 2014 Lactation Summit

Europe PanelThe 2014 Lactation Summit was designed to listen and learn from the missing voices of the profession so that strategies for dismantling institutional oppression within the profession can be developed.

Much was learned from the 2014 Summit, but there is still listening to be done. Over the next few weeks, Lactation Matters will be breaking out the Summit findings from each community that spoke at the Summit. Our goal is two-fold: to shine a brighter light on the concerns raised in each session, and to solicit other voices who were not present at the Summit.

The 2014 Summit was the result of a year-long planning effort by a 22-member design team made up of diverse representatives from seven countries of the world. It was hosted jointly by International Board of Lactation Consultant Examiners® (IBLCE®), International Lactation Consultant Association® (ILCA®), and Lactation Education Accreditation and Approval Review Committee (LEAARC).

The design team recommended a structure to hear from 26 individuals representing the following categories:

  • African Americans in the U.S.
  • Hispanics in the U.S.
  • Native Americans in the U.S.
  • North and South America
  • Asia Pacific
  • Russia and Europe
  • Communities that cross geographic and ethnic lines (males, lay breastfeeding support groups, those working in remote regions of the world, and the LGBTQI community)

While there are specific barriers unique to various racial, ethnic, geographic, and other groups, several general themes emerged that were common to many of the groups. These findings will help guide future discussions and action plans needed to dismantle institutional oppression.

The following is a summary of the assessments made by individuals representing the panel on Europe and Russia . Read our other posts on the assessments made by individuals representing the panels on African Americans in the U.S., Native Americans in the U.S., Hispanics in the U.S., North and South America, and Asia Pacific. To access information on all of the panels presented, read a complete summary of the report here.

In future posts, we will be highlighting the assessments made by other communities in the order they were presented in the Summary Report.

We hope that, after reading, you will consider sharing your comments, ideas, and suggested solutions. Please click here to offer your input.

Europe and Russia

The panel addressing issues in Europe and Russia noted that the three lactation organizations must be committed to truly being international. The processes to establish the profession and maintain it reflect the lens of the United States, and do not play out as intended in many countries of the world. Some of the significant issues addressed include:

  • Few number of IBCLCs – creates challenges in Russia and Europe. In Russia, where there are 146 million people, there are only 10 IBCLCs. In Italy, where there are 60 million people, there are only 198 IBCLCs. In Latvia, a country of 2.1 million, there are 3 IBCLCs. In Ireland, with 4.6 million people, there are 167. When the numbers are small, it is harder to promote the profession and access appropriate education and clinical mentorship opportunities.
  • The size of Russia – with 10 time zones within the borders of the country, access to education and clinical requirements is an uphill battle for aspiring IBCLCs.
  • Few resources and training opportunities – are available in the Russian language. Currently only those who also speak English are able to take the exam as it is not yet translated into Russian or many other languages. Also, there are no educational materials in Russian; candidates must call sites with English-speaking operators to register for the exam.
  • Only 13 of the 24 official languages approved by the European Union – are listed on the IBLCE website and only some information is translated; most key documents are not. ILCA has even fewer resources available in appropriate languages. English is spoken by around 50% of the peoples in Europe. Although many Europeans speak more than one language, English may not be one of them, or their understanding may be only at VERY basic levels. This is a significant issue since key documents and resources related to the exam are not available in the languages needed.
  • Financial costs – in Russia, the dollar to ruble exchange is currently 1 to 50, where it was 1 to 33 before. That means the cost for preparing for and taking the IBCLC exam has become much less affordable. There are similar concerns in European countries, as well.
  • Eligibility requirements – have affected many prospective IBCLCs. The required coursework is not readily available as individual courses, or affordable in Europe, and many online opportunities are available only in English.
  • Access to education and training resources – in the appropriate language and at an affordable cost remains an ongoing challenge. This affects not only initial entrance to the profession, but also maintenance of the certification once it is attained. Many Europeans and Russians do not own credit cards, making it difficult to access online education such as webinars, and exchange rates can make overseas learning prohibitive, especially for Eastern Europeans. One 100-hour breastfeeding course has been developed in Russia for web-based learning to address these issues.
  • Pathways are limited in Europe. Pathway 1 is effectively limited to health care professionals due to unavailability of individual university courses and limited range of required lactation education courses. There are no Pathway 2 programs, and mentorship through Pathway 3 is limited due to lack of mentors. This effectively blocks non-health care professionals, including experienced lay breastfeeding support counselors, from accessing the exam.
  • The IBCLC is not yet a recognizable profession in Russia – There is a certain mistrust that the profession is coming from western societies with certain rules and regulations that are not appropriate to other countries.
  • Making a living as an IBCLC – is rare in Europe. Many aspiring lactation consultants question whether navigating the significant obstacles is worth the cost and effort if they cannot support themselves or their families with a job in the field.

