A recent controversy regarding an article about the handling of human milk containers during the COVID-19 pandemic has raised important concerns from readers of the Journal of Human Lactation.
We hope that the following helps answer some of your questions and guide your next steps as a skilled lactation provider.
What is the article about?
The Journal of Human Lactation recently published a series of articles related to COVID-19, including the “Insights into Practice and Policy” article Safe Handling of Containers of Expressed Human Milk in all Settings During the SARS-CoV-2 (COVID-19) Pandemic, by Kathleen A. Marinelli, MD, IBCLC, FABM, FAAP and Robert M Lawrence, MD, FABM, FAAP.
This article highlights that, at the time of publication, there is no evidence of the COVID-19 virus in human milk. It also notes that, at the time of publication, no guidance had been published concerning the disinfection of the outer surfaces of containers of expressed milk during the COVID-19 pandemic. [editor’s note: since the time of publication, the Human Milk Bank of North America (HMBANA) has released a set of guidelines, which can be found here.]
The article makes recommendations for milk expression and for the disinfection of containers of expressed milk.
What is the concern?
Following publication of the article, HMBANA shared concerns that the recommendations were “created and published without the involvement of milk banking and food safety experts.” In particular, HMBANA’s statement expressed objections to the author’s recommendations for disinfection that they describe as exceeding “FDA’s legal limit for food manufacturers.” HMBANA called for the retraction of the article.
How has ILCA addressed this concern?
First, some background: in order to ensure that scientific journals can operate as freely as possible from non-scientific concerns, they typically operate separately from their professional organization. The Journal of Human Lactation (JHL) is no exception. ILCA provides operating support to the JHL and extends subscriptions to JHL to its members. ILCA does not oversee JHL staff and exerts no influence over the content of the articles.
That being said, ILCA heard HMBANA’s concerns and took them seriously. ILCA reached out to both JHL and JHL’s publisher, not to influence the content, but with the goal of ensuring a thorough and transparent review of HMBANA’s concerns.
How has the Journal of Human Lactation addressed these concerns?
Discussions and disputes about scientific research and commentaries are not uncommon. The discussion that result are, in fact, a part of the process that brings us the best possible thinking in lactation research.
However, when there is a concern that there may be a risk to human health, or a dispute in a time of emergency such as the COVID-19 pandemic, sharing information quickly about the difference of opinion is paramount. Scientific journals, including JHL, have a process in place for moments such as these.
The JHL editor-in-chief has released an Editor’s note, which alerts the scientific community to the presence of a concern. The JHL has published two letters outlining some of the concerns, which can be found here and here. The article authors have also been given the opportunity to respond here. (Note that the articles and the responses either are or will be open source as soon as possible.)
What resources are available to my health care facility for decision-making about our policy regarding the handling of human milk?
First and foremost, it is important to note that there continues to be no evidence of the COVID-19 virus in breastmilk.
ILCA has made available on our COVID-19 page the milk-banking guidelines from HMBANA as well as a statement from the European Milk Bank Association. In addition to the robust conversation referenced in this post, JHL has also made available a letter sharing the experience of an Italian donor milk program, which can be found here.
In the face of the rapidly changing information regarding COVID-19, ILCA will continue to share guidelines, resources, and information here. We welcome your suggestions of additional resources to share with the ILCA community. Please share updates to media@Ilca.org.
Every day, new information is released about the COVID-19 virus. New statistics refute earlier assumptions, new data challenges current protocols, and just-released guidelines are revised and replaced.
As a professional helping lactating families, how do you wade through the flood of information? And how do you translate it to action steps for your practice?
In a recent webinar Cecília Tomori, PhD, MA, Director of Global Public Health and Community Health at Johns Hopkins University School of Nursing, offered guidance on understanding COVID-19 data. Tomori weaves together a thoughtful and fresh multi-disciplinary discussion of the basics of the virus, how to digest and evaluate information and guidelines, and how to translate it all into practical action.
Below is a summary of the key take-aways from Tomori’s webinar.
Keep following emerging evidence. As a lactation professional, make sure you are staying up to date—and also make sure the sources you use are credible. Tomori herself relies heavily on the World Health Organization for information. (She includes a list at the end of her webinar of other reliable sources.)
Think critically. Be prepared to analyze and question what you hear and read. “Whatever level it is—locally or nationally—we can’t just read information uncritically,” Tomori says. “In a time of uncertainty and limited evidence with these … kinds of complexities, we really need to think very carefully.” Thinking critically means staying aware of your own biases, according to Tomori. “These are going to be deeply embedded and related to the cultural context that [you] come from,” she notes. “So this is going to take some deconstructing.”
