Chocolate Milk: The Documentary

Photo courtesy of Elizabeth Bayne.

At risk. Unfit. Angry. These are words mainstream media often associate with Black mothers. Chocolate Milk: The Documentary counters this habitually negative narrative as award-winning director and producer Elizabeth Bayne, MPH, MFA explores the racial inequities of breastfeeding in her first feature-length film.

NAPPLSC President Felisha Floyd, BS, CLC, IBCLC, RLC  screened a 30 minute clip of Chocolate Milk at Healthy Children Project’s latest International Breastfeeding and MAINN Conference followed by an eye-opening, interactive discussion.

Bayne says she has the ambitious goal to host 200 community screenings of Chocolate Milk in celebration of National Breastfeeding Month this year. She hopes to examine racial disparities in breastfeeding by humanizing the experience of Black mothers.

When the narrative about the Black community is that they’re under threat, at risk, there’s so much violence and dysfunction, and then you come to someone’s home and you meet this mom getting [her kids] dressed, feeding them, interacting with her husband…” Bayne begins. “You see this side of Black America that you don’t get a glimpse of in the media.”

Documenting a movement

Chocolate Milk: The Documentary started as a web series featuring interviews with mothers and health care providers.

One day Bayne, also a public health professional, skimmed The Nation’s Health, a publication of the American Public Health Association (APHA), and came across an article about racial disparities in breastfeeding. A few years into her career, this was the first time she had encountered the idea that women struggle to breastfeed in the United States, and that women of color suffer from especially low breastfeeding rates.

“That really resonated with me,” she says.

Bayne started talking to people about breastfeeding, eventually convening a focus group of about ten health care professionals and Black mothers. It was during these conversations that the academic papers Bayne had been consulting came to life.

“I wish I had a camera. Why am I not recording this?” Bayne remembers thinking as she digested the women’s stories.

Ultimately, Bayne did begin recording, editing scores of roughly one hour interviews into two to three minute episodes and posting them online. The response was positive and soon women were contacting Bayne directly to share their stories on camera.

Bayne developed the web series as a way to contribute to the conversation about breastfeeding happening on social media and to gain trust within the community.

Quickly realizing the depth of the challenges mothers face, Bayne committed to a feature length documentary in order to document the Black breastfeeding movement.

Changing perspective

Bayne says she intends to dismantle stereotypes about Black mothers by presenting a different view of the community. Chocolate Milk is intended not just for women, but for the people whom they rely on for support, including their families, healthcare providers, communities and even mainstream America.

Photo courtesy of Elizabeth Bayne.

The selection screened at the International Breastfeeding and MAINN Conference features Tami, a mother who intended to breastfeed but ultimately ends up supplementing with formula.

Floyd facilitated a discussion centered around two questions: Was Tami successful in her breastfeeding experience? and Did race play a role in Tami’s breastfeeding experience? Stand on this side of the room if you strongly agree, stand on the other side of the room if you strongly disagree and stand in the middle of the room if you are unsure or undecided, Floyd instructed us.

To the far left (or right) of the room, I was struck by one participant’s comment that perhaps Tami’s experience was not influenced by race, but by her socioeconomic status, and that perhaps Tami simply needed to do more research.

At one point, I wondered if we viewed the same clip; in it we learn that Tami is college educated, and we watch her extensively Google information about breastfeeding.

Photo courtesy of Elizabeth Bayne.

A few Black women on the other side of the room spoke up: “Race is always a factor in the lived experiences of Black women.”

Confused by the participant’s presumed unwillingness to acknowledge racism, I wondered about Bayne’s interpretation. She says that racism today is not always as overt as in the Jim Crow South, and she hopes to “tap into that.”

To illustrate, Bayne tells the story of a Black woman who had just given birth and wanted to breastfeed, but the hospital nurse told her, “No, no, Black women don’t breastfeed.”

“[The nurse] had this perception [of Black mothers]. She couldn’t hear this woman telling her she wanted to breastfeed,” Bayne explains.