We welcome your comments, ideas, and suggested solutions. Please click here to offer your input.

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ILCA Elections: Board of Directors, Bylaws, JHL Article of the Year

ILCALogo_full_text (2)This week, the ILCA Board of Directors presented a ballot asking ILCA voting members to vote for the following:

  • Board of Directors elections;
  • 2015 Bylaws changes; and
  • JHL Article of the year.

All IBCLC ILCA members, in good standing, should have received an email from ILCA on 9 April 2015 containing a link to the ballot. If you did not receive an email and you should have, please contact the ILCA Office at info@ilca.org (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.

To ensure a timely and secure election, all voting will take place through an online survey.

Prior to casting a vote, all voting ILCA members are encouraged to thoughtfully consider all information provided below. This will enable you to make an informed decision.

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

The balloting commences 9 April 2015 and concludes 9 May 2015, at which time all electronic votes will be tallied by the ILCA staff.

Board of Director Elections

On behalf of the Board of Directors, we are pleased to present the 2015 ballot for election of Directors.

This slate of candidates for the Director of Membership & Affiliate Services position was presented to the ILCA Board of Directors by the ILCA Nominating Committee. After thorough review and analysis, the slate was approved as submitted.

The Director must now be elected by a majority of ILCA voting members. (Note: ILCA Bylaw 3.4 confers voting privileges to those dues-paying ILCA members who are also IBCLC certificants.)

Please take time to review the profiles of each nominee (click here) prior to casting your vote.

The ILCA Board extends a special thanks to the Nominations Committee for their efforts on behalf of the entire membership.

2015 Bylaws Changes

The ILCA Board of Directors supports the proposed changes.

The specific changes are summarized below or can be viewed in this revised bylaws document, (click here) edited with “tracked changes,” letting you compare the old version with the new.

Changes include revisions to the ILCA board makeup, size and term limits.

  • ILCA Board Members To Be Selected By Membership Vote

Change: In the proposed bylaws, all reference to Tier 1 Partner Affiliates Board Members has been removed.

Rationale: This wording was initially added to the Bylaws to accommodate the planned restructuring of the ILCA Board of Directors incorporating Tier 1 Affiliates. This restructuring was contingent upon the adoption of new affiliate agreements, which incorporated “bundled” or common membership among ILCA and the affiliate. The joint decision by ILCA and the former Partner affiliates to abandon this strategy and to “unbundle” membership voids the previous rationale.

The bylaws as currently written state that each Partner Affiliate (defined as separate organizations with an independent Board of Directors and governance, 100% of whose members are required jointly to be members of both ILCA and the Partner) will appoint or elect one board member.

As the condition of bundled membership has been removed, this structure no longer reflects the reality of ILCA leadership. The ILCA board proposes that all positions be filled by an election of its members.

 The proposed changes do not prevent board members of other organizations from entering board elections. Candidates for election are encouraged to share their qualifications to serve, which may include their active involvement in IBCLC and breastfeeding advocacy around the globe.

 These changes allow ILCA to more accurately reflect both the current reality of its structure and the needs of members worldwide.

  •  Reduction in board size

Change: The board will have no less than three and no more than nine members.

Rationale: A smaller board is proposed for two reasons.

The provision allowing for more board members was added last year to accommodate the addition of Tier 1 Partner Affiliates. This provision is no longer applicable.

A smaller board also makes organizational sense, as smaller boards tend to have lower costs while increasing levels of participation and generating higher quality decision-making.

  • Presidential Term Limit Clarification

Change: Provisions have been added to clarify that the second term of a member selected for the position of President may be extended up to two additional years to fulfill the term of President.

Rationale: Without this provision, many experienced Board Members (those selected for a second term) would be ineligible due to term limits. This is formal recognition of the current practice.

Best JHL Article of the Year (2014)

As in years past, you are also invited to cast one vote for the Best Article appearing in the 2014 issues of the Journal of Human Lactation. Click here for a complete list of articles published in a 2014 issue of the Journal of Human Lactation. 