Understand the limitations. When evaluating today’s newest COVID-19 information, Tomori says it is important to remember that we are living in an environment of constant change, and that new information is simply the best current understanding, not a definitive answer. “None of us knows everything, and tomorrow, there may be evidence that may change our minds,” she says.
Examine the implications for equity. “Health and illness is always shaped by structural and social inequities,” Tomori notes. “Epidemics are not equalizers. Just because the virus is not aware of social divides, the way in which it moves directly builds upon inequities. [The effect of the virus is to] heighten and reveal profound inequities, and to do so both globally and locally.” When evaluating a piece of COVID-19 guidance or information, Tomori urges practitioners to train themselves to ask, “How will this affect different people differently?”
Remain an advocate. When you see new COVID-19 policies or guidance affecting birthing or lactating families, Tomori advises reading it through a lens of advocacy for families. “Look for opportunities to support parents’ and infants’ rights,” she says. While some settings may offer less option for shared decision making than others, Tomori urges practitioners to work within their own settings to maximize the ability of parents to engage in understanding risk-benefit analysis and making choices.
Evaluate guidance on separation. One of the key questions during COVID-19 relates to the separation of birthing parents and infants. Tomori urges practitioners to understand that guidance is frequently rooted in a deep cultural bias toward seeing separation as neutral or default. “The mother and neonate are [seen as] completely separate individuals,” she says. “ …. These kinds of assumptions have to do with the socio-historical changes we have seen in the past 200 years … [mother-baby togetherness] is not considered something that is the default, but rather as a potential threat—in this case, a vector of transmission.”
In fact, the harms related to separation are extensive. “It takes the infant out of its normal niche, prevents co-regulation, disrupts breastfeeding, and presents a significant stress for mother, infant, and family.” Breastfeeding is especially important in offering protection from infectious disease, both from other illnesses and potentially mitigating COVID-19.
Seeing separation as inherently protective can also be misleading. “[The assumption is that] separating an infant from a COVID-19 positive [birthing] parent will achieve a neutral environment without the virus,” Tomori says. “But it actually exposes the infant to new exposures. Each health care worker or care handling the infant is a [potential] new exposure … the result is that the infant has a high likelihood of exposure but fewer benefits from proximity and breastfeeding.”
Transmission and clinical course in infants. The risk and clinical course of COVID-19 in infants has been the subject of a lot of interest, but data is still limited or incomplete. Evidence suggests a milder clinical course for COVID-19 in children overall, but the possibility of severe disease in infants, due to immune system immaturity and other factors. With regard to vertical transmission/in utero transmission, Tomori points out that a new study suggests it is possible but this finding remains unconfirmed. She says, “[This] may change in the coming weeks, but as of today, we do not have evidence of it.” There is no evidence of virus in breastmilk at this time either. The risk of transmission after birth can be minimized with good respiratory hygiene (e.g. wearing a mask) and handwashing.
Look for opportunities to collaborate. When trying to understand and apply COVID-19 information and guidance, do not go it alone, Tomori advises. Instead, connect with colleagues, learn from their expertise, and share your own. “Reach out to experts and ask for information,” she says. “This is a great opportunity for collaboration. We all need to be looking for opportunities to work together so we can support families the very best we can.”
The challenge of figuring out how to interpret new data and guidance during COVID-19, and how to provide answers to the families who rely on you, can feel overwhelming. But there are ways to work with the overwhelm, according to Tomori.
“Whenever we feel like there is overwhelming despair, I think it’s best to move toward action,” she says. “Work together. Communicate to address concerns, to raise questions, to relay information to colleagues, and to provide leadership in the environments where we operate.
“We are in this for the long haul,” she continues. “So we really need to be thinking very carefully about how we support families, because while it’s an emergency and many of us are dealing with very acute circumstances, we’re going to be dealing with some of these issues for many months to come. So we’re going to need to figure out how to build the best possible support that we can for families around the world.”
The International Lactation Consultant Association (ILCA) and the United States Lactation Consultant Association (USLCA) stand firmly in support of the World Health Organization (WHO) and their critical work helping “mothers and children survive and thrive,” particularly during the COVID-19 pandemic.
The care plans and policies that are established during COVID-19 for the care of new families are essential to the wellbeing of parents and babies, now and throughout the life course of the family.
ILCA and USLCA offer deep appreciation and support for WHO’s significant efforts to provide evidence-based research, guidance, and support to individuals, organizations, and countries to guide those decisions.
