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Tag Archives | Disparity

New Resource to Encourage Normal, Healthy Birth

By Jeanette McCulloch, IBCLC

preagnant africanIn the introduction of Linda Smith’s book, “Impact of Birthing Practices on Breastfeeding,” Diane Wiessinger aptly sums up how we can help get breastfeeding off to a good start:

“It’s the birth, stupid!”

As lactation consultants, we know both anecdotally and through research the impact on breastfeeding of common birth interventions in the U.S, including: non-medical inductions; certain labor drugs; lack of freedom to eat, drink, or move about as needed; and unnecessary surgical delivery. While interventions can be lifesaving when medically appropriate, the number of routine interventions has meant an unprecedented impact on healthy, normal birth.

The result? According to Amnesty International: “It’s more dangerous to give birth in the United States than in 49 other countries. African-American women are at almost four times greater risk than Caucasian women.” And what do we know as lactation consultants? The same routine interventions that are impacting birth safety are also creating breastfeeding challenges.

Three leading midwifery organizations in the US formed a partnership to create educational materials designed to help those who are pregnant – or planning to become pregnant – learn about how a normal birth process can improve health of both mother and baby.

The International Lactation Consultant Association has signed on as a supporter of the project’s first handout, which guides women through the process of learning about normal birth and the choices they can make to increase the chances of a physiologic birth.

The handout is available as a PDF download here or you can purchase pre-printed packs at minimal cost here. The materials can serve as a helpful reference in your prenatal breastfeeding class packets. You can also share the link to the PDF widely on your own social media, helping as many mothers and mothers-to-be learn about normal, physiologic birth.

The handout was created in partnership between the American College of Nurse Midwives (ACNM), the Midwives Alliance of North America, and the National Association of Certified Professional Midwives. It has received endorsements from many of the leading organizations working towards increasing normal birth options, including Citizens for Midwifery and the International Center for Traditional Childbearing. For more information, visit the ACNM’s consumer education project here.

JeanetteJeanette McCulloch, IBCLC, is a lactation consultant in private practice in Ithaca, NY. She is also the co-founder of BirthSwell, which is improving infant and maternal health through digital skills for birth and breastfeeding pros and volunteers.

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One Every 21 Seconds: Let’s Remember What We are Fighting For

By Kathleen Kendall-Tackett, Ph.D., IBCLC, FAPA

Photo via www.mrqa.com

One of my favorite movies is The Girl in the Café. It is a quirky, and somewhat improbable love story between two very lonely people, Lawrence and Gina (played brilliantly by Bill Nighy and Kelly MacDonald), who meet by chance in a café in London. Lawrence works for the Chancellor of the Exchequer (the minister of economics and finance) in Great Britain. His team is preparing to attend the G8 Summit with the other world leaders. On impulse, he invites Gina to accompany him to the G8, and she learns about the Millennium Development Goals for the first time. What she learns becomes the central focus of the rest of the movie.

The Millennium Development Goals

In 2000, 189 heads of state issued the UN Millennium Declaration, which was a plan for countries and development partners to work together to reduce poverty and hunger, tackle ill-health, gender inequality, lack of education, lack of access to clean water, and environmental degradation. They established eight Millennium Development Goals (MDGs), with targets set for 2015. One of the most important goals is MDG 4: Reduce child mortality.

Fortunately, there has been some progress here, but there is obviously more to do. Annual deaths of children under five years of age in 2009 fell to 8.1 million, down by 35% from 1990. Diarrhea and pneumonia cause the deaths of nearly three million children under five each year worldwide. An estimated 40% of deaths in children under five occur in the first month of life.

According to the World Health Organization, infant and young child feeding is a key area to improve child survival. The first two years of a child’s life are particularly important, as optimal nutrition during this period will reduce morbidity and mortality, reduce risk of chronic diseases, and lead to overall better development. “In fact, optimal breastfeeding and complementary feeding practices are so critical that they can save the lives of 1.5 million children under five every year.”

UNICEF also made a similar statement regarding deaths from pneumonia and diarrhea, the two most-common causes of child death worldwide.

We know what needs to be done. Pneumonia and diarrhea have long been regarded as diseases of poverty and are closely associated with factors, such as poor home environments, undernutrition, and lack of access to essential services. Deaths due to these diseases are largely preventable through optimal breastfeeding practices and adequate nutrition, vaccinations, hand washing with soap, safe drinking water and basic sanitation, among other measures. 

Does MDG 4 Apply to Mothers in the U.S.?

Yes, you might say, breastfeeding is important in the Third World, but not really critical in the U.S., where “safe” alternatives abound. Of course, I’ve heard all this before. But consider this. The U.S. now ranks 41st in infant mortality.  In other words, our
babies are dying too. What is particularly concerning is the large disparity by ethnic group.

According to the Centers for Disease Control and Prevention, African Americans have 2.3 times the infant mortality rate as non-Hispanic whites. They are three times as likely to die as infants due to complications related to low birthweight as compared to non-Hispanic white infants.