Please learn all you can and join the conversation!

Can I discuss this with my colleagues before I vote?

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

The Balloting Process

The balloting concludes 9 May 2015, at which time all electronic votes will be tallied by the ILCA office.

Questions? Comments? Share them here!

We want to hear from you.

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Gathering More Voices: The Asia Pacific Panel at the 2014 Lactation Summit

8The 2014 Lactation Summit was designed to listen and learn from the missing voices of the profession so that strategies for dismantling institutional oppression within the profession can be developed.

Much was learned from the 2014 Summit, but there is still listening to be done. Over the next few weeks, Lactation Matters will be breaking out the Summit findings from each community that spoke at the Summit. Our goal is two-fold: to shine a brighter light on the concerns raised in each session, and to solicit other voices who were not present at the Summit.

The 2014 Summit was the result of a year-long planning effort by a 22-member design team made up of diverse representatives from seven countries of the world. It was hosted jointly by International Board of Lactation Consultant Examiners® (IBLCE®), International Lactation Consultant Association® (ILCA®), and Lactation Education Accreditation and Approval Review Committee (LEAARC).

The design team recommended a structure to hear from 26 individuals representing the following categories:

  • African Americans in the U.S.
  • Hispanics in the U.S.
  • Native Americans in the U.S.
  • North and South America
  • Asia Pacific
  • Russia and Europe
  • Communities that cross geographic and ethnic lines (males, lay breastfeeding support groups, those working in remote regions of the world, and the LGBTQI community)

While there are specific barriers unique to various racial, ethnic, geographic, and other groups, several general themes emerged that were common to many of the groups. These findings will help guide future discussions and action plans needed to dismantle institutional oppression.

The following is a summary of the assessments made by individuals representing the panel on Asia Pacific. Read our other posts on the assessments made by individuals representing the panels on African Americans in the U.S., Native Americans in the U.S., Hispanics in the U.S., and North and South America. To access information on all of the panels presented, read a complete summary of the report here.

In future posts, we will be highlighting the assessments made by other communities in the order they were presented in the Summary Report.

We hope that, after reading, you will consider sharing your comments, ideas, and suggested solutions. Please click here to offer your input.

Asia Pacific – Japan, China, New Zealand, Australia

As in many other parts of the world, the needs and issues of both predominant and underrepresented communities vary throughout the Asia Pacific region. While enormous strides have been made to advance the lactation profession in this region of the world, access to the profession is difficult even for dominant cultures and those with socioeconomic resources. Inequities experienced by underrepresented aboriginal, Maori, and Chinese communities make access even more difficult.

Australia
It was noted that 240 years ago the population of Australia was mostly aboriginal. Today, 95% of the population of Australia consists of immigrants or descendants of immigrants. The cultural diversity throughout the country and large distances between communities means that lactation education must be taken to the people. While there are more than 1,000 IBCLCs in Australia, significant barriers abound, including:

  • Distance, transportation and cost – are barriers to acquiring required lactation education and clinical instruction.
  • Fears — that the IBCLC exam is too hard or difficult to attain.
  • Discrimination against aboriginal populations – make inequities an ongoing reality and concern.

China
Significant barriers to the profession exist in China. Despite the large geographic size and population of the country, only a small handful of IBCLCs exist there. This represents both a challenge and an opportunity. Common barriers identified include:

  • Language barriers – exist, with no comprehensive breastfeeding education texts in Chinese. This makes it virtually impossible to advance the profession in culturally appropriate ways unless people also speak English.
  • Education and exam costs – are prohibitive. In China, health care providers are not paid at levels similar to those in the United States.
  • Lack of educational opportunities – result in breastfeeding education not being readily available for health providers. This means it is also not available for aspiring IBCLCs.
  • Low numbers of IBCLCs – create a noticeable gap in professionals who can provide training and mentorship opportunities. Lack of knowledge about the IBCLC profession makes it hard for others to understand and accept it.
  • Enormous strides – have been made in a relatively short period of time. Over 200 peer counselors have been trained, and this core group is now energized to want to become IBCLCs. Another avenue for outreach is the field of mother-infant care specialists who provide breast massages, the only certificate that the government of China has issued. IBLCE has now included a simplified Chinese section to the IBLCE website, and a Chinese blog on lactation now has nearly a million followers from across the country. An online chat group has begun purchasing English texts and each member of the study group translates a portion of the book and then shares what they learned to help one another prepare for the IBCLC exam.
  • Resources and education – are desperately needed for Chinese IBCLC candidates. These aspiring IBCLCs need books and educational resources in Chinese, online training opportunities in Chinese, and opportunities in hospitals and private practices to acquire clinical experience hours. In addition, the IBCLC exam needs to be translated into Simplified Chinese in order for more people to be able to sit the exam. Lactation consultants from other countries are welcomed in China to provide training and assist in the growth of the profession.

