Suggestions for white lactation care providers on a path toward antiracism

One of the tenets of practicing as a Certified Lactation Counselor (CLC) is active listening. It’s the first step to humbly entering a relationship between ourselves and the parents we serve. Listening is one of the most effective, if not the most effective, skills a CLC can use to help families address their concerns and celebrate their triumphs. 

Active listening serves us well outside of the client-counselor relationship too. When we truly listen, we can learn to respect and celebrate humanity in the spaces where our differences collide. 

Photo by James Eades on Unsplash

For centuries, Black, Indigenous, People of Color (BIPOC) have had their experiences ignored and dismissed by those who don’t care to listen. Stories have been silenced altogether in fear of reprisal. 

Ancient Song Doula Services (ASDS) has launched their Listen To Me Now campaign, a safe space “to tell the truth about what parents, providers, family members, and communities are experiencing.” 

Active listening cues when it’s time to speak up. The current, global energy surrounding systemic racism calls upon us with privileged identities to seek individual awakening and to actively participate in the dismantling of unjust, inequitable systems. 

When the protests disperse and Race fades from the limelight, the work will continue. 

At this crucial time, we are all called to the work of dismantling injustice. (I would like to note here that my original sentence read: “Maybe– hopefully– you have already started this work.” until my editor pointed out that this assumes the reader is white. It is amazing how deeply woven and how subtle white supremacy can be, how easily overlooked it can be when you’re of privileged identity. I wrote those original words with pure intentions, but centered myself and my racial identity dismissing the entire population we’re rallying for.) 

In the words of ASDS Founder and CEO Chanel L Porchia-Albert:

“Now we are at a juncture of great awakening for some. A call to action to understand one’s own moral compass within the human dynamic.  A defining moment of choice.  A choice between doing good, a choice to promote justice and equity, a choice to reckon with understanding the power and privilege afforded to some at the expense of others.  

A choice to actively work towards dismantling intergenerational racism and the trauma it has caused over generations of Black people…

Now more than ever we need our collective community to drive equity, accountability, and sustainability to families. Because the privilege of some to sit and wait is not afforded to others and what we can do must be done now!… Onward Ever, Backward Never!!” 

Porchia-Albert suggests ways to engage:

  1. Share our Listen to Me Now Campaign centering the voices of Black pregnant people, providers, and community members in sharing their stories that will inform health policy, accountability, and collective change.
  2. Share and Donate to our Equity, Continuity & Hope GoFundMe created to support the community during this pandemic.  Help us to reach our goal! and let’s go beyondbirthwork!!
  3. Become a monthly donor your contribution will allow us to create sustainable change for our immediate community and beyond. 

One ally posted in a private lactation professional Facebook group wondering what her white CLC colleagues are doing to fight against injustice in healthcare. 

Photo by James Eades on Unsplash

Several care providers offered suggestions on how they’re working toward justice and equity including: 

Healthy Children Project Faculty Felisha Floyd, BS, CLC, IBCLC, RLC created a post calling for the investment in Black communities and Black businesses. There is a thread of Black birth workers’ Cash Apps for those compelled to contribute to their work. Find it here

NICHQ CEO Scott D. Berns reminds us in a message that “Everything we do should be viewed through a racial lens.”

Berns goes on to write, “Mr. Floyd, a 46-year-old Black man, along with concerned and outraged onlookers, called for help – but their voices were ignored, and a man died. Systemic racism is unacceptable. Let’s not continue to allow the voices for change fall on deaf ears.”  

Change is not easy, and this work is not easy. 

Melissa DePino, the white woman who shared the Starbucks video and co-founded the @privtoprog movement with Michelle Saahene acknowledges that in her piece A Love Letter to All the Overwhelmed White People Who Are Trying

Change takes time. DePino writes that it also takes a sincere desire to push through guilt and shame. It takes humility and an effort to get to know the parts of ourselves that we may not like. 

She concludes, “So my advice to you, having been where you are, is to sit back and listen. Don’t talk unless in white spaces to interrupt racism and to tell others you are on the path to antiracism…” 

Progress through podcast: Care provider supports families through relevant lactation education

When Tangela L. Boyd, MA, IBCLC, CLC, CLE, CCCE, CPD, a Union Institute & University affiliated faculty member and owner of Mommy Milk  & Me, Inc., had her twin boys 14 years ago becoming a mother of four, she simultaneously entered a space of advocacy.

