Archive | World Breastfeeding Week

World Breastfeeding Week: Massachusetts, USA Hospitals Go Bag Free

By Marsha Walker, RN, IBCLC

Massachusetts is now the second state in the US, behind Rhode Island, to have had all of its maternity hospitals eliminate the practice of distributing formula company discharge bags. Ban the Bags is a campaign that began in 2006 to rid hospitals of the practice of distributing formula company discharge bags or other discharge gifts to mothers when leaving the hospital. It was started after efforts in Massachusetts failed to insert regulations regarding such a ban into our hospital perinatal regulations. Ban the Bags, the Massachusetts Breastfeeding Coalition, and the MotherBaby Summit have all encouraged hospitals to eliminate this practice through letter writing, education of hospital management at summits designed just for them, and downright shamed them into doing it in order to get off the list of hospitals we kept who continued engaging in this practice. The list of hospitals who continued to give out these bags was displayed on the MotherBaby Summit website and was placed on a large poster board and displayed annually at the Massachusetts Breastfeeding Coalition’s yearly conference. Ban the Bags answered many e-mails with suggestions, references, and approaches to help individuals get the bags removed from their hospital.

Ban the Bags found that many hospitals did not really care about the effect of formula bags on breastfeeding but responded when told that it was a breech of medical ethics, was in opposition to the hospital’s own mission and vision, and was no different than unethical arrangements with pharmaceutical companies. We encouraged people to contact their hospital Ethics Committee for an opinion on a practice that promoted the use of a potentially hazardous product and how this related to the ethical principles of “first do no harm” and the obligation of health care providers to act in the best interest of their patient. We counseled people to contact the hospital’s Corporate Compliance Department to report how these bags were a conflict of interest, especially since HIPAA defines them as a form of marketing. We recommended that people contact the hospital’s Risk Management Department to inform them that because the hospital had no stock control there was no method to contact patients who had received the bags if there was a recall of the formula. Such a recall occurred in 2006 when one company’s bags were recalled due to the defective packaging of formula inside which resulted in a vitamin C deficiency. Also, the powdered version of formula is not sterile and the hospital could be handing out and liable for a product contaminated with Chronobacter sakazakii. Mothers were never instructed by the hospital in how to safely prepare the powdered formula that they were essentially marketing for formula manufacturers. Eliminating the bags was a fairly easy way to increase the hospital’s score on the mPINC survey.

Ban the Bags advocates toss bag into the original location of the Boston Tea Party!

Hospitals were concerned that they would have to pay for formula, as the formula companies fought hard to prevent the disappearance of this lucrative and inexpensive marketing tactic. We have found that this was not actually true, as manufacturers did not remove their product from the hospital which represented essentially a captive audience. Companies know that well over 95% of mothers continue to use the brand of formula given to their infant in the hospital. Why would a formula company give up this potent marketing advantage? We heard how terrible it would be for poor mothers who could not receive this “gift.” Of course there is only enough formula in the bag for about a week or so worth of feedings, just enough to reduce a mother’s milk supply and accustom the infant to the bottle. Detractors complained that we were “forcing” mothers to breastfeed or removing their choice of infant feeding methods. Mothers decide how they wish to feed their infants well before entering the hospital. Bags have no effect on feeding decisions, they have only one purpose, which is to cause a breastfeeding mother to use formula and create a customer/market where none existed before. We have found that when hospitals remove the bags, they show up in community pediatric and obstetric offices, clinics, and even in ultrasound departments. Make sure to ask that all of these entities cease distributing formula company materials, as this works directly to counteract your efforts in the hospital.

Ban the Bags at has many helpful recommendations on approaching the elimination of this practice. I am happy to help and you can email me at

Marsha Walker is a registered nurse and international board certified lactation consultant. She maintained a large clinical practice at a major HMO in Massachusetts, is a published author and an international speaker. Consulting with hospitals, providing in-service presentations, speaking at conferences and workshops and advocating for breastfeeding at the state and federal levels occupy her professional time. She is currently a member of the board of directors of the Massachusetts Breastfeeding Coalition, Baby Friendly USA, Best for Babes Foundation, and the US Lactation Consultant Association (USLCA). She is a past president of the International Lactation Consultant Association (ILCA).


