Guiding resources for infant and young child feeding during emergencies

Not long ago, when extreme weather occurred, we were told it wasn’t possible to link specific events to the climate crisis. Now though, scientists have figured out a model to represent how the climate crisis produces specific weather events like Hurricane Harvey and the extreme heat in the Pacific Northwest.

We know that these extreme events will occur more and more, continuing to affect everyone on the planet. Climate-related emergencies are displacing entire populations of people. Read about The Great Climate Migration here and here.

As climate-change related emergencies continue, the need for support for mothers and their young children is crucial. In the United States, “we have a long way to go to ensure that families are held with kindness and care during emergencies,” United States Breastfeeding Committee’s (USBC) Amelia Psmythe Seger writes in Disasters Don’t Wait.

Photo Credit: CDC https://www.cdc.gov/nccdphp/dnpao/features/disasters-infant-feeding/index.html

Protecting and supporting breastfeeding at every level and continuing with appropriate complementary feeding are proven strategies for reducing health risks to infants and young children and can limit the impact of the rapidly growing formula industry on climate change and the first-food system.  

In an event earlier this year, the Global Breastfeeding Collective (GBC) and the IFE Core Group hosted Strategies for Infant and Young Child Feeding (IYCF) in Climate-Related Emergencies.

Speaker Isabelle Modigell, lead author of the Operational Guidance: Breastfeeding Counselling in Emergencies, shared a list of resources that will inevitably become more and more applicable to those working in the field of maternal child health as we are challenged by the climate crisis. 

As planetary health heals and healthy IYCF becomes a global priority, it is our hope that these resources someday become obsolete. In the meantime, please consult the strategies set forth in these documents as we trudge through current realities. 

  • The Sphere Handbook sets minimum, humanitarian standards. In its Food Security and Nutrition chapter, Standard 4.1 covers policy and coordination and Standard 4.2 covers multi sectoral support.  

 

  • For details on how to implement these minimum standards, head to IFE’s operational guidance on infant and young child feeding in emergencies.  This document is portioned into six key sections, available in over 10 languages, and as Modigell points out, the hard copy is small and easy to pop into luggage, a definite advantage as internet access is often limited or absent during emergencies.  

 

  • Based on the Operational Guidance on IYCF-E (OG-IFE), IFE published the Infant and Young Child Feeding in Emergencies (IYCF-E) infographic series. The infographics are designed for a diverse audience, from midwives to policy makers. This resource has information on things like stopping inappropriate donations and dealing with waste management. 

 

Creating strong plans, support and policies during non-emergency times is also critical of course. When these safeguards are already in place, it lowers vulnerabilities during emergencies. For this, Modigell says, we must start with the Code, and we must improve ongoing access to skilled breastfeeding counseling.

Photo by Luiza Braun on Unsplash

From a U.S. perspective, as part of its Racial Equity training series, USBC hosted an Infant and Young Child Feeding During Emergencies (IYCFE) webinar featuring Katherine Shealy, Centers for Disease Control and Prevention, Aunchalee Palmquist, Carolina Global Breastfeeding Institute, UNC-Gillings School of Public Health, Felisha Floyd, National Association of Professional and Peer Lactation Supporters of Color (NAPPLSC), Lourdes Santaballa, Executive Director, IBCLC, IYCFS at Alimentación Segura Infantil (ASI), and Tracy Erickson, Texas Department of Health Services, WIC Program. It was designed to help coalitions and organizations build the capacity to coordinate support and be active IYCFE stakeholders. You can watch that here.

Also on the national front, USBC delivered their organizational sign-on letter supporting the DEMAND Act of 2022 (Delivering Essentials to Mothers Amid Natural Disasters Act). The DEMAND Act would ensure that lactation support services and supplies are eligible expenses for emergency assistance through the Federal Emergency Management Agency (FEMA) Critical Needs Assistance program. The letter was delivered to members of the House Subcommittee on Economic Development, Public Buildings, and Emergency Management and the Senate Committee on Homeland Security and Governmental Affairs. Additional signers will be added on a rolling basis. Updates on this effort and others can be found in their Weekly Wire Newsletter.

It’s Black Maternal Health Week: “Building for Liberation: Centering Black Mamas, Black Families and Black Systems of Care”

April is National Poetry Month. “[It] reminds the public that poets have an integral role to play in our culture and that poetry matters,” says the Academy of American Poets.  In a beautiful convergence, this week is also Black Maternal Health Week (BMHW) nestled intentionally within National Minority Health Month

Written decades ago on a different continent,  Poem for South African Women by June Jordan resonates today with the message of fighting systemic racism. 

“We are the ones we have been waiting for,” Jordan penned.

It embodies the #BMHW22 theme, “Building for Liberation: Centering Black Mamas, Black Families and Black Systems of Care”. The theme reflects founding and leading organization Black Mamas Matter Alliance’s (BMMA) work in centering Black women’s scholarship, maternity care work, and advocacy across the full-spectrum of sexual, maternal, and reproductive health care, services, programs, and initiatives. 

The BMHW22 campaign is a week of awareness, activism, and community building intended to:

  • Deepen the national conversation about Black maternal health in the US;
  • Amplify community-driven policy, research, and care solutions;
  • Center the voices of Black Mamas, women, families, and stakeholders;
  • Provide a national platform for Black-led entities and efforts on maternal health, birth and reproductive justice; and
  • Enhance community organizing on Black maternal health.  [https://blackmamasmatter.org/bmhw/]

You can watch BMMA’s National Call surrounding the fifth-year anniversary of BMHW here which highlights all of the major activities happening online and across the nation in celebration of Black mothers and their families. On April 17, individuals have the opportunity to get to know the organizations that make up BMMA, Black-led organizations that are doing the work and making a difference for BIPOC families. Of those organizations is reproductive justice organization Restoring Our Own Through Transformation (ROOTT). ROOTT’s Jessica Roach’s TEDx talk is just one example that encapsulates both the maternal infant health crisis we find ourselves in and the triumphs that are to be elevated.  

Celebrate the first-ever Community Doula Week

Everyone has “a week,” says BirthMatters community doula Eboni Williams who is based in Spartanburg, SC. There’s National Healthcare Volunteer