By presenting a breadth of Black experiences, Bayne hopes Chocolate Milk will remind viewers that “people are people”.

People of Color experience “fatigue in terms of trying to defend and educate” those who are not ready to understand.

“I don’t know if it’s a community’s responsibility, but as a communicator it’s my responsibility to try,” she says.

The women helping women

Chocolate Milk delves into the work of Black maternal child health professionals too.

Photo courtesy of Elizabeth Bayne.

“We can’t talk about breastfeeding without talking about including more Black health professionals and valuing Black health professionals as much as we value those who are White,” Bayne says.

She goes on to say that overall, lactation professionals’ work is undervalued because it is not always funded by health plans. As a result, Bayne has found that lactation specialists often provide guidance for free.

“Women go to the home even if they’re not paid; they can’t stand the thought of [a] woman going without assistance,” she says.

It’s a scenario that can contribute to a lot of burn out.

Bayne includes a midwife– the first Black midwife in her area in fact– in Chocolate Milk, to help depict the intricacies of helping others, self-care, and “just juggling so much.”

Representing a community

Bayne continues to share Chocolate Milk at conferences, and says she’s received valuable feedback.

Photo courtesy of Elizabeth Bayne.

Not a mother herself, Bayne was “nervous” about how well she was representing mothers’ challenges and if she was capturing their voices accurately.

Getting their story right,” Bayne reports. “That’s been the most reassuring and rewarding part.”

She laughs remembering filming one mother-child couplet as the little boy continually reached into his mother’s blouse. During filming, Bayne was unsure what to think of the interaction. When she screened this scene at a conference, the women laughed because they knew exactly what that meant. Chocolate Milk offers a comforting relatability.  

In progress

Bayne has connected with many experts for the documentary including Kimberly Seals Allers, Kathleen Kendall-Tackett, Jacqueline H. Wolf, Kimarie Bugg, Kiddada Green, Elizabeth Woods, Arissa Palmer, and Brandi Gates. She’s also hoping to feature Dr. Regina Benjamin, Regina King, Erykah Badu, and Kerry Washington.  

You can sponsor Chocolate Milk: The Documentary by clicking here.

Underdeveloped plans for infant and young child feeding during emergencies

Federal Emergency Management Agency (FEMA) called Hurricane Katrina “the single most catastrophic natural disaster in US history.”

Source: United States Breastfeeding Committee

In preparation for the storm, the government organized an alternate site for the Super Bowl but failed to employ an infant feeding in emergencies (IFE) plan, Healthy Children Project Executive Director Karin Cadwell reports. In the aftermath of the catastrophe, pets and exotic animals were accounted for, but mothers and infants were separated from one another as hospitals were evacuated.

WBTi Panel Members

In 2016, Healthy Children Project, Inc. (HCP)  convened an Expert Panel to complete the World Breastfeeding Trends Initiative (WBTi) an international tracking, assessment and monitoring system for national implementation of the Global Strategy on Infant and Young Child Feeding. The USA scored 0 out of 10 points on WBTi Indicator 9, which measures implementation of actions to protect infant and young child feeding (IYCF) during emergencies.

WBTi originator Dr. Arun Gupta challenged HCP to conduct a state-by-state review of WBTi indicators that can be measured on a state level. The US Expert Panel reconvened in 2017 to complete the United States of America and U.S. Territories 2017 Assessment Report. Results further show the absence of state policies ensuring babies and young children are safely fed during emergencies. HCP’s Cindy Turner-Maffei says that the lack of well-developed plans for protecting IYCF during emergencies was one of the most worrisome findings of the U.S. WBTi Assessment.

HCP’s Anna Blair and Cindy Turner-Maffei pictured with Dr. Arun Gupta.

She explains: “Scores above two points were rare, and most of the points scored regarded funding allocation for emergencies, not for specific inclusion of the needs of infants and young children in emergency plans.”