Japan
Japan experienced phenomenal growth in the lactation profession from 1995 when the first IBCLC was certified to 2013, when there were 891 IBCLCs in the country. Much of this rapid growth was attributed to targeted outreach. Nonetheless, significant barriers make expanding the profession quite difficult.

  • Heavy reliance on the profession grounded in the medical field – makes it more difficult for others to feel welcomed into the profession. The majority of current IBCLCs in Japan are also midwives or nurses; 11% are also physicians.
  • Recertification – is a significant barrier for current IBCLCs. The time, energy, and cost required for continuing education are significant. The value of having become IBCLC certified is not always appreciated among current members of the profession in the country.
  • Exam entrance requirements – are difficult. The health science education required is expensive and difficult to locate and access. Many resources and training programs, including online programs, are not available in Japanese.
  • Significant language barriers – exist in Japan, making it difficult for many members of the community to access the education required. This is of special significance for minorities in Japan who often do not speak English and lack literacy in Japanese, as well. Internal communications remain a challenge in Japan.

New Zealand
In New Zealand significant issues exist with regard to the monetary exchange rate, which often makes it impossible to access U.S. based lactation courses, ILCA membership, and other resources. The Maori are the largest native community within New Zealand, yet they are not well represented in the profession of IBCLCs. High rates of teen pregnancy and lack of access to traditional resources, including basic Internet access, pose additional challenges.

We welcome your comments, ideas, and suggested solutions. Please click here to offer your input.

1

Ethical Leadership: Meeting obligations under the International Code

by ILCA Board Member Lisa Akers MS, RD, IBCLC, RLC

ILCALogo_full_text (2)Organizations of all types have shown important advancements in ethical practices over the past century, even as the challenge of providing ethical leadership while following evidence-based practice and performance standards remains unchanged. ILCA® is dedicated to promoting a climate that facilitates ethical decision-making and commitment to the profession. As such, ILCA supports the hierarchy of infant feeding as specified in the Global Strategy for Infant and Young Child Feeding (2003)[1]. Upholding the International Code of Marketing of Breast-milk Substitutes[2] and all relevant subsequent World Health Assembly resolutions (i.e. International Code) is one way in which ILCA reflects an ethical climate and positively effects decision-making. ILCA has long taken steps to ensure that it “does not invest in, nor accept funding, donations, advertising, or sponsorship from corporate entities that do not meet their obligations” under the International Code.

More recently ILCA took the seriousness of its obligations for upholding the International Code to a higher level by forming an independent panel of International Code experts in November 2013. The International Code Expert (ICE) Panel is recognized for their training and experience interpreting the International Code. The ICE Panel was first introduced through the Lactation Matter blog in June 2014 and continues to provide expert guidance to the ILCA Board behind the scenes. The ICE Panel has enabled ILCA to re-examine sponsorship relationships. Among its responsibilities, the ICE Panel has been charged with determining “whether potential commercial affiliates are meeting their obligations under the International Code.” All potential commercial affiliates are now subject to an examination process by which the ICE Panel determines if they are meeting their obligation specified by the International Code. When a commercial affiliate is determined to not be meeting their obligation, the ICE Panel provides feedback to the organization on meeting International Code standards.

While the ICE Panel recognizes that mothers choose to use feeding bottles or other devices to give their expressed milk to their babies, this is not the same as direct breastfeeding and is specifically addressed in the Global Strategy. When there are clinical or medical problems that temporarily or permanently prevent direct breastfeeding, alternative feeding devices are clinically appropriate and instruction in their use should be taught by healthcare professionals (International Code Article 4). ILCA supports one-to-one instruction from the IBCLC® and health professionals[3] as the appropriate action.[4] Under its obligations of the International Code, ILCA does not support the public promotion of bottles and teats to the general public.