Their guidelines provide much needed support for keeping breastfeeding and chestfeeding parents and infants together, and offer recommendations to safely breastfeed; they also provide information on protecting milk production and providing human milk to babies if there is separation.
This role is critical across the entire globe, as breastfeeding and chestfeeding is demonstrated to save lives, reduce burdens on the health care system, and increase food security now and into the future. These protections for families — which are felt regardless of the economic development status of the country — are critical now more than ever. WHO’s work in supporting these aims is indispensable.
ILCA and USLCA strongly urge the United States, and all countries, to continue their funding to the World Health Organization, especially at this critical time.
Adelante Network Anna Sumner, Australia Athena Lactation, LLC The Baby’s Voice BPNI Maharashtra, India California Advanced Lactation Institute, USA Cheryl Patel, RN, LNC, IBCLC Chinese Lactation Consultant Association (CLCA), Taiwan Christine’s Care & Compassion, USA Colorado Breastfeeding Coalition, USA Early Dawn Doula and Lactation Services, USA Egyptian Ministry of Health and Population, Egypt ELACTA, Austria ELCA, Egypt Every Mother, Inc., USA Galactablog, Ireland Hanen Association for Breastfeeding Promotion, Tunisia Janette Brooke, Australia Joy MacTavish, IBCLC / Sound Beginnings LLC, USA Kawartha Birth and Lactation, Canada KellyMom.com La Leche League USA Lactation Consultant At Home, LLC Lactation Consultants of Great Britain, UK Latch In Color Lisa Staggs, BSN, RN, IBCLC Lucile Packard Children’s Hospital Stanford, USA The Milk Collective, USA The Milky Mermaid LLC, USA The Milky Way LLCA, USA Mina Ognjanovic Jasovic IBCLC Mom & Baby by Gaby Uribe, Mexico Mother’s Own Milk Matters, USA NHS, UK Nurturing Traditions, LLC Pretty Mama Breastfeeding LLC Sarah Wydner RN, IBCLC, USA Senecca Kirkhart, CPNP, IBCLC, USA Somerset West Community Health Centre, Canada St Georges University Foundations Trust, UK Successful Breastfeeding LLC Terra Nova Midwifery, Canada Westchester Lactation Consultants Women’s and Children’s Health Network, Australia Your Baby Butler, USA Zdravo Bebe-Centar za majki, Macedonia
Individuals
Khansa Abd Halim, Malaysia Michelle Angelini, Canada Jasna Apostolski-Nikolov IBCLC, Macedonia Magdalena Arciszewska, Canada Eya Belkhir, Tunisia Andrea Blanco, USA Kelly Bonyata Janette Brooke, Australia Elizabeth Brooks JD IBCLC FILCA, USA Decalie Brown, Australia Anna Cannon, UK Colleen Carney, USA Tiziana Catanzani, Italy Rebecca Costello, IBCLC, MPH, USA Paulina Erices, USA Pauline Garcia, USA April Grady, USA Michele Griswold, USA Margaret Haines, USA Trish Islam, UK Jessica Jolley, USA Molly Jonas, USA Nut. Karen, Mexico Charnise Littles Bonnie Logsdon Suzanne Mackinnon IBCLC, Canada Sonia Mathisson Josefa Martinez, USA Karen Cecilia Mejía Espinoza, Mexico Jocelyn Milanes Nor Kamariah Mohamad Alwi, Malaysia Daniela Nicolin, Italy Amanda Nutkins, UK Aunchalee Palmquist, USA Inge Sofia Pena, USA Lauren Pitts, USA Chelesa Presley, USA Milagro Raffo, Peru Amanda Russell, USA Dawn Russell, USA Leah Segura, USA Eve Schein, USA Kati Smith, USA Christine Staricka, USA Anna Summer, Australia Lynn Tauss, USA Cecilia Tomori, USA Shu-Fang Wang, Taiwan Natalie Ward, USA Allyson Wessells, USA Jorhdyn White Kelly Yanuri
New York City, New York, United States currently has more COVID-19 cases than any other place in the world—and one borough, Queens, has had more deaths than any other place in New York City.
Annie Frisbie, IBCLC, has run a private practice from her home in Queens since 2011, and she has helped hundreds of families in and around her New York City borough. In 2018, she was given the United States Lactation Consultant Association for extraordinary service to the profession, and she’s the author of several books about private lactation practice. Nothing, however, could have prepared her for the challenges her practice is facing now.
In this interview, Frisbie shares her experiences living and working at the current epicenter of the pandemic.