World Breastfeeding Week: Supporting Hmong Women in Sacramento, CA

In celebration of World Breastfeeding Week, Lactation Matters will post every day this week, highlighting the stories of breastfeeding in different cultures and countries.

At Lactation Matters, celebrating World Breastfeeding Week means not only highlighting breastfeeding in the many countries on earth, but also  in the individual cultures in each country.  One size does not fit all!  Today, we share an interview with Yang Her, an IBCLC working with the Community Resource Project WIC program in Sacramento, CA. She has worked tirelessly for many years to encourage and support the Hmong mothers in the community to breastfeed.

Photo by United Nations Photo via Flickr Creative Commons

The Hmong people are a group of Asian people, originally from mountainous regions of China, Vietnam, Laos, and Thailand. Many came to the United States as refugees following the communist takeover of Laos, settling primarily in Wisconsin, Minnesota and California with Sacramento being home to one of the largest populations.  Breastfeeding support that focuses on the unique cultural needs of a mother is always important.

How did you come to be an IBCLC?  What personal and/or professional experiences led you down the path? 

I had my first child, Leo, in June 1989 and was not able to breastfeed him because I didn’t have any breastfeeding education. While I was pregnant with him, there were a number of controversial of breast cancer commercials on television. 3 days after our birth, I woke up with body aches, as well as very painful and lumpy breasts.  All I could remember was what I had watched on TV and wondered if I was at risk for breast cancer!  I was scared and called my doctor right away. When I got to the doctor’s office that morning, he said not to worry and explained a bit about engorgement.  He gave me a tiny white pill (I had no clue what it was called) and told me to give Leo formula. That same day and through the night, the pain in my breasts went away slowly. By day 4, I resumed breastfeeding but Leo was fussy and pulled away from my breasts. By day 5, my breasts are soft and from that day on, my milk dried up. Leo was on formula and he didn’t tolerate it well. He would vomit with one formula or gets diarrhea or constipation with the other. I also had to return to work after 6 weeks but had to quit shortly after my return because my son was sick so often.  When I was pregnant with my 2nd child, Allen, I was determined to breastfeed and learned as much as I can about breastfeeding. I breastfed Allen for 3 1/2yrs and loved the experience and went on breastfeeding my 3rd and 4th child.

Several years later, in 994, I was a WIC participant and was recruited as a Hmong breastfeeding peer counselor.  I worked in that capacity for a year and learned that I was not the only mother that didn’t know much about breastfeeding. My passion to advocate, educate, promote, and support breastfeeding mothers grew. I continued working with WIC as a nutrition counselor as well as a breastfeeding educator. It was so rewarding that I went on to pursue my CLE in 1999 and became an IBCLC in 2005.

What are the cultural  norms of breastfeeding in the Hmong culture?  What specific challenges are there in working with this population of mothers and babies?

Photo by nikkodem via Flickr Creative Commons

Back in our homeland, almost every Hmong mother breastfeds.  The child and mother hardly separates from each other and if they do, the time is brief and the baby is fully fed before the mom goes anywhere. Mothers always carry their babies either on her chest or her back with a baby carrier.  Whenever the baby shows hunger cues, the mother would remove the baby from the carrier and breastfed, and then once the baby is content, she carries the baby again.  This is how she continues to do her daily tasks whether it’s cooking, sewing, cleaning, or farming. Hmong mothers are very creative in caring for their infants while maintaining their roles as a wife, mother, and daughter in-law. A mother can wear 20 different hats and would still be able to breastfeed her infant. There was no such thing as pumping and storing for separation periods.

Here in the USA, their roles may still be the same, however, breastfeeding their infants on demand has shifted by the fact that they are not always with their infants.  There are a number of strict cultural beliefs about pumping and milk storage that effect the ease with which breastfeeding can continue in these circumstances such as:

Food and breastmilk cannot be stored in one place. This means, a breastfeeding mother who works or in school will need to buy a new refrigerator or freezer just to store her pumped breastmilk.