“I had a very adventurous time with those guys in the NICU,” Boyd remembers. “It changed the way I thought about breastfeeding.” 

As a young Black mother, Boyd says she feels fortunate to have had support from hospital staff to feed her twins (which she went on to do for three years), acknowledging that this is not often the case for BIPOC families

“That support in turn gave me the desire to help other mommies,” she says.

Boyd’s passion lies in uplifting underserved communities, particularly families living in the rural regions of the Southeast U.S. where she lived for nearly 20 years. 

Now located in Florida, Boyd’s newly released podcast, The Early Postpartum Period, offers a way to stay connected and reach underserved mothers with basic, relevant breastfeeding information. 

Boyd admits that the technology was something new to her and it required much patience to bring the project to fruition. Still, she says, it’s something that she wants to commit to for a long time to come, connecting with families especially in the time after they’ve left the hospital. Boyd hopes to soon host focus groups to get a better understanding of what kind of information families would like her to cover in the episodes. 

In the meantime, she plans to release more episodes over the summer. Her practice emphasizes the importance of organization, so she’s planning a podcast featuring organizational skills and time management tips. 

“There is a lot of lactation education out there and I don’t want to be repetitive,” Boyd begins. “I want to hit areas that will really be relevant and give [parents] something they can use, not just something they can listen to.”  

Boyd explains that learning organizational skills can bring a sense of calmness which allows parents the energy to move forward with daily tasks, rather than getting engulfed by an often chaotic world. She suggests things like preparation, avoiding procrastination and working up endurance through taking a breath and stepping away when necessary. 

Especially as our country examines our foundations and current events have brought race to the forefront, Boyd emphasizes the urgency to address high Black maternal mortality rates.

The pandemic has illuminated ways in which to address these rates, Boyd explains, like out of hospital birth and doula support. 

“We have to move forward,” Boyd encourages. 

You can connect with Boyd on Twitter here and find her website here

Boyd has been featured on Ifeyinwa Asiodu’s PhD, RN, IBCLC Blacktation Diaires for her work on increasing breastfeeding and perinatal education rates among BIPOC. She has also written for Kimberly Seals Aller’s Mocha Manual.

Accessing the Milky Way scholarship opportunity

Recently, Healthy Children Project put out a statement about our stance on the current events. “These are incredibly trying and painful times. As we negotiate the very current multiple impacts of the COVID-19 pandemic, recent events remind us that systemic racism and social injustice are longstanding national plagues…For too long families of Black and Brown babies have lived in fear for their children, themselves and their loved ones. The Healthy Children Project and the Center for Breastfeeding will not tolerate injustice, hate, bigotry and racism in any form.”

We expressed our solidarity with birthing families, our staff, our participants, our families, our communities, and our friends and hold Black, Indigenous , Mothers of Color in our hearts, our mission and our vision and reiterated that we will not tolerate injustice, hate, bigotry and racism in any form. We especially remember the words of Dr. Martin Luther King, Jr. “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.”

Our mission and focus is all about supporting mothers and their breastfeeding journeys. We know that Black women experience maternal mortality and morbidity at three to four times the rates of white women and infant mortality is twice as high for babies born to Black mothers when compared to babies born to white mothers. We also know that breastfeeding can help mitigate both of these unacceptable disparities. 

We are taking steps to help Black mothers and Black communities while staying focused on what we do best; train people to assist with breastfeeding. 

Healthy Children Project and the Center for Breastfeeding has always been committed to making lactation care community diverse and equitable. We have worked to make the Lactation Counselor Training Course (LCTC) accessible by giving scholarships each year to organizations such as ROSE and HealthConnect One.

But we realized that we could do even more. Towards that end, we announce that we have started an initiative called Accessing the Milky Way. This initiative will send Black, Indigenous , People of Color to the online LCTC by offering scholarships that range from partial to full. 

The first phase of this initiative will provide full tuition for the online LCTC on full scholarship for 25 BIPOC. This Accessing the Milky Way scholarship will pay the entire tuition for the course. 

In addition, we have started a fund to pay for the required text book and the testing fee for each of the 25 recipients to further eliminate barriers to becoming a Certified Lactation Counselor. 