What is life like for you right now?
The [New York City] hospital experiencing the greatest surge is a mile and a half from my house. It’s the hospital where, if we called 911, that’s where they would take us.
We have been staying home for quite a while now. My children are two weeks into virtual schooling. They have not really left the house except for short walks, and my husband is also only leaving the house for short walks or bike rides.
So we’ve gone from living in New York City where we have everything available 24 hours a day to having just what’s in our house, and we’re grateful for what we have. There is just a lot of uncertainty.
What effects are you seeing for the families you work with?
New parents are under extreme stress. They have partners who’ve lost their jobs, or they’ve lost their job. None of them know whether they have a job to go back to. They are living with so much uncertainty. Can they pay their bills?
And then add to that being trapped at home all day. Some of them were planning to have family fly in when the baby was born, and their family can’t come. I spoke to one woman who said, “I am by myself for the entire day.” She’s having to do a lot of things to keep breastfeeding going, and she said, “How am I supposed to do it?”
And there is just no answer.
It’s heartbreaking.
With over-crowded hospitals and restrictions on who can accompany people in labor, what is the situation like for families preparing to give birth?
What I am hearing is that the pregnant families are so scared.
Every day, there is a new story about what pregnant parents are going through. One of the big hospitals here just announced that they are going to be testing every parent who comes in in labor, and if you have your baby before they get the test results back, they are separating you, routinely. Some hospitals are not allowing doulas and partners.
There are so many competing factors. We can all see that slowing down [the spread of the virus] is so important, but we also know the effects of separation on babies, and we know the risk factors for parents when their babies are separated from them and the negative effect of stress in the postpartum period. What kind of short- and long-term effects are we going to see from that?
[eds notes: some of these policies have changed in New York since the time of this interview, find details here, paywall may be in effect. Find international guidelines, which recommend keeping birthing parents and babies together – with appropriate protection – regardless of COVID-19 status here]
What conversations are you having with families to help them navigate the situation?
When I talk to them, I acknowledge that this situation is hard, and it might be really hard. But I also try to help them go in with a plan. I tell them, “The more frequently you remove milk, the more milk your body makes. If it’s rough in the hospital, just start hand expressing and give your baby your colostrum and then get home. And then we’ll talk and we’ll figure it out when you get home. Just get out of the hospital and we’ll work on the rest of it.”
I have also been recommending that people learn to do hand expression of colostrum while they’re still home, because that is a really tangible thing that families can do. They know they are going into a very potentially isolating and scary experience, but they also know, “I’m already familiar with my breasts.” If somebody says, “Your baby needs to be supplemented,” you can say, “Great, I brought it with me.” You already know what your beasts can do.
You are currently doing all your consults virtually. How did you work through the decision to suspend home visits?
I did my last home visit a week ago. At the beginning of last week, [my plan was to continue to] do home visits on a case by case basis. I planned to screen everybody and sanitize everything.
And then, the very last one I did was a uniquely terrifying experience. Not because of what was happening inside the parents’ home, because that was lovely. There was a baby, and a new family, and all the beautiful things that mean so much to all of us that work in lactation. It was great. And I washed my hands, I sprayed down my scale.
But to get in and out, I had to go through a large, open lobby that was full of people working from home in a big apartment building. I had to get into an elevator. I had to touch buttons. As I was about to get into an elevator, somebody stepped in and said, “Here, there is room for you, too.” And I thought, “The last thing I am going to do is get into an elevator with you.”
I had my husband drop me off and pick me up, because I would have had to use valet parking. I don’t want someone else inside my car right now.
There was so much fear. What am I bringing into this family’s home? And what am I taking out, because I am passing through so many public spaces?
I had to make the decision to stop home visits. The density is such a big factor in my decision.
And I do recognize that there is a harm to that—things are going to be lost for these families because they can’t have us in their homes. I lost a lot of sleep over that decision, and I know I’m not the only one. It’s not something I came to lightly, and I am very concerned about the families that don’t have access to [in-person] care. But at the same time, it’s just very frightening here.
At this point, I think it’s very important not going to judge anyone’s choice to do home visits or not to do home visits. No one should be shaming people who are still doing home visits. We need to trust our colleagues that they are making good clinical decisions, and if they are still providing home care, we should just thank them for it. And for people who have said, “I can’t do home visits right now,” we need to thank them for recognizing their limitations and for doing their part to keep families safe. We need to make sure everyone in our community feels like we are supporting each other, because that is how we’re going to support families.