ILCA’s mission “to advance the International Board Certified Lactation Consultant® (IBCLC) profession worldwide through leadership, advocacy, professional development, and research” would not be realized without fostering a positive ethical climate. ILCA continually strives to uphold the International Code while remaining cost effective and considerate of the external patrons during the decision-making process. ILCA asks that members also support their obligation to the International Code through their personal interactions with mothers and commercial relationships.

[1] “The vast majority of mothers can and should breastfeed, just as the vast majority of infants can and should be breastfed. Only under exceptional circumstances can a mother’s milk be considered unsuitable for her infant. For those few health situations where infants cannot, or should not, be breastfed, the choice of the best alternative – expressed breast milk from an infant’s own mother, breast milk from a healthy wet-nurse or a human-milk bank, or a breast-milk substitute fed with a cup, which is a safer method than a feeding bottle and teat – depends on individual circumstances.” World Health Organization, & United Nations Children’s Fund. (2003). Global Strategy for Infant and Young Child Feeding (pp. 30). Geneva: World Health Organization.

[2] World Health Organization. (1981). International code of marketing of breast-milk substitutes. WHO Chron, 35(4), 112-117.

[3] World Health Organization, & United Nations Children’s Fund. (2003). Global Strategy for Infant and Young Child Feeding (pp. 30). Geneva: World Health Organization.

[4] Global Strategy, article 19.

Lisa-AkersLisa Akers is a Registered Dietitian Nutritionist (RDN) and an International Board Certified Lactation Consultant (IBCLC). She has been working in the field of public health and human lactation for over 14 years. Her current position as the State Breastfeeding Coordinator is to support and promote breastfeeding endeavors for the Commonwealth of Virginia, which includes the development of public policy and media campaigns, curricula, publications and training; oversight of the Virginia WIC Breastfeeding Peer Counselor Program; and service as the Virginia Department of Health liaison to the Virginia Breastfeeding Advisory Committee. Lisa serves as the Director of Marketing on the ILCA Board of Directors. She also serves as the Chair of the Women’s Health Dietetic Practice Group (DPG) and is the Academy of Nutrition and Dietetics’ delegate to the United States Breastfeeding Committee.

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Gathering More Voices: The North and South America Panel at the 2014 Lactation Summit

7The 2014 Lactation Summit was designed to listen and learn from the missing voices of the profession so that strategies for dismantling institutional oppression within the profession can be developed.

Much was learned from the 2014 Summit, but there is still listening to be done. Over the next few weeks, Lactation Matters will be breaking out the Summit findings from each community that spoke at the Summit. Our goal is two-fold: to shine a brighter light on the concerns raised in each session, and to solicit other voices who were not present at the Summit.

The 2014 Summit was the result of a year-long planning effort by a 22-member design team made up of diverse representatives from seven countries of the world. It was hosted jointly by International Board of Lactation Consultant Examiners® (IBLCE®), International Lactation Consultant Association® (ILCA®), and Lactation Education Accreditation and Approval Review Committee (LEAARC).

The design team recommended a structure to hear from 26 individuals representing the following categories:

  • African Americans in the U.S.
  • Hispanics in the U.S.
  • Native Americans in the U.S.
  • North and South America
  • Asia Pacific
  • Russia and Europe
  • Communities that cross geographic and ethnic lines (males, lay breastfeeding support groups, those working in remote regions of the world, and the LGBTQI community)

While there are specific barriers unique to various racial, ethnic, geographic, and other groups, several general themes emerged that were common to many of the groups. These findings will help guide future discussions and action plans needed to dismantle institutional oppression.

The following is a summary of the assessments made by individuals representing the panel on North and South America. Read our other posts on the assessments made by individuals representing the panels on African Americans in the U.S., Native Americans in the U.S., and Hispanics in the U.S.. To access information on all of the panels presented, read a complete summary of the report here.

In future posts, we will be highlighting the assessments made by other communities in the order they were presented in the Summary Report.

We hope that, after reading, you will consider sharing your comments, ideas, and suggested solutions. Please click here to offer your input.

North and South America – Canada, Mexico, South America

Many real-world stories were shared, noting similar barriers already described. Additional issues of transportation, costs, and language were noted. It should be noted that the South American representative to the Summit was unfortunately unable to attend; input from South America will be critical moving forward.

Canada
In the world’s second largest country, travel and transportation costs, as well as distance and access to appropriate resources were identified as significant barriers to accessing the profession.