We invite you to nominate a person that you know who wants and deserves the opportunity to take the LCTC in order to better serve and support the mothers in their community. We will be accepting nominations now through July 10, 2020. If you would like to nominate an individual, please send an email to info@centerforbreastfeeding.org and include the nominee’s name, phone number, email address, city and state, and a short description of the work they are doing and the benefit to their community by them becoming a Certified Lactation Counselor. Self-nominations are welcome. 

There are two fixed costs that cannot be covered by the scholarship. The cost of the text book is $75.75 and the fee to take the exam after the class (administered by the Academy of Lactation Policy and Practice) is $120.  This additional $195.95 is another barrier to BIPOC getting training that will support the families in their communities. Healthy Children Project faculty is working to raise a total of $4900 which would cover these fixed costs for all 25 recipients of the scholarship. Those interested in growing this fund may visit the GoFundMe page here.

Paternal mental health and engagement

Humans are born connected. Separation is a learned behavior and in Western society, is often an accelerated process beginning just moments after birth

Photo by Kreated Media on Unsplash

If we can learn to separate, then we can unlearn those practices too. We can learn to reconnect. 

In recent time, skin-to-skin contact immediately after birth and beyond has been widely embraced as a tool to keep mothers and babies connected and to promote bonding. Skin-to-skin contact is encouraged to facilitate bonding between baby and father and other care providers too. 

As NICHQ President and CEO Scott D. Berns, MD, MPH, FAAP points out in Fathers: Powerful Allies for Maternal and Child Health, “father engagement and involvement is a critical opportunity to improve children’s health outcomes in the decades to come”… beginning in the prenatal period. 

Despite overwhelming evidence demonstrating the importance of paternal involvement, fathers are up against significant barriers “including systemic obstacles related to employment, and a lack of confidence stemming from social stereotypes about the expected role of a father—namely that their role is somehow secondary to the mother’s.” [https://www.nichq.org/insight/fathers-powerful-allies-maternal-and-child-health

Fathers BJ (left) and Frankie (right) embrace their seconds-old-newborn boy Milo. Milo’s umbilical cord is still attached to the surrogate in this image. Photo by Ontario artist Lindsay Foster. Formerly published in: http://www.ourmilkyway.org/skin-to-skin-image-goes-viral/

In an effort to address paternal mental health, Healthy Children Project faculty Eira Yates in partnership with OhioGuidestone developed the Yates Paternal Depression Screening Tool for male fathers, a first of its kind measurement. 

The tool is reminiscent of the Edinburgh Postpartum Depression Scale (EPDS) developed to screen for depression in women during and after pregnancy and childbirth, but different in that it is sensitive to fatherhood and “not retrofitted and adapted from tools developed to capture unique characteristics of depression in women and mothers.” 

Photo by Kelly Sikkema on Unsplash

The Yates tool can screen male fathers during the perinatal period (prenatal or before birth up to 12 months after birth) for signs of depression with questions related to Mood/Loss of Interest and Motivation, Aggression/Irritability, Self-Concept/Feelings of Worth, Social System Deficits and Drug/alcohol use.  

“We believe that a culturally sensitive, carefully designed tool can give insight into the particular ways depression manifests in male fathers, identify men at risk for perinatal depression, and highlight the need to tailor treatment and services to the unique experiences of male fathers,” Brittany Pope, M.S., Director of Applied Clinical Sciences and Research at OhioGuidestone explains. “Furthermore, we hope to spur opportunities to explore potential programming, treatment and policy changes, both to raise awareness of the need to screen male fathers and to offer efficient and effective services and programs to meet their clinical and parenting needs.” 

The tool isn’t yet published and due to COVID-19,  research activity has been suspended, however the team plans to reopen the study using remote telehealth videoconferencing in August/September. This method will allow for even higher recruitment and screening. 

You can learn more about the screening tool at The Institute of Family & Community Impact’s website here

Photo by Chris on unsplash

In another effort to include fathers in the conversation around birth practice, separation and support,  Lactation Specialist Lydia O. Boyd, CLE is conducting a survey to capture the experiences of Black males through the Covid-19 pandemic. The survey can be found here

Reaching Our Brothers Everywhere (ROBE), an organization dedicated to educating, equipping, and empowering men to impact an increase in breastfeeding rates and a decrease infant mortality rates within the African-American communities, is hosting its 2020 Virtual Summit June 23 & 25 featuring speakers Dr. Saturu Ned, former Black Panther, Dr. Brian McGregor, Dr. Torian Easterling, Kenn Harris from National Healthy Start and the entire ROBE team. Register here.

