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Reflections from a Former Chris Mulford ILCA-WABA Fellow

The International Lactation Consultant Association® (ILCA®) and the World Alliance for Breastfeeding Action (WABA) are pleased to once again jointly sponsor the exciting opportunity for a Fellowship to travel and work with WABA on outreach and advocacy projects at their headquartersin Penang, Malaysia. ILCA has designated this annual Fellowship, the 6th to be awarded, as the Chris Mulford WABA ILCA Fellowship. Chris had been an ILCA member and helped to guide the birth and growth ofthe profession with a gentle spirit and wise leadership. Chris first joined WABA in 1996 at the first WABA Global Forum in Bangkok and became a long term volunteer for WABA. She worked mainly on Women and Work and Gender issues, bringing many achievements in supporting working women to breastfeed globally. She also paved the way for the first WABA‐ILCA Fellowship, in 2007, by being an exemplar of a Fellow. At Lactation Matters, we are proud to highlight this post, by Denise Fisher, a recent fellow, about her experiences in Malaysia with WABA.

For more information about applying to become a Fellow, please see this document. The deadline for applications is October 22, 2013.

By Denise Fisher AM, MMP, BN, IBCLC

In 2010, I was honored to be selected the Fellow to work with the World Alliance for Breastfeeding Action (WABA) staff on several projects to support breastfeeding worldwide.

WABA’s home office is in Penang. Penang has been called the Jewel of the Orient, and is a beautiful island off the coast of Malaysia. Malaysia is a bustling melting pot of races and religions where Malays, Indians, Chinese, and other ethnic groups live together harmoniously. Because of this multiculturalism, this tropical paradise has also made Malaysia a gastronomical paradise, and even the Malays from Kuala Lumpur will tell you that Penang is the place for the best food.

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I was incredibly excited to be given the opportunity for this fellowship to not only continue my passion for promoting breastfeeding, but to do it in such a fascinating country.

Now, while I was working on a purely volunteer basis, I was aware that ILCA® and WABA had invested financially in my travel and accommodation, and my family and work colleagues back home were also putting in big-time for me in my absence; so while the temptation was to spend many hours on the beach, I was keen to be able to help WABA as much as possible. I was given several projects to complete. They select projects that are in line with your interests and skills, so needless to say mine were either internet-related or education-related.

The biggest project was the establishment of the Breastfeeding Gateway. We worked as a small team to establish it in time to be launched for WABA’s 20th birthday celebrations. The goal of this Gateway is to provide you with all the quality information about a topic in one easy collection.  For example, you may be asked at work to develop a policy on an HIV-positive mother breastfeeding. You only need click on the HIV heading in the Gateway to open a page with links to all the quality information sites relevant to HIV on the internet, saving you hours of searching. This is perfect for students too – so easy. I loved helping to create this resource – it was such fun to work together on it.

Another project I had was to go to one of the local hospitals and film a mother doing skin-to-skin care and have baby self-attach. As a midwife, the opportunity to visit the maternity unit was one not to be missed, and then we had the most delightful mother, with a very obliging newborn who did exactly what he was supposed to (phew!).

Presenting a full-day workshop for the medical and nursing staff at the local university was pretty nerve-wracking, but on the day it all went smoothly and everyone was happy. Doing a workshop for the mother support group that had been established by a previous WABA/ILCA Fellow was much less stressful and I got to cuddle babies!

IMG_6511It wasn’t all work though. The WABA staff welcomed me into their lives and social events, and were all very friendly. I still keep in contact with some of them. I’ve been told I have to come back when the durian are fruiting (!). A young intern from America was working there at the same time I was, so both being visitors to the island, we spent our leisure time exploring – most memorable was the bicycle tour through Georgetown (the capital of Penang). You think traffic is bad where you live – wait until you’ve ridden a bike through the streets of an Asian city! This was a history and food tour – we went to lots of the historical sites (Georgetown is a UNESCO World Heritage Site) and our guides (two lovely young men) told us about living and working in Penang now, and what it was like for their parents and grandparents. And then there was the food – they took us to each of the places that was famous for each of the dishes Penang is famous for – lucky we did lots of riding to work it off. Another tour I did with my son was a guided taxi ride around the island. It truly is a tropical paradise.

Since my time in Penang, I’ve become one of a select group who get to meet up at the ILCA conference and talk about the good old days – the former WABA/ILCA Fellows! And even better, this year ILCA decided to honor us with a special Fellow’s pin. Based on my wonderful experience which was so personally and professionally rewarding I’d encourage everyone to consider applying for this yearly fellowship. You won’t regret it.

IMG_6093Denise is a registered nurse, midwife practitioner, and lactation consultant who has worked in education for many years. In recognition of her services to health professional education, specifically in the mother and baby area, Denise was inducted as a Member of Australia last year. Recognizing that the internet was the way of the future, Denise and her team created Health e-Learning in 2000, followed by the very popular GOLD conferences, to provide breastfeeding education for lactation consultants and other health professionals. She is now the Director of Step2 Education, a company that delivers Baby Friendly education to hospitals worldwide. Denise is married to Steve and mother to 3 beautiful young adults – James, Nicholas and Laura, and lives outside a little country town in Queensland, Australia.