Puerto Rico and Texas scored 0 out of 10. New Jersey and Mississippi scored 2 out of 10. Oklahoma 3 out of 10. Connecticut took the lead at 6 out of 10.

Source: United States Breastfeeding Committee.

“Panel members were struck by the fact that few of the states and territories that had recently experienced significant disasters were among those with significant scores for Indicator 9,” Turner-Maffei continues. “Ironically, some states and territories have well-elaborated plans for the care and feeding of household pets in shelters, but none for infants and young children.”

In an effort to increase awareness and preparation, 1,000 Days— a non-profit working to improve nutrition and ensure women and children have the healthiest first 1,000 days–compiled a list of five things we need to know about breastfeeding in emergencies in their latest blog post published below. 1,000 Days also shares Supporting New Mothers in the Wake of Hurricane Maria, a guest post by Lourdes Santaballa, IBCLC and founder of ASI Alimentación Seguar Infantil. 1,000 Days created a Social Media Toolkit with shareable graphics and sample social media messaging.

 

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5 Things You Need to Know About Breastfeeding in Emergencies

Civil unrest and war, natural disasters and epidemics can force families from their homes, limit access to affordable, nutritious foods and clean water, and cause disruptions to basic services—like electricity and health care.

Breastfeeding is no easy feat—and when combined with the additional challenges that families face during emergencies, it can seem nearly impossible.

These recommendations are based on the recently published “Breastfeeding in Emergency Situations” Advocacy Brief, and for more resources please check out the Global Breastfeeding Collective, which is led by UNICEF and WHO.

Here are 5 things you need to know about breastfeeding in emergencies:

1.  Breastfeeding is the safest, most nutritious and reliable food source for infants under the age of six months.

Breastmilk is always the right temperature, requires no preparation and is readily available even in settings with limited access to clean water and adequate hygiene.

2.  Breastfeeding decreases the risk of infection and disease, which is vital to survival in emergency settings.

Breastmilk contains antibodies and other components that protect children against deadly infections. In emergencies, when there may be limited or no access to clean water and hygienic conditions, breastfeeding can drastically reduce the risk of diarrhea and other deadly diseases.

3. Breastfeeding mothers need (even more!) support during emergencies.

With adequate support almost all mothers can breastfeed, even in emergency situations. Support for mothers includes privacy and space, psychological counseling and assistance with attachment and positioning. Emergencies are stressful and may cause trauma for mothers, which leads to a need for even more support. For some mothers, breastfeeding can even help reduce stress.

4. When breastfeeding is not possible, immediate support is necessary to explore feeding options and protect the health of vulnerable infants.

The use of infant formula or powdered milk can pose significant health risks to babies in emergency situations where there may be limited or no access to clean water and hygienic conditions. They should only be provided when all other options have been explored. Non-breastfeeding mothers should receive immediate support from professionals to assist with safe feeding options, such as hand expression or cup feeding. Infant formula and powdered milk should not be donated but rather purchased as needed and administered carefully by professionals to minimize risk.

5.  Preparedness is key to ensure babies everywhere have the best opportunity to survive and thrive. Strengthening systems and capacities for breastfeeding support is a crucial form of emergency preparedness. Putting policies, programs and actions in place will provide support for mothers to breastfeed even when they are affected by an emergency.

In 2016 alone, at least 535 million children lived in countries affected by emergencies.

Emergencies pose a significant threat, causing child mortality rates to increase up to 70 times higher than average. Emergencies can happen anywhere, at any time—putting the world’s youngest children in an extremely vulnerable position.

During emergencies, the life-saving protection of breastfeeding is more important than ever. In emergency settings, breastfeeding guarantees a safe, nutritious and accessible food source for infants and young children and a protective shield against death and disease. But breastfeeding in emergencies is no small task—mothers face immense challenges, and we must provide support and put the rights, dignity and well-being of mothers at the center of our focus.