This is not something to police anybody about. Nobody knows anything right now, and we do know that babies need help. So let’s just trust that the people who are still doing home visits are not behaving cavalierly.
Many IBCLCs are working with telehealth for the first time. What have you learned about how to provide a great consult when you’re working through a video screen?
We’ve all been dropped in feet first! I did a record number of consults this week, and they were all virtual. I went in with a little fear. I was thinking, “Do I really have the skills for this? I’m not a movie director.”
[When it comes to the details of using video], there are good resources out there to help you. For example, to [help you figure out] the sort of pictures you might want to get if you are trying to assess oral anatomy. Dr. Bobby Ghaheri has a blog postthat gives advice for things like where to put the camera, how to take a burst, how to take a video. I share this post with my clients.
But in a big-picture sense, I have been getting a lot of questions like, “Do you chart differently for virtual consults?” People have been telling me, “I need all new things to do virtual.”
My advice is, you don’t need all new things. You are still the same lactation consultant you were when you were sitting on your client’s couch or when they were sitting in your office. We have to remember that the basics still apply. What do we do? We ask questions. We listen. We observe. We ask more questions. We take a history. Those are still the same things you will be doing.
[As I was starting to do virtual consults], I was thinking—there are things I do with my hands and I have so much knowledge in them. And now I can’t touch anyone. So I started to ask myself, what do I usually feel for? And how can I convey that to the parent?
So that means saying to the parent, “Can you put your finger into your baby’s mouth? Here is how I would do it.” And then physically demonstrating to them what I would do. And then not saying, “Do you feel this, this, or this?” But saying instead, “What does it feel like to you?” And then really listening to what the parent is saying and using your imagination to try to feel what the parent is saying they feel. And that’s different from putting your finger in the baby’s mouth and knowing what you feel. It’s a different way of interpreting data. But you still know what you’re trying to find out. You still have all those clinical skills.
I have also been recommending that my families that are concerned about weight gain get a scale to use at home, because we really don’t want them going to the pediatrician and there are no drop-in breastfeeding groups. So ordinarily, I would say, “Wait, we’ll keep and eye on it, and I’ll come back and weigh your baby.” Now, we’re not weighing babies, but families can weigh babies.
I’ve always believed that parents truly are the expert on their own baby. I tell them, “We’re just going to keep talking. And I’m going to listen to what you’re telling me.” One wonderful thing that’s happening is that we’re showing parents their own resilience. [We’re saying], “I am not there, but you are, and there are things that you know and can do. And I can teach you and counsel you and help you step into your own authority as a parent.” We are coming back to the foundations here.
That’s beautiful, because that’s what the best consult does anyway.
Exactly. So in some ways, not being able to be the expert with the magic hands could be good. There could be benefits that come out of that. I think I will personally grow as a clinician through having to do virtual consults. I might even keep them in the mix after this is all over, because I feel like they might be really helpful for certain things. Like if I don’t really want to drive 30 minutes to do a 30-minute pumping consult and look for parking, I could definitely do that virtually.
For IBCLCs who are feeling scared about virtual consults and wondering if you have what it takes to do it, you might not know that until you just jump in and start doing it. There are great trainings out there about how to do virtual consults. It would be a good idea to seek that out, and then you’re supporting another IBCLC who has skills to share. I am a big fan of learning from others.
What are you doing to take care of yourself and get support?
As care providers, we’re all under a lot of stress, and it’s crucial that we get our own support for that. Sometimes my clients tell me they are scared of something, and I think, “I’m scared of that, too!” But I can’t bring that into our clinical relationship. But then I have to walk away and I have their problems and my problems now. With the empathy that we naturally have as lactation consultants, everything is triggering right now.
The main thing I did was immediately find a therapist. I recognized that it was a critical need, as important as food and water and shelter. I need someone I can talk to and process this with, because it’s not going to work otherwise. This is too big. It’s not like, “Oh, you’re a little stressed. Do some deep breathing and self-care. Take some time for yourself.” No. This is huge, and it’s okay to reach out for professional help. It doesn’t mean you’re weak or there is something wrong with you. It might be the most important thing you do for your clients, if not for yourself.
You’ve been reminding your clients that birthing families have always been strong.
Yes. Right now, we can just do our best with what we have, and I think we have a lot more than we realize. We as clinicians have a lot of resources, and our families have a lot.
I loved an article that came out this week in The Cut, a New York magazine, with a midwife named Robina Khalid. I have been sending it to my clients. She reminds families that there is always going to be hardship, and there has always been hardship. But there have also always been parents and babies, and at the end of the day, babies don’t know there’s hardship. They just know you. And you can do this. That is the message I want to amplify to families right now.