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New HIV and Breastfeeding Resource from the World Alliance for Breastfeeding Action (WABA)

By Pamela Morrison, IBCLC

Photo by  DFID - UK Department for International Development via Flickr Creative Commons

Photo by DFID – UK Department for International Development via Flickr Creative Commons

Have you gained the impression that maternal infection with the Human Immunodeficiency Virus (HIV) automatically rules out breastfeeding? Or that formula-feeding by HIV-positive mothers, whenever possible, is always recommended? If you have had access to different global World Health Organization (WHO) HIV and infant feeding recommendations over the years, do you find them confusing? If the answer to any one of these questions is Yes, then you are not alone.

Based on the huge amount of research conducted since the 1985 discovery that HIV could be transmitted in mothers’ milk, global guidance about breastfeeding in the context of HIV has been changing every few years. One of the spillover effects has been that IBCLCs and others who work with mothers and babies have frequently been exposed to outdated and/or myth-information.

However, IBCLCs can now feel more confident than ever before in supporting HIV-positive clients who express a desire to breastfeed. With certain safe-guards, including maternal adherence to antiretroviral (ARV) regimens which are mandatory in developed countries, the risk of transmission of HIV through breastfeeding can be reduced to virtually zero.

Originally conceived as a joint ILCA-WABA collaborative project, with a gestation period of over seven years, WABA marked World AIDS Day this December with the easy delivery of a new Comprehensive Resource entitled “Understanding International Policy on HIV and Breastfeeding” which can be downloaded HERE.

Intended for use by policy-makers, national breastfeeding committees, breastfeeding advocates, women’s health activists and others working for public health in the community, the Resource sets out why breastfeeding in the context of HIV has never been as safe as it is today. Recent research shows that HIV-positive mothers who receive effective ARVs, protecting their own health sufficiently to result in a near-normal life-span, can also expect that the risk of transmission of HIV to their babies during pregnancy, birth, and throughout the recommended period of breastfeeding, can be close to zero. As a consequence, today’s HIV-positive mothers are enabled to avoid both the stigma and the risks of formula-feeding because current HIV and infant feeding guidance is once again more closely aligned to WHO recommendations for their uninfected counterparts, in place over the last decade: exclusive breastfeeding for 6 months and continued breastfeeding with the introduction of age-appropriate complementary feeding for up to 2 years or beyond.

Building on current research, the 2010 global HIV and infant feeding guidelines and ARV recommendations for prevention of transmission of vertical HIV show that, for the first time, there is enough evidence to recommend ARVs while breastfeeding. Where ARVs are available, it is recommended that HIV-positive mothers breastfeed until their babies are 12 months of age. Furthermore, updated WHO programmatic advice issued earlier this year for ARVs for pregnant women and prevention of HIV infection in their infants has gone a long way towards clarifying many previously perceived ambiguities. Rather than different ARV regimens being decided on the basis of an individual HIV-positive mother’s disease progression, a clear recommendation is now made for provision of ARVs to all HIV positive pregnant women from the time that they are first diagnosed with HIV and continued for life.

With proper treatment, an infected mother’s viral load becomes undetectable, not only protecting her own health and survival, but also reducing to virtually zero the risk of her baby acquiring HIV through her breastmilk.

Thus, current guidance has enabled countries as diverse as South Africa and the United Kingdom to develop national recommendations which once again effectively support breastfeeding for all babies. The up-to-date guidelines simultaneously free health workers from having to tailor infant feeding advice to the HIV-status of their clients and lift from HIV-positive mothers the stigma attached to previous advice about formula-feeding. Most importantly, current guidance ensures the greatest likelihood of HIV-free survival for babies exposed to the virus.

Fully referenced throughout, the Resource’s six sections clarify many past misconceptions by helping to explain how they came about. They track the impact of HIV on women and their infants, review past and current research on transmission of the virus through breastfeeding, trace the evolution of past guidance, outline current policy and counselling recommendations and list easily accessed informational and training materials.

The Resource clarifies how, in a situation of competing infant feeding risks, breastfeeding can now be safely promoted and supported. It is hoped that this tool will enable all who work with HIV-positive mothers to confidently endorse current HIV and breastfeeding recommendations so that each individual child’s chance to survive and thrive can be maximized.

We hope that this document impacts practice and helps to support mothers with HIV all over the world. Please download your own copy of “Understanding International Policy on HIV and Breastfeeding” HERE

pmorrisonPamela Morrison’s interest in HIV and breastfeeding arose from having worked as a private practice IBCLC in a country where HIV-prevalence amongst pregnant women reached 25%, yet breastfeeding was both the cultural norm and a cornerstone of child survival. While in Zimbabwe, Pamela also worked as a BFHI Facilitator and Assessor, as well as serving on the Zimbabwe National Multi-sectoral Breastfeeding Committee and the national BFHI Task Force. She has also served on the World Alliance for Breastfeeding Action (WABA) Task Forces for Children’s Nutrition Rights, and for HIV and Infant Feeding, and the ILCA Ethics & Code Committee. After moving to England in 2005, she was employed until 2009 as a Consultant to WABA. She is currently the ILCA media representative on HIV, and continues to do volunteer work for WABA.