Infant mortality rate per 1,000 live births, 2008

Source: CDC 2012. Infant Mortality Statistics from the 2008 Period Linked Birth/Infant Death Data Set.
 

A key factor in these statistics is breastfeeding. In a national CDC survey, 54.4% of African American mothers, 74.3% white mothers, and 80.4% of Hispanic mothers attempted to breastfeed. Breastfeeding rates were the lowest for African American mothers in 13 states, where they had breastfeeding initiation rates at least 20% lower than white mothers. In six states (Alabama, Arkansas, Kentucky, Louisiana, Mississippi, and South Carolina), the prevalence of initiating breastfeeding among African-American women was less than 45%.

Now for some good news. As Tanya Lieberman shares in a blog posts for Best for Babes, the answer to this problem right in front of our face.

Evidence is accumulating that not only does following the Ten Steps improve breastfeeding success rates in general, it actually eliminates or significantly reduces race-based disparities.

Consider the following examples:

One study of Baby Friendly hospitals in the U.S. found that “breastfeeding rates were not associated with number of births per institution or with the proportion of black or low- income patients.” In other words, whether you had a large or small population of women who were African American, breastfeeding outcomes were the same. Disparity? Poof!

Here’s another study, of Boston Medical Center, which became a Baby-Friendly Hospital in 1999. The rate of breastfeeding among African American women went from 34% in 1995 to 74% in 1999. Yes, that’s super impressive on its face. But consider this: the overall breastfeeding rate went from 58% to 78%. So that means African American mothers were within 4 percentage points of the overall hospital rate. A study found that, “Among a predominantly low-income and black population giving birth at a U.S. Baby-Friendly hospital, breastfeeding rates at 6 months were comparable to the overall US population.” Disparity? Gone, baby, gone.

One Every 21 Seconds

In the climactic scene in Girl in the Café, Gina makes an impassioned speech to the
assembled world leaders (shortly before she is removed from the gathering), pleading with them to do something to help. She points out that one child dies of extreme poverty every three seconds. She snaps her fingers and says, “There’s one….and another…and another.”

We can make a similar statement. If we consider the WHO estimate of 1.5 million infant and child deaths annually, we can say that one child dies every 21 seconds due to lack of breastfeeding. “There’s one…and another…and another.” In the time it takes me to complete a 60-minute lecture, 171 children have died. With the U.S. ranking 41st in the world in infant mortality, this problem is not just “out there.” It is at our door as well.

We have made wonderful strides in 2012 in improving breastfeeding rates. It’s been an excellent year. Not surprisingly, there has also been a backlash. When people claim that this is matter of “upper-class white women” interfering needlessly in the lives of patients and trying to deny them “choice,” I hope you will see that they have truly missed the point. We need to continue to hold the line and remember what we are really fighting for. I long for the day when we can no longer say “there’s one…and another…and another.”

Wishing you a happy and healthy 2013. Thanks for fighting the good fight.


Kathleen Kendall-Tackett, Ph.D., IBCLC, FAPA is a health psychologist and board-certified lactation consultant. Dr. Kendall-Tackett is Owner and Editor-in-Chief of Praeclarus Press. She is a research associate at the Crimes against Children Research Center at the University of New Hampshire and a clinical associate professor of pediatrics at Texas Tech University School of Medicine in Amarillo, Texas. She is Editor-in-Chief of the journal, Clinical Lactation, a Fellow of the American Psychological Association, and is president elect of the APA Division of Trauma Psychology. This post is a preview of her editorial in the Vol 3-4 of Clinical Lactation. You can read more about Kathy at www.KathleenKendall-Tackett.com.

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Reducing the Breastfeeding Disparities Among African American Women: A Commentary from ROSE, Inc.

Reaching Our Sisters Everywhere, Inc. (ROSE) seeks to enhance, encourage, support, and promote breastfeeding throughout the USA, by working to reduce the breastfeeding disparities among African American women. We also seek to strengthen the health of their families through, mentoring, breastfeeding support groups, social support, outreach, education, health policies and social marketing. ROSE works with national groups to strengthen local groups that serve African Americans who breastfeed.

It is our understanding that a storm is brewing in the lactation community among International Board Certified Lactation Consultants (IBCLC) and the several other lactation certifying organizations to gain the title of grand matron of the breastfeeding world. The African American community needs all the breastfeeding management assistance we can get in order to overcome the breastfeeding disparities in our community. ROSE is grateful for the work that you all do. We understand that breastfeeding promotion is not enough. To be successful, mothers may need hours of skilled help that is provided when needed. We are of the position that there is a need for several levels of lactation managers. There is a need for the novice, the beginner, the intermediate and the expert lactation specialist. We are of the position that EVERY informed person can help a mother to breastfeed. We are in NEED of every advocate who wishes to be involved with lactation management, to be applauded and welcomed to the table of breastfeeding protection. Everyone does not NEED a cardiologist. Everyone does not need a specialist. However, when a specialist is needed, it is wonderful to be able to refer to the IBCLC.