Are you a skilled lactation provider serving families during the COVID-19 pandemic? ILCA wants to hear your stories. Email at media@ilca.org.
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All international world health guidelines agree: Breastfeeding should continue and be supported during the COVID-19 epidemic, with appropriate precautions.
Breastfeeding protects infants and young children, particularly against infectious disease.1 When a person is lactating and becomes ill with a virus, they develop antibodies to fight the illness. Those antibodies are then conveyed to the infant through breastmilk, helping to protect the infant from illnesses to which the parent has been exposed.2
According to UNICEF, “Considering the benefits of breastfeeding and the insignificant role of breastmilk in the transmission of other respiratory viruses, the mother can continue breastfeeding, while applying all the necessary precautions.”3
Now more than ever, families need lactation support to navigate infant feeding questions and challenges. According to the World Health Organization, “Breastfeeding counselling, basic psychosocial support and practical feeding support should be provided to all pregnant women and mothers with infants and young children, whether they or their infants and young children have suspected or confirmed COVID-19.”4
Breastfeeding or chestfeeding people at home with mild symptoms of a suspected COVID-19 infection are currently advised by WHO to wear a mask and perform hand hygiene before and after having close contact with the baby, in addition to other guidelines provided here.5
Breastfeeding or chestfeeding people with more severe cases can continue breastfeeding. If severe illness prevents direct breastfeeding, the parent should be supported to safely provide their expressed milk to the infant while continuing appropriate infection prevention and control (IPC) measures.6 If the lactating parent is too unwell to express milk, find resources for the delivery of human milk in WHO’s clinical interim guidance here.
Mothers and infants should be supported to stay together and maintain skin-to-skin care, regardless of suspected, probable, or confirmed COVID-19 status, while using appropriate precautions. See WHO’s interim guidelines, including appropriate IPC, here.7
Skilled lactation providers in the community setting can consider telehealth when face-to-face care is challenging. ILCA is deeply grateful to health care providers in all settings during this critical time. In some areas and in some cases, delivery of lactation care via telehealth may be a resource. Find telehealth resources for lactation consultants here.
The International Lactation Consultant Association will continue to provide resources to skilled lactation providers during the COVID-19 pandemic. Find your regional guidelines, resources for lactation consultants, and communications tools here: ilca.org/covid-19.
NOTE: Guidance for families and for those providing lactation support during COVID-19 is evolving. We at ILCA will do our best to keep this information as updated as possible. The information posted here may not reflect the latest news and practice guidance. Please visit our COVID-19 resource page here, review the full guidelines, and observe your local and regional care guidelines.
As skilled lactation providers, we know that national and global policies affecting health care, workplace support, and access to breastfeeding and chestfeeding support impacts our individual clients’ ability to reach their infant feeding goals. We additionally know that reaching those individual goals impacts that one family, but also the health of the community and even the climate. This is why ILCA is committed to international advocacy that ensures that promotion and protection of breastfeeding is recognized as a key issue for ensuring gender equality and sustainable development.
ILCA and the World Alliance for Breastfeeding Action have partnered to create the following statement to be delivered to the Commission on the Status of Women (CSW64) with the goal of highlighting the promotion and protection of breastfeeding and skilled lactation care on the world stage. Although the event itself has been scaled back in light of the current concerns regarding coronavirus disease (COVID-19), we hope to elevate the statement at upcoming meetings of the General Assembly. We also welcome you to share the statement widely within your community and with your national leadership.
Statement:
“Breastfeeding is the biological norm but it is not yet the social norm. When a mother chooses to breastfeed, every one of us has the responsibility to protect and support her. By doing so we’ve started a partnership with her. Breastfeeding partnerships matter, a lot! Not just at home with a partner and family but also at work and socially…..when everyone involved learns and positively accepts the challenge to shift breastfeeding to become the social norm.” Leah Hughes, Girls Globe
This year, the global community will mark the twenty-fifth anniversary of the Fourth World Conference on Women and adoption of the Beijing Declaration and Platform for Action (1995). The highlight includes a review of current challenges that affect the implementation of the Platform for Action and the achievement of gender equality and the empowerment of women and its contribution towards the full realization of the 2030 Agenda for Sustainable Development. The protection, promotion and support of breastfeeding is embedded in the 1995 Beijing Declaration and Platform for Action1, International Labour Organisation (ILO) maternity protection Convention C1832 and CEDAW3. Breastfeeding is one of the most effective and cost-effective ways to save and improve the lives of children everywhere, yielding lifelong health benefits for infants and their mothers. Therefore, breastfeeding is also a key intervention to achieve all the 17 Sustainable Development Goals.