  • Exam site assignments – do not always accommodate everyone. Some Canadians reported they had to take the take the exam in the United States, requiring passports and often significant travel expenses for airfare or mileage, hotel, meals, child care, and work replacement. Carpooling is often not possible as people are frequently assigned to take the exam at different sites in the U.S.
  • Language barriers – pose hardships for many aspiring lactation consultants. This is further complicated when office staff for IBLCE do not speak French, making it more challenging to register for the exam.
  • Racism – is a significant issue in Canada. For example, a painful history of killing First Nations children and outright abuse of aboriginals in Canada has resulted in continuing issues of discrimination and lack of access to appropriate health care among underrepresented groups. There is a great need for families to heal from intergenerational trauma.
  • Cultural practices – of First Nations peoples are not recognized or valued by those from the dominant culture in Canada.
  • Lack of IBCLC mentors – is a special concern within aboriginal communities. Because many aboriginals lack trust in the dominant culture, this is a significant need. Currently there is only one IBCLC in Canada from a First Nations tribe.
  • Cost and lack of jobs – are significant challenges to motivating people to become IBCLCs in Canada.

Mexico
Despite the large population of Mexico (over 20 million in Mexico City alone) there are relatively few IBCLCs (only 20). There are 67 native languages spoken in Mexico, and there are wide variances in beliefs and practices surrounding breastfeeding, with significant issues impacting the lactation profession.

  • The profession – is mostly unknown in the country. Lactation is not incorporated into medical training, and health providers are not knowledgeable about the profession.
  • Lactation knowledge – is lacking. Many health workers believe they are already lactation experts. Unified evidence-based standards are not shared between health providers, resulting in inadequate lactation care. There are few Spanish language lactation courses and continuing education programs available to educate health professionals and aspiring IBCLC candidates and help them maintain the credential.
  • Breastfeeding promotion – is challenging. Aggressive formula marketing practices have penetrated the indigenous communities in Mexico. Complementary feeding practices are not based on best practices in nutrition. While the Baby-Friendly Hospital Initiative (BFHI) is gaining momentum in the country, the public health department added 15 additional steps (for example, vaccinations) that make acquiring BFHI designation much more cumbersome and difficult to attain.
  • Time constraints and high turnover – add to issues of lack of motivation and knowledge about the profession.

We welcome your comments, ideas, and suggested solutions. Please click here to offer your input.

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#ILCA15: Register NOW for our Clinical Skills Rotations

Blog Images (1)We are excited to once again offer our popular Clinical Skills Rotations. Participants will rotate between our skill stations in each two hour session. At each station, those attending will spend 25 minutes with an expert facilitator, who will provide a demonstration and support hands-on skill practice.

Clinical Skills Rotations are available for beginning practitioners (primary session) and for seasoned consultants (advanced sessions). You may register to attend on either Wednesday, Thursday, or Friday, depending upon the skill level you select. Expanding the offerings to three days doubles the number of participants who may take advantage of this popular offering!

Attendees are asked to register for only one Clinical Skill Rotation block  to allow sufficient room for others to participate. This is a popular feature of the ILCA conference so register early if you wish to participate!

Primary Clinical Skills Rotation (available Wednesday, 22 July 10:30am – 12:30pm and Thursday, 23 July 2:45pm – 4:45pm):

  • Breast Massage Influenced by Japanese Style. (Rika Dombrowski, RN, MS, MA, IBCLC)
  • Teaching Tools for Basic Breastfeeding Skills. (Sherry Payne, MSN, RN, CNE, IBCLC, CD)
  • Three Important Rules for the Beginner IBCLC. (Barbara Wilson-Clay, BSEd, IBCLC, FILCA)
  • Case Study Review: Reducing the mother’s anxiety to accept help. (Mireya Patricia Roman, LMHC, IBCLC)

 Advanced Clinical Skills Rotation (available Wednesday, 22 July 1:30pm – 3:30pm and Friday, 23 July 3:00pm – 5:00pm):

  • Being the IBCLC Detective: Where do the clues take us? (Carole Dobrich, RN, IBCLC, RLC)
  • Powers of Deduction: Tongue kinematics in normal infant suck. (Catherine Watson Genna, BS, IBCLC)
  • Handling the Pain: Use of therapeutic breast massage for the treatment of engorgement, plugged ducts and mastitis. (Maya Bolman, RN, BA, BSN, IBCLC)
  • Choosing Supplementation Methods and Devices. (Tanefer L Camara, IBCLC, MS-HCA)

Are you looking to increase your clinical skills? Join us!