Breastmilk cannot be leaked anywhere. Culturally, there is a significant risk if anyone other than her infant accidently ingests or touches her breastmilk.   The in-laws may discourage a mother from breastfeeding by telling her that if she breastfeeds, she would need to stay home because they will not take the risk of touching her pumped breastmilk.

What I have witnessed is Hmong mothers who are married to Hmong men are more likely to not breastfeed. On the flip side, Hmong mothers who are married outside of the race are more likely to breastfeed.  When I asked for their reasons, almost always, it’s the Hmong belief that prevents the mothers from breastfeeding.  The cultural beliefs is often not discussed with the mother until she decides to breastfeed. I look forward to sharing more about these beliefs in my upcoming book.

Can a Hmong LC like me make a difference providing breastfeeding education?  It is possible if I can find a solution to the Hmong belief and restriction of human milk.  I know I have a long way to go but I also believe that where there’s a well, there’s a way.  It’s a matter of time.

What is one of your most rewarding experiences as a breastfeeding professional?

One of my most rewarding moments is when a breastfeeding mother comes to her appointment feeling discouraged, sad, and in pain and walks out of my office at the end of a consult feeling confident, understood, and knows that she’s not alone in her journey to successfully breastfeeding.

Thank you, Yang Her, for the work you are doing among Hmong women!


World Breastfeeding Week: Breastfeeding in Papua New Guinea

In celebration of World Breastfeeding Week, Lactation Matters will post every day this week, highlighting the stories of breastfeeding in different cultures and countries.

Written by Jeralie Fairbanks, RN, IBCLC

In June 2012, I had the opportunity to visit Kudjip Nazarene Hospital in the Western Highlands Province of Papua New Guinea. As a lactation consultant in the United States, I was amazed at how women in Papua New Guinea breastfed and the many cultural differences surrounding infant feeding. There are many spiritual practices that interfere with the initiation of breastfeeding, however, breastfeeding is the only option for most women as formula and milk of any kind are not readily available. If women deliver in a hospital and their newborn is premature, then their newborn can receive formula. There are no breast pumps available in this part of Papua New Guinea so women hand express to feed their premature infants.

Papua New Guineans are tribal oriented, which means that the tribe raises the children. When a woman comes into the hospital for childbirth, she brings family tribe members or village wontoks (clan members) with her. After the baby is born, the family members help to care for the newborn while the mother sleeps and recovers. This entails holding the newborns, swaddling in cloth, or bringing the baby to the mom to breastfeed. Because the infant mortality rate is 43.29 deaths/1,000 live births, many do not initiate bonding with the infant out of fear that the baby might die.

The country of Papua New Guinea is approximately the size of California with a population of 7 million. Access to health care is limited and many women deliver in their village. It is one of the most culturally diverse countries with varying practices related to childbirth and breastfeeding.

While in Papua New Guinea I had the opportunity to visit a health clinic in a village. This clinic had a birthing center that had just opened. There were posters about infant growth and the importance that a baby is weighed monthly. There were, also, pictures demonstrating the importance of maternal nutrition while breastfeeding. I was pleased to see the progress since my last visit in 2008. Although a third-world country, it is progressive.

I taught at the School of Nursing in Kudjip and stressed the importance of skin-to- skin at birth and initiating breastfeeding within the first hour. The students in the School of Nursing were very receptive and interested in this and were talking with patients about what they had learned the next day in the hospital setting. It was encouraging to know that all that is needed is education to provide an improvement in outcomes.

Women in Papua New Guinea have no difficulty breastfeeding in public as that is simply what the breasts are for. Babies are carried in bilums on either the mom’s or family wontok’s back. And babies are breastfed on demand. It was exciting to be able to provide an IBCLC’s viewpoint and positively impact initiation of skin-to-skin and breastfeeding at Kudjip Nazarene Hospital.

Jeralie Fairbanks RNC, IBCLC is a Labor and Delivery Nurse at Rogue Regional Medical Center in Medford, OR where she enjoys assisting families with their first breastfeed and those first few days.  She is married and has two sons ages 12 & 9. She has a passion for missions and has had the opportunity to travel to the Nazarene Seo Company Hospital in Kudjip, Papua New Guinea twice.