Women’s reproductive health and rights must be prioritised as a key component of the Sustainable Development Goals. Lactation and breastfeeding are part of the reproductive continuum and require access to consistent information and skilled support. Breastfeeding protects the health of women by reducing the risk of breast and ovarian cancer, diabetes, and heart disease. Increased breastfeeding rates could prevent 20,000 maternal deaths each year from breast cancer alone and prevent over 820,000 child deaths each year. Breastfeeding rates are stagnant or declining in many parts of the world. The cost of not breastfeeding on the global scale is about $302 billion annually. Although some progress has been made in supporting breastfeeding it is far from being the social norm.
When breastfeeding support is offered to women, the duration and exclusivity of breastfeeding is increased. Characteristics of effective support include: that it is offered as standard by trained personnel during antenatal or postnatal care, that it includes ongoing scheduled visits so that women can predict when support will be available, and that it is tailored to the setting and the needs of the population group. The Warm Chain places the mother-baby dyad at the core and follows the first 1,000 days timeline. With consistent messages and proper referral systems throughout the warm chain, the mother-baby dyad will benefit from ongoing support and skilled assistance.
Women’s economic empowerment is inextricably linked to their empowerment as mothers and primary infant caregivers. According to the ILO, 830 million women workers do not have adequate maternity protection. When fathers/partners support breastfeeding and are involved in caring for the baby, breastfeeding improves, the parental relationship is better. Supporting parents at work is a prerequisite for optimal breastfeeding, distributing care work and transforming social norms. Parent-friendly policies, which enable women to remain and progress in paid employment and encourage men to take their fair share of care work, are crucial to achieving gender equality at work and at home.
Balancing work and family life, including breastfeeding, is increasingly necessary for all. This will ensure a productive and healthy workforce thus leading to a better society. Effective partnerships between governments, employers, trade unions and civil society organisations will increase access to gender equitable social protection. Gender equitable social protection includes legislation, positive social norms and supportive work policies which are the basis of the Empowering Parents Campaign.
Implement gender-equitable social protection that will enable breastfeeding and greater gender equality.
Enact and monitor national legislation and policies that uphold the rights of women and their children in diverse contexts.
Enact paid parental leave and workplace breastfeeding policies for women in the formal and informal economy.
Create a warm chain of support for breastfeeding across healthcare, workplace and community from pregnancy until the child’s second birthday.
Invest in interventions such as support for breastfeeding as a means to improve the health and survival of women and children.
Together we can help create a better world for women and men, girls and boys by supporting breastfeeding to become the social norm. This will benefit all of society.
Lactation education. Home lactation support. Helping breastfeeding and chestfeeding families in clinics and hospitals. Human milk research. Emergency and disaster support for displaced families with infants. These are just a few of the ways that you as International Board Certified Lactation Consultants® (IBCLCs®) are contributing to world health outcomes by sharing your expertise.
On 4 March, we welcome your community to celebrate YOU by thanking IBCLCs.
We hope you will also take this opportunity to celebrate the IBCLCs that have made a difference in your life, through mentorship, community, or support.
Show your IBCLC pride! Starting now, use our IBCLC Day frame on your Facebook image to help build recognition for your profession.
We have also welcomed code-compliant organizations that would like to provide special offers to IBCLCs for #happyIBCLCday to do so on our event page. Feel free to check out what they have shared with you here. We also hope that you will share with us what you are doing in your local community to celebrate!
How well does your clinical setting or private practice serve LGBTQIA patients and clients? Is there more you could be doing? In ILCA’s recently released webinar, Care of the Same Sex Family, Diane DiTomasso, PhD, RN, shares strategies for effectively supporting LGBTQIA families.
Here are ten highlights for providing culturally appropriate care from her webinar. Answer the following questions to see how your practice measures up—and where you can improve.
Have you checked your implicit biases?
The first step, according to DiTomasso, is scrutinizing your own attitudes—especially subtle ones, which often come from early learning. “Take a minute and think about the earliest messages you ever received about people in this population and the source of those messages,” she advises. “Who taught you what and how to feel about people in the LGBTQIA community?”
If parents or other influences communicated negative attitudes, your early programming may still be influencing your behavior in ways you don’t realize—even if your beliefs as an adult don’t align with those messages. “Consider your verbal and nonverbal communications, and the intentional or unintentional signals you may be sending based on those messages you received,” DiTomasso says.