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If YOU Don’t Advocate for Mothers & Babies, Who Will?

Written by Jennie Bever Babendure, PhD, IBCLC

As IBCLCs, part of our Code of Professional Conduct  (IBLCE November 1st, 2011)calls on us to adhere to the World Health Organization’s (WHO) International Code of Marketing of Breast-Milk Substitutes and Subsequent Resolutions.  For those of us who hold this Code in high esteem, the news that WHO is accepting corporate funding and instant payday loans for its obesity initiative is enough to turn our stomachs many times over. According to the article, the Pan American Office of the WHO (based in Washington, D.C.) has begun to accept funding from fast food makers, among them the food giant and WHO Code violator Nestle.

As I struggled to reconcile the idea that an organization focused on world health would accept funding to fight obesity from the organizations that stand the most to gain from creating it, I began to feel crushing discouragement. How on earth can we, as a small band of mothers and breastfeeding professionals supporting the WHO Code, compete with multinational corporations with seemingly endless supplies of money? How can we succeed at supporting the WHO Code when the WHO is taking money from one of the worst offenders?

This is the point in the story when the hero has been soundly defeated. She goes back home with her eyes on the ground kicking stones in the path. She decides she will never win, so she might as well give up and just make noodles for the rest of her life (oh wait, I think that might be from one of my son’s favorite movies).

After a long night of frustration, writing, and a little alcohol, I chose to reframe the issue as a CALL TO ACTION. And if the WHO violating the WHO Code isn’t a call to action slapping me in the face, I don’t know what is!

But what can we do?

Most of us are doing our darndest to help mothers and babies start and continue breastfeeding in the face of tremendous marketing and cultural pressure to do otherwise. We stay awake nights worrying about how to best help a mother struggling with thrush or low supply, pour over research on tongue-tie and search the web for resources for new mothers. What more can we do?

The time has come for us to see our roles expand.  Our job as lactation professionals must not only be to provide individual breastfeeding support, but also to advocate for maternal and child health on a larger scale. If we don’t begin to protest the status quo and work to change the political and cultural barriers that mothers face in their attempts to reach their breastfeeding goals, we will be fighting the same battles for the next 100 years. The International Baby Food Action Network (IBFAN) has long been at this fight. They shouldn’t have to fight alone.

In many places, we are beginning to see policies and legislation changing. We need to harness that momentum to move the tide even further. Now more than ever, mothers and babies need us to advocate for them and they need us to empower them to demand change themselves. Not just in the clinic or hospital, but in the grocery stores and restaurants, in the hallways and on the floor of congress. When mothers and babies protest a mother being asked to leave for nursing in public, we need to show up. When our congressmen and women debate policies that impact breastfeeding, we need to show up. When a news station wants to run a story on breastfeeding, we need to show up. When the WHO takes money from Nestle, we need to show up!

For some, showing up means planning and attending nurse-ins and rallies, for others it is talking, blogging and posting information on the cultural and political barriers to breastfeeding on websites, twitter and Facebook pages. Still others have the ability to influence corporations and other organizations they are a part of by changing the way they do business, who they work with, and how they support their employees. Even beginning to have conversations with the mothers you work with about choosing to support companies that uphold the WHO Code can have an impact!

We can also leverage our resources by joining forces with other organizations working to improve maternal and child health. In addition to IBFAN and the World Alliance for Breastfeeding ActionNatasha K. Sriraman has written about the organization 1000 Days for the Academy of Breastfeeding Medicine.  With a goal of improving life by improving maternal and infant nutrition in the first 1000 days –pregnancy through the second birthday—1000 days seems like a natural ally of lactation consultants and maternal-child health advocates.  Working with like-minded organizations will increase our ability to impact policies and legislation that prevent corporations like Nestle from sabotaging breastfeeding in both developed and developing countries by marketing their products directly to mothers.

When I was younger, I was under the illusion that if something important were happening, someone else would take care of it. As I’ve gotten older I’ve realized that is rarely the case. When the WHO takes money from a formula company, something is terribly wrong. If we don’t do something about it, who will?

If you are interested, please consider joining the “Friends of the WHO Code” Facebook Group to discuss violations of the WHO Code, especially those on social media, and how we can empower lactation professionals, volunteers and mothers to stand up for its importance.

Jennie Bever Babendure, PhD, IBCLC: I am mother to 2 active boys and an Assistant Research Professor in the College of Nursing and Health Innovation at Arizona State University. As breastfeeding researcher, I am constantly scanning the literature for articles that guide my research and inform my clinical practice. One of my goals is to increase the evidence base of our profession as lactation consultants. I feel it is important for lactation professionals to be aware of and contribute to breastfeeding research, especially when so much of it is fascinating! As an ongoing contributor to Lactation Matters, it is my hope that you will find the articles I highlight as interesting and informative as I do, and that you will use them to guide you in the important work of lactation professionals and breastfeeding advocates. For more research news and commentary, check out my blog at www.breastfeedingscience.com. I can be reached at jennie.bever@gmail.com.

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