*As stated in our article about proposed changes to the BFHI, we expected to publish a post about the UK BFHI this week. The article will be postponed until a later date.

 

Proposed new guidelines for BFHI

Source: United States Breastfeeding Committee.

In October of last year, WHO and UNICEF released proposed new guidelines for the Baby-Friendly Hospital Initiative (BFHI) in a document called Protection, Promotion, and Support of Breastfeeding in Facilities Providing Maternity and Newborn Services: The Revised Baby-friendly Hospital Initiative 2017.

WHO developed new guidelines for the Ten Steps based on systematic evidence reviews on each of the steps. The guidelines were written by an external Guideline Development Group following standard WHO procedures, according to WHO’s website.

WHO and UNICEF opened a comment period for public consultation on the document, but many expressed concern over the brevity of the comment period. In fact, in an email addressed to Friend(s) of Baby-Friendly USA, BFUSA Executive Director Trish MacEnroe wrote: “Baby-Friendly USA (BFUSA) first saw this document on October 11 and, like all other global BFHI and breastfeeding experts, we were given less than two weeks to fully digest its contents and consider its ramifications.” In her email, MacEnroe acknowledged the importance of the document for Baby-Friendly practices around the world.

MacEnroe also addressed concerns from currently designated facilities and those in the 4D Pathway.

“Stay the course,” she wrote. MacEnroe explained that the proposed changes are a long way from being implemented; a process that first requires WHO to synthesize feedback into official language and then for BFUSA to develop an implementation strategy.

“In the meantime, the current standards are in place and will remain in place for the foreseeable future,” she offered.

Challenges and criticism of BFHI

As Dr. Fiona Dykes, head of the the Maternal and Infant Nutrition and Nurture Unit (MAINN) at the University of Central Lancashire (UCLAN), explained in her presentations at the latest International Breastfeeding and MAINN Conference, the approach of the WHO/UNICEF sponsored BFHI has been met with criticism over the course of its 25 years in existence.

Its top-down, bureaucratic approach using protocols, policies and surveillance, can be challenging to implement and operationalize in a culturally sensitive way, Dykes said.

Further, this approach can lead to “ritual behavior” where care providers care for the institution before the mother, sometime breaking rules to satisfy a task, she went on. Still, participating systems sometimes have inadequate compliance with the Code.

BFHI relies on breastfeeding champions and when these individuals retire, the process falters.

“The rug is pulled from under the initiative when you take away the breastfeeding champion,” Dykes said.

The same idea applies to its reliance on external donors rather than government budgets; Take away the money, and again the rug is pulled out from under the initiative.

A focus on individual facilities’ accomplishments versus national standards challenges BFHI as an initiative too. The emphasis on awards and status is not a sustainable model, Dykes commented.

What’s more, BFHI unintentionally encourages an inequitable system where some mothers have access to Baby-Friendly designated facilities and gold standard care, and other mothers birth in communities where “it’s not even talked about,” Dykes said.

WHO estimated that as of 2017, only about 10 percent of babies in the world were born in a facility currently designated Baby-Friendly.

Revising BFHI

In an effort to address these shortcomings, WHO and UNICEF created updated directions for BFHI implementation.

The document, while criticized for being poorly written, offers a refreshing tone with guidance focused on close and loving relationships.

“Mothers should be supported to recognize and respond to their infants’ cues for feeding, closeness and comfort, and enabled to respond accordingly to these cues with a variety of options, during their stay at the facility providing maternity and newborn services…” one line reads.

It goes on, “Supporting mother to respond in a variety of ways to behavioural cues for feeding, comfort or closeness enables them to build a caring, nurturing relationship with their infants and increases their confidence in themselves, in breastfeeding and in their infants’ growth and development.”   

The document also addresses items like establishing national standards, integrating into other health systems, and establishing regular internal monitoring and external assessment.

Dykes commented: “The bottom line is as long as we are getting best practice, then how that works doesn’t matter too much, as long as it can be embedded and sustained.”