Becoming and maintaining the designation as an IBCLC is a complicated and expensive process. Many of us, concerned with addressing the disparities of breastfeeding in the African American community do not have the luxury of the time that it takes nor the necessary funds to be involved in this complicated process. This is what we have been told by African American health care providers and community organizers as we travel. That some sort of designation is important for the provider of direct lactation services in the hospital, is an underlying theme. We are of the firm belief that EVERY person, that has contact with and cares for mothers and babies in the hospital, should be trained to assist mothers in the hospital with skin to skin, latch and pumping when necessary. Our goal is to have every African American woman who has successfully breastfed a baby help another African American woman breastfeed her baby. Most of these women will never be an IBCLC.

Reaching Our Sisters Everywhere, Inc. recently coordinated a Breastfeeding Summit which involved African American healthcare providers, community advocates, organizations, and government representatives from throughout the United States. We came together to ponder, discuss and debate the breastfeeding disparities in the African American community. We also celebrated. We celebrated the many accomplishments of the breastfeeding advocates that were gathered. This was an African American “Dream Team” of breastfeeding experts. There were 49 persons who assisted with the planning and execution of the summit. Three were African American IBCLC’s. Ten were African American CLC’s. All were experts at what they brought to the table to assist African American women breastfeed their babies.

Discussions during the Summit included: reforming healthcare through breastfeeding, exemplary lactation projects, consulting with doctors on effective initiatives, samples of breastfeeding support programs, saving our babies, reclaiming our breastfeeding experience, a continuum of care from the hospital to the neighborhood which featured primary care, hospital, community and public health and bridging the gap on breastfeeding disparities. These were the concerns of the experts on the planning committee. They were confirmed to be significant issues in our community by those in attendance. The raging debate about what certifying body should reign supreme in lactation management cannot distract us as we seek to save our babies. We could, however use your help with special situations when the occasion arises. ROSE will continue to be about the business of increasing initiation rates and duration rates of breastfeeding in the African American community.

You may contact ROSE, Inc. by sending email to BreastfeedingRose@gmail.com or visiting their website at BreastfeedingRose.org.

Kimarie Bugg MSN, MPH, is President and CEO of Reaching Our Sisters Everywhere Inc. (ROSE), a nonprofit developed to decrease breastfeeding disparities in the African American community. ROSE’s mission is to train African American healthcare providers and community organizations to provide culturally competent encouragement and support so that African American mothers may begin to breastfeed at higher rates and sustain their breastfeeding experience to match the goals expected by the Surgeon General of the United States. Kim has been a bedside breastfeeding counselor in a large metropolitan hospital, managed perinatal and breastfeeding projects and programs at the state level, and has served as a technical advisor to Best Start, as well as for the US Baby Friendly Hospital Initiative. Kim was a founding member and officer of Georgia breastfeeding task force (coalition) and SEILCA. Kim was trained at Wellstart International and has traveled throughout the United States and several foreign countries training healthcare professionals to manage lactation. Kim previously worked for Emory University, school of medicine, department of pediatrics as a nurse practitioner. She also provides the training for Georgia’s WIC Breastfeeding Peer Counselors, a proud position held since 2005. Kim is married to Dr. George Bugg Jr, a neonatologist and they have five breastfed children.

Mary Nicholson Jackson, CLC, works in a large urban hospital as a breastfeeding consultant and is the co-president of the Georgia State Breastfeeding coalition. Mary is Vice President of ROSE She is on numerous committees and task forces that address breastfeeding and lactation management in the community. She previously worked with Healthy Mother, Healthy Babies of Georgia. Mary is married and the mother of three adult children. She has three grandchildren.

Betty Neal, R.N., MSN, is a founding member of Reaching Our Sisters Everywhere Inc. (ROSE), a nonprofit developed to decrease breastfeeding disparities in the African American community. ROSE’s mission is to train African American healthcare providers and community organizations to provide culturally competent encouragement and support so that African American mothers may begin to breastfeed at higher rates and sustain their breastfeeding experience to match the goals expected by the Surgeon General of the United States. Betty has worked in women’s health for over 30 years. She completed certification as a Women’s Health Nurse Practitioner from Emory University. She recently retired from the State of Georgia Department of Human Resources, DeKalb County Board of Health as a public health nurse and program administration where she managed, developed and implemented numerous statewide and local public health programs. Her past experiences include instruction in a baccalaureate nursing program and mother-baby nursing in a large urban hospital. She has an passion for mothers and babies and believes we must support and ”nurture our mothers who will nurture our babies”.

Andrea Serano, a ROSE Inc. staff member, is from North Hollywood CA., and attended Mount St. Mary’s College with a major in Healthcare Policy and minor in Business Administration. During her course of studies, she participated in the Washington Semester Program- Transforming Communities at American University. She has interned at the U.S. Department of Health and Humans Service in the Office on Women’s Health and at Great Beginnings for Black Babies. Andrea has participated in breastfeeding awareness movements through the use of social media and hopes to one day establish a young women’s development center in the country of Belize.

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