A call to reinvigorate the International Code Of Marketing Of Breastmilk Substitutes

Last month marked the 39th anniversary of the World Health Organization (WHO) International Code Of Marketing Of Breastmilk Substitutes. As the World Alliance for Breastfeeding Action (WABA) reminds us,  “Following the adoption of the Code in 1981, governments have been called upon by the World Health Assembly to give effect to the provisions in the Code through national legislation. So far, UNICEF/ World Health Organization (WHO)/ #IBFAN have identified 136 countries as having Code regulations in place.”

Photo by Andre Adjahoe on Unsplash

You might know that the U.S. is not one of these nations. 

In a timely offering– when formula companies use the crises of the pandemic to prey on mothers and babies– The Network for Global Monitoring and Support for Implementation of the International Code of Marketing of Breastmilk Substitutes and subsequent relevant World Health Assembly Resolutions (#NetCode) has developed a toolkit to reinvigorate and reinforce ongoing monitoring and periodic assessment of the Code and national laws. The toolkit offers health advocates an opportunity to connect with governments to establish a sustainable system that will monitor, detect and report violations of national laws. Find it here: https://waba.org.my/netcode-toolkit-for-ongoing-monitoring-and-periodic-assessment-of-the-code/?fbclid=IwAR2PzeROMctrsCJ3ZiG8gah07IXQMhI-3eSn6EqLDhV3-TdGhhmk-IxDzt4

“Formula manufacturers are exploiting the panic and fears of contagion to intensify their aggressive marketing practices,” Patti Rundall writes in the Baby Milk Action policy blog. “In this context, government action to regulate the marketing of breast-milk substitutes has never been greater.”

On May 28, the World Health Organization (WHO), UNICEF, and the International Baby Food Action Network (IBFAN) launched the virtual 2020 Status Report which highlights which countries have implemented measures required by the Code. [The official launch event can be viewed here.]

Photo by Kelly Sikkema on Unsplash

“Given the important role of health workers in protecting pregnant women, mothers and their infants from inappropriate promotion of breast-milk substitutes, the 2020 report provides an extensive analysis of legal measures taken to prohibit promotion to health workers and in health facilities,” Thahira Shireen Mustafa, Department of Nutrition and Food Safety, writes. 

In the U.S. in late March, Baby-Friendly USA released a statement detailing access to adequate nutrition for babies born during the Covid-19 crisis with an announcement explaining that BFUSA  would relax one standard regarding the provision of small quantities of formula upon discharge to formula feeding families in communities experiencing shortages in retail outlets. 

“We did so to ensure that formula feeding families receive essential support during this global emergency,” BFUSA CEO Trish MacEnroe writes. “We did NOT loosen restrictions on interactions with formula companies.”

MacEnroe goes on to write, “Regrettably, some formula companies have interpreted our statement as a window of opportunity to reengage their aggressive marketing tactics with Baby-Friendly designated hospitals… 

“We at BFUSA are appalled that these companies would use the pandemic as an ‘opportunity’ to advance their business interests under the guise of an intent to support facilities during this difficult time.

So, please let us be perfectly clear: Our standards are still our standards. We have not ‘loosened’ our guidelines and we still expect Baby-Friendly designated facilities to shield health care workers, mothers and families from commercial influence, as outlined in the International Code of Marketing Breast-Milk Substitutes.”

Photo by Luiza Braun on Unsplash

In other parts of the world too, companies exploit the Covid-19 crisis. Baby Milk Action documents how one company violates Indian Law with their YouTube channel. Keep scrolling and scrolling and scrolling on Baby Milk Action’s page and you’ll find offense after offense after offense documented in multiple countries. 

In response, there are several documents cited offering guidance on how to navigate avoiding partnerships with these corporations.  Find them here

On an individual level, this is a great time to remind Certified Lactation Counselors (CLCs) of our Code of Ethics which states we must “Abide by the International Code of Marketing of Breast-Milk Substitutes and subsequent resolutions which pertain to health workers.”