RegisterNow

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Gathering More Voices: The Hispanic Panel at the 2014 Lactation Summit

6The 2014 Lactation Summit was designed to listen and learn from the missing voices of the profession so that strategies for dismantling institutional oppression within the profession can be developed.

Much was learned from the 2014 Summit, but there is still listening to be done. Over the next few weeks, Lactation Matters will be breaking out the Summit findings from each community that spoke at the Summit. Our goal is two-fold: to shine a brighter light on the concerns raised in each session, and to solicit other voices who were not present at the Summit.

The 2014 Summit was the result of a year-long planning effort by a 22-member design team made up of diverse representatives from seven countries of the world. It was hosted jointly by International Board of Lactation Consultant Examiners® (IBLCE®), International Lactation Consultant Association® (ILCA®), and Lactation Education Accreditation and Approval Review Committee (LEAARC).

The design team recommended a structure to hear from 26 individuals representing the following categories:

  • African Americans in the U.S.
  • Hispanics in the U.S.
  • Native Americans in the U.S.
  • North and South America
  • Asia Pacific
  • Russia and Europe
  • Communities that cross geographic and ethnic lines (males, lay breastfeeding support groups, those working in remote regions of the world, and the LGBTQI community)

While there are specific barriers unique to various racial, ethnic, geographic, and other groups, several general themes emerged that were common to many of the groups. These findings will help guide future discussions and action plans needed to dismantle institutional oppression.

The following is a summary of the assessments made by individuals representing the panel on Hispanics in the U.S. Read our other posts on the assessments made by individuals representing the panel on African Americans in the U.S. and Native Americans in the U.S.. To access information on all of the panels presented, read a complete summary of the report here.

In future posts, we will be highlighting the assessments made by other communities in the order they were presented in the Summary Report.

We hope that, after reading, you will consider sharing your comments, ideas, and suggested solutions. Please click here to offer your input.

U.S. – Hispanic Panel

A multitude of barriers impact access to the lactation profession within Hispanic communities in the U.S. Although similarities were found with other groups, unique issues were noted among Hispanics in the United States.

  • Generalizations about Hispanic groups – are frequently made, clustering all groups that speak Spanish into one category of “Hispanic.” In fact, the word “Hispanic” is widely used to denote a single population group in national data, research methodologies, and general policies and programming. However, “Hispanics” are not a single group and are, instead, a diverse body of peoples from many different countries, traditions, and cultural practices. Even language variances are noted within Spanish-speaking cultures. One attendee noted, “Knowing one type of Hispanic means…knowing one type of Hispanic.”
  • Anti-immigrant/anti-Hispanic attitudes – are pervasive throughout the United States, and begin at an early age. Typical assumptions include the myth that people from Spanish-speaking countries (or for whom English is a second language) lack the education to attain the profession or cannot communicate in English and cannot perform well. These assumptions are hurtful and degrading, and result in a lack of the support that aspiring IBCLCs need to pursue the profession. Hispanic immigrants do not feel welcomed; the social, cultural and professional discomfort that many IBCLCs from the profession’s dominant culture feel about Hispanic immigrants erects barriers to their certification as IBCLCs, and to their advancement to positions of power and leadership within the IBCLC profession.
  • The immigrant experience – A fundamental lack of understanding of the immigrant experience is widespread throughout the dominant culture of the United States. The typical immigrant’s story is filled with human drama, with characteristics and qualities such as sacrifice, courage, loss, hope, tragedy, principle, fear, character, and sorrow. These qualities permeate and define every immigrant’s relationship to the U.S., its residents, and as a result, the IBCLC profession. To fail to understand this is to fail to understand immigrants.
  • Structural barriers – that keep mothers and babies from breastfeeding in traditional “Hispanic” cultural groups also keep people from becoming IBCLCs. Acculturation contributes to a significant decline in breastfeeding rates among people from Spanish-speaking countries.
  • Language barriers – are major issues in the United States among Spanish-speaking and English as a Second Language (ESL) communities. Often health providers do not know Spanish and rely on translation or interpretation services at health facilities, which are not always personal. These same language barriers make it difficult for Spanish-speaking people to access required coursework, appropriate clinical mentors, clinical hours, and continuing education.
  • Lack of knowledge – among those in the dominant culture about the educational opportunities in other countries. This lack of knowledge has led to assumptions that Spanish-speaking people are not well educated.

We welcome your comments, ideas, and suggested solutions. Please click here to offer your input.

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