For example, she referenced UK BFHI which, while still embracing the 10 Steps, is “doing their own thing.”

“They have a very nuanced approach,” Dykes said.

Research Associate at DECIPHer, Cardiff University and Research Manager for NCT Heather Trickey wrote Can we have better conversations about breastfeeding? in light of UNICEF’s Call to Action on Infant Feeding in the UK, a campaign centered around four key actions which includes implementing evidence-based initiatives that support breastfeeding like the Unicef UK Baby Friendly Initiative.  

“We deeply admire the work of our colleagues in the UK,” MacEnroe wrote in an email to Our Milky Way.  “When we see the final document from WHO, we will consider a variety of options for implementing the revisions.  Our goal is to create the best and most effective breastfeeding support program for mothers and babies in the US.”

Stay tuned to learn more about UK BFHI and Trickey’s work next week on Our Milky Way.  

Implementing the possible

Gill Thomson presents at the International Breastfeeding and MAINN Conference.

When you hear Dr. Gill Thomson talk about birth trauma, or when you learn how poorly the U.S. scores on the World Breastfeeding Trends Initiative (WBTi) assessment, or when you witness maternal child health advocates reluctant to acknowledge the effects of racism, it’s easy to feel stunned and helpless; like the work we’re doing is taking us nowhere. But then there are the encouraging, triumphant moments like when the U.S. Senate introduced the Supporting Working Moms Act of 2017, when a breastfeeding emoji emerged, and when Camie Goldhammer breastfed her daughter healing the past, reclaiming her culture.

This year’s International Breastfeeding and MAINN Conference held both discouraging and uplifting moments sparking abundant energy. This week’s post is an attempt to channel that energy into actionable items.  “Don’t let the vision of the ideal prevent the implementation of the possible,”   Dr. Renée Flacking quoted Healthy Children Project (HCP) Executive Director Karin Cadwell reminding us all the importance of moving forward.

Jeni Stevens, George and Jess take a selfie at the conference.
  • Assess your state breastfeeding coalition. What are its priorities? Do those priorities reflect its focus? How is it serving your communities? HCP’s state by state WBTi assessment helps states pinpoint where they need to focus efforts. HCP faculty suggest connecting with other coalitions in states that scored high in areas where your state lacks. Use them as models. In places where conferences or licensure is the main focus, switch gears and do something with this report.

 

  • Self reflect. Generational trauma and racism undeniably and profoundly affect People of Color. Maybe we aren’t slave owners, maybe we don’t don white hoods, so it can be challenging to admit and accept that each day, we participate in systems that oppress. “It’s a sucky system to be in,” NAPPLSC’s Felisha Floyd acknowledged. “It was none of our choices to be in it.”  But without reflection and ownership of these inequities, we’ll never achieve equity for those who suffer most.  You can take Project Implicit’s social attitudes test which measures implicit associations about race, gender, sexual orientation, and other topics here.

 

  • In this light, call out racism when you see it. “Normalize uncomfortable conversations. You can’t grow from comfort. Be change agents,” Floyd suggested.

 

 

  • Help Nikki Lee make breastfeeding safe for mothers living in shelters. Provide feedback on her 10 Steps to a Breastfeeding Friendly Shelter (Scroll down for document). Email her at nleeguitar@aol.com.

 

 

 

 

  • Submit pieces about breastfeeding to media outlets. Breastfeeding is not often positively or accurately portrayed in mainstream media. Let’s change that! Write a piece about how breastfeeding is disease prevention, empowering, the epitome of eating local, etc. etc. etc.

 

  • Stop centering yourself in others’ narratives. Birth and lactation professionals are not heroines meant to save the day; we are “facilitators”, as Floyd puts it.

 

  • Seek out stakeholders. Infant feeding is at the core of… everything. Find parallel advocacy groups and join forces.

 

Nikki Lee’s draft of 10 Steps to a Breastfeeding-Friendly Shelter

International Breastfeeding and MAINN Conference links to documents and resources

Deerfield Beach, Fla. Stunning!