Are you fluent in LGBTQIA concepts and terms?
Knowing the right words to use reflects a commitment to respectful care. Some basic terms to know: Sexual orientation refers to how a person characterizes their sexual and emotional attraction to others. Gender identity is the internal sense of being male, female, both, or neither. When a person’s gender identity conforms to the gender they were assigned at birth, they are cisgender. Gender fluid means gender identity is not fixed—a gender fluid person may identify as male or female at different times. Someone who is transgender has a gender identity that does not correspond with the gender they were assigned at birth. Those who were assigned male sex at birth but who identify as female may refer to themselves as transgender women, trans women, or male-to-female persons. People who were assigned female at birth but identify as male may refer to themselves as transgender men,trans men, or male-to-female persons.
Another note on language: Pronouns are extremely important. “When we address people by the pronouns they use, that is central in … building rapport,” DiTomasso says. “Match the person’s language. Use the pronouns they use and use the names they use. This is so important.”
For a more comprehensive list of terms, the United States’ National LGBTQ Educational offers an updated and comprehensive list of terms here.
What messages do your workspace and paperwork convey?
These elements send powerful signals. Avoid clinic or practice names and signs that seem welcoming to only one gender. Include literature relevant to LGBTQIA people in your waiting areas, and establish gender-neutral bathrooms, DiTomasso suggests. Revise your forms and documents to reflect the diversity of sexual orientations, gender identities, and family structures. For example, instead of asking for “male or female” on a form, ask, “What is your gender identity?” Then offer these options: male, female, neither, both, transgender, other. “All of these things could be done in an afternoon,” DiTomasso says. “It doesn’t take a lot of time to go online and find a gender-neutral bathroom sign and tape it up, or to revise your forms and documents.”
However, “[Signs and forms] are meaningless if the care received and the treatment don’t match them,” DiTomasso cautions. “What matters is the way you are treated by the people—it’s so much more powerful than any of these other things.”
Are you open and trustworthy?
Do you encourage your clients to share sensitive information, by being a good listener? LGBTQIA clients may be reluctant to disclose personal information for fear of discrimination and compromised quality of care. “The consequences of nondisclosure can include development of mistrust, missed opportunities for health education, and ill-informed clients and health care workers,” DiTomasso says. How do you help someone feel safe to share information? “Open the door for disclosure. Recognize how difficult it is to come out, over and over,” she urges. “Ask open-ended questions with attention to tone of voice and body language. Encourage conversations. If you don’t know what to say, simply say, ‘Tell me about it.’ Let people talk. The key is using clear, nonjudgmental communication.”
Do you make assumptions during client contacts?
Assuming heterosexuality and assuming gender identity are “common and widely accepted,” according to DiTomasso, but this can lead to unintentional blunders—for example, asking a married female client about her husband, when in fact, she is married to a woman. “It takes a lot of emotional energy to correct someone,” DiTomasso says. “It’s like when someone calls you by the wrong first name. It becomes all you can think about in the interaction. You are embarrassed, because you don’t want to embarrass them.” If such a mistake happens? “Simply apologize and move on,” she suggests. Don’t allow embarrassment to cause you to overcompensate, making your client even more uncomfortable. “And then work on trying not to make assumptions, because that avoids the whole problem to begin with!”
The best way to avoid assumptions? Use inclusive rather than exclusive language. Examples of inclusive questions: Do you have a partner or significant other? How do you refer to your partner? Can you tell me about your family?
Are you aware of unique clinical concerns?
Certain issues like anxiety, depression, and substance use are higher among LGBTQIA populations. Other issues are as well, such as intimate partner violence and sexual abuse. Excellence in care means being aware of these statistics.
Does your workplace address invisibility?
Making sure LGBTQIA people are part of your community is another important step. “[We need to] recruit, support, and retrain ‘out’ LGBTQ-identified people to work in health care facilities,” DiTomasso says. You can also establish a visible LGBTQIA presence through posters, photos, other materials in your setting. “They make a difference,” she says.
Do you support research efforts?
More studies are needed to examine the impact of prejudice and discrimination on the wellbeing of LGBTQIA people and their families and to focus on the unique health needs and concerns of people in LGBTQIA groups.
Are you an ally?
“You may not be a member of this group, but you sure can be an ally,” DiTomasso says. What does that over-used word actually mean? “It means you stand up for and support the rights of minority people,” she says. “You respond to anti-LGBTQIA behavior, and you let people know you do not tolerate homophobia or transphobia. This sends a strong message.”
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.)