World Breastfeeding Week: New Breastfeeding Bill in Israeli Parliament

In celebration of World Breastfeeding Week, Lactation Matters will post every day this week, highlighting the stories of breastfeeding in different cultures and countries.

Written by Ellen Shein, IBCLC, LLLL

Photo by Shaare Zedek Medical Center in Jerusalem (permission requested)

In 2011, a member of of the Israeli Parliament, Danny Danon,  proposed a bill for encouraging breastfeeding and limiting the activities of formula companies in the hospitals in Israel. Some of the main hospitals are government run, which means that for the past 30 years, the hospitals have had a hand in promoting the use of formula on a widespread level. Up until the present, many hospitals in Israel have received ONE KIND of infant formula for free from the major importers and manufacturers here.  Additionally, these hospitals have been paid millions of shekels for this exclusivity! Money from these companies have funded many salaries of nurses and of course has helped pay for much needed medical equipment. It is therefore, very difficult in today’s financial crunch to imagine hospitals surviving without these large sums.

These practices, of course, are in direct conflict with the directives and recommendations of the World Health Organization’s International Code of Marketing of Breastmilk Substitutes. The current bills states that hospitals will now have to purchase formula by tender and that the formula provided to mothers who choose not to breastfeed will NOT be limited to one specific brand. Statistics show that if a mother is given formula A in the hospital, she will stick with that brand.

Over the years, there have been overtures in Israel which have succeeded in preventing formula reps from handing out free samples in the hospitals, well-baby clinics and physicians’ offices. The companies have managed however to get a hold of statistics lists which include the names and addresses of new families and are still aggressively marketing their products.  This is done by making sure that each new mother receives formula samples by mail or in “gift packages” for new mothers handed out by one of the largest pharmacy chains.  Additionally, there are other private schemes which send stewardesses to the homes of 25,000 babies each year!

There is much dissention and objection to this new law. Many of the parliament members see this as an affront to women making a free choice in regards to how to feed their babies. In my opinion, the main mistake was to refer to this law as “encouraging breastfeeding” when in fact it should be about the “protection of the infant by freedom of feeding choices”. Part of the law includes a paragraph suggesting that the mother who chooses NOT TO breastfeed must sign a form stating that she is aware of the many benefits of breastfeeding yet chooses not to. This form should have nothing to do with breastfeeding and everything to do with formula feeding. Everyone knows the benefits of breastfeeding, but how many moyhers really know what those little bottles of formula are made of and what the negative outcomes can and most likely will be affecting their babies?  Many mothers have already chosen their method of feeding before arriving at the hospital and, here in Israel, we have a great track record of nearly 87 percent of all mothers initiating breastfeeding. We do not have to encourage the masses to breastfeed. What we need to do is inform those that choose NOT TO of the risks of formula feeding.

No one talks of the benefits of clean air when talking about the hazards of smoking, nor do they tiptoe around the damaging results of alcohol and drug consumption. But for some reason, no one seems to have the courage to stand up and point out the potential health risks that mothers who choose formula subject their babies to.

In early July, there was another finance committee meeting in the Knesset (Parliament) to which breastfeeding advocates were invited. There were representatives from La Leche League of Israel, the Israel Association of Certified Lactation Consultants (an ILCA affiliate) and a few other grass roots organizations. Unfortunately, we were not able to speak at this meeting, but are hopeful that this bill will ultimately be passed. It has passed a first reading, and now, it will probably wait til after the summer recess.

With a bit of language changing and letter writing, we are hopeful that most of the parts of this bill will pass. We are doubtful that the signing of any document will go through unless the Members of Knesset change the wording a bit and change the focus towards helping to improve health outcomes for babies, and not on encouraging breastfeeding.

Ellen Shein has been an IBCLC since 1987.  She began with La Leche League International and served on its Board of Directors from 2005 – 2011, representing Africa and the Middle East.  Currently, she is the Chairperson of the Israel Association of Certified Lactation Consultants. In addition, she is in private practice with Malhiv Breastfeeding and Support Center for New Mothers.