Unless I am chasing after my children in fear of their lives, I do not run. Quite honestly, even when I’ve grave concern for their safety, I proceed with more of a brisk walk than a sprint. The point is, I’m not a runner. But Friday evening, after the three days I spent at the International Breastfeeding and MAINN Conference, I wanted to run. I harbored so much energy, I felt as if my legs would take off in a dusty, cartoon-like fury down the streets of Deerfield Beach, Fla.

Surely, my fellow conference goers, you felt and foster this energy too. “My mind is just exploding with ideas,” one conference participant exclaimed during Barb O’Connor’s presentation on the ‘Grandmother’s Tea’. Another, mouth agape, speechless after interacting with Cathy Holland during her presentation on Emotional Freedom Technique (EFT). Others buzzed about Dr. Joanne Datangel-Gallardo’s relactation presentation and Camie Goldhammer’s Culture, Trauma, and Parenting: How It Is All Connected. The list of highly inspirational and informative speakers goes on.   

Embedded in our speakers’ presentations were links, documents, resources that you may have missed. I captured some of them which I’ll share below; of course nothing will be included from the breakout sessions I couldn’t attend. So if you have resources you’d like to share, it would be helpful to do so in the comments section of the blog below. We’d appreciate that!

Before we move on, I’d like to share with you a strategy Healthy Children Project’s Kajsa Brimdyr shared with me to help sift through the immense amount of insight shared by conference presenters and participants. For each article, stat or idea noted, Kajsa intersperses them through her calendar with an alarm, so that she can revisit them in manageable moments. Brilliant!

Wishing you all the best as you process the tremendousness of the International Breastfeeding and MAINN Conference experience!

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The Global Breastfeeding Collective: a partnership of 20 international agencies with the goal of increasing investment in breastfeeding worldwide led by WHO and UNICEF

Impact of the Baby-friendly Hospital Initiative on breastfeeding and child health outcomes: a systematic review

Protection, Promotion, and Support of Breastfeeding in Facilities Providing Maternity and Newborn Services: The Revised Baby-friendly Hospital Initiative 2017: proposed, revised guidance for the Baby-friendly Hospital Initiative.

Baby-Friendly USA response to the revised document

Conference participant reviews poster presentation

Clean Label Project Infant Formula and Baby Food

Cacho’s human donor milk study

The Dartmouth Atlas of Health Care: estimates that 30 percent of the nation’s health care  spending is a waste

The GRADE Appraisal System: an approach to grading quality (or certainty) of evidence and strength of recommendations used by Dr. Elizabeth Crabtree and colleagues

World Breastfeeding Trends Initiative (WBTi) United States State by State Report

Recommendations on appropriate complementary feeding here and here

From the First Hour of Life: A New Report on Infant and Young Child Feeding 2016

Breast cancer infographic

Brimdyr, Cadwell, and Stevens’ free presentation of An implementation algorithm to improve skin-to-skin practice in the first hour after birth on iLactation

Let the Duck Races begin! Participants raised over $1,000 which will allow HCP to purchase 40 headlamps for a hospital in Uganda.

The Grandmothers Tea Project by Barb O’Connor materials and curriculum

UK BFHI The evidence and rationale for the Unicef UK Baby Friendly Initiative standards

Chocolate Milk: The Documentary Series: a documentary by Elizabeth Bayne, MPH, MFA that explores black motherhood. Film creators are still fundraising to complete the project. Find out more about their fiscal sponsorship here.

PBS’s Unnatural Causes: “What connections exist between healthy bodies, healthy bank accounts, and skin color? Four individuals from different walks of life demonstrate how one’s position in society – shaped by social policies and public priorities – affects health.”

Basketball coach and player human connection video

Carbon Footprint Due To Milk Formula IBFAN & BPNI report

“Dog milk” video comedically mocks use of species not specific milk consumption