Let’s Celebrate: World Breastfeeding Week and Happy Birthday, Lactation Matters!

One year ago, Lactation Matters launched with a focus toward informing and advocating for IBCLCs.  It was no accident that the first posts were published every day during World Breastfeeding Week 2011. The theme of last year’s World Breastfeeding Week was about connecting breastfeeding advocacy with the mothers that need it and ILCA’s commitment to a blog took that theme and ran with it.

Here we are one year later.  Our blog has hundreds of regular readers and dozens of contributors.  We have posted interviews, calls to action, highlights of current research, practical applications and pieces that highlight the important work that IBCLCs do in the world.

Once again, Lactation Matters is looking forward to celebrating World Breastfeeding Week.  Each day this week, we will highlight the work of those advocating for breastfeeding in a different country or culture.  We encourage you to read, to think, to act.  Get involved with your local coalition.  Reach out to a local mother.  Join your professional organization.  Engage with the media.  Come along side a mother and baby.  Together, we can build a worldwide culture of breastfeeding.


ILCA would love if you could share your World Breastfeeding Week stories and photos with World Breastfeeding Week Kit and promotional items still available here!


What will you do to celebrate World Breastfeeding Week?

If you have a story or idea for a post on Lactation Matters, please contact us at 


FREE Access to the Journal of Human Lactation during August in celebration of World Breastfeeding Week

The Journal of Human Lactation (JHL) is the premier quarterly, peer-reviewed journal publishing original research, commentaries relating to human lactation and breastfeeding behavior, case reports relevant to the practicing lactation consultant and other health professionals who assist lactating mothers or their breastfeeding infants, debate on research methods for breastfeeding and lactation studies, and discussions of the business aspects of lactation consulting.

In celebration of World Breastfeeding Week, JHL is offering free access to a number of their most-read articles through August 31, 2012. While ILCA members receive and have access to JHL as a member benefit, the availability of the free articles is especially beneficial for our colleagues from other disciplines.  Please share widely these resources to pediatricians, obstetricians, midwives, nurses, educators, researchers and general public.

Free articles from JHL (through August 31, 2012) include:

Human Colostrum and Breast Milk Contain High Levels of TNF-Related Apoptosis-Inducing Ligand (TRAIL) by Riccardo Davanzo, Giorgio Zauli, Lorenzo Monasta, Liza Vecchi Brumatti, Maria Valentina Abate, Giovanna Ventura, Erika Rimondi, Paola Secchiero, and Sergio Demarini

Maternal Request for In-hospital Supplementation of Healthy Breastfed Infants among Low-income Women by Katie DaMota, Jennifer Bañuelos, Jennifer Goldbronn, Luz Elvia Vera-Beccera, and M. Jane Heinig

Expansion of the Ten Steps to Successful Breastfeeding into Neonatal Intensive Care: Expert Group Recommendations for Three Guiding Principles by Kerstin Hedberg Nyqvist, Anna-Pia Häggkvist, Mette Ness Hansen, Elisabeth Kylberg, Annemi Lyng Frandsen, Ragnhild Maastrup, Aino Ezeonodo, Leena Hannula, Katja Koskinen, and Laura N. Haiek

Milk and Social Media: Online Communities and the International Code of Marketing of Breast-milk Substitutes by Sheryl W. Abrahams

Development of a Postnatal Educational Program for Breastfeeding Mothers in Community Settings: Intervention Mapping as a Useful Guide by Hanne Kronborg and Gerjo Kok

Barriers, Facilitators, and Recommendations Related to Implementing the Baby-Friendly Initiative (BFI): An Integrative Review by Sonia Semenic, Janet E. Childerhose, Julie Lauzière, and Danielle Groleau

Breastfeeding at NICU Discharge: A Multicenter Italian Study by Riccardo Davanzo, Lorenzo Monasta, Luca Ronfani, Pierpaolo Brovedani, and Sergio Demarini

A Model Infant Feeding Policy for Baby-Friendly Designation in the USA by Lori Feldman-Winter, Diane Procaccini, and Anne Merewood

What are your favorite JHL articles from the past year?  How have they impacted your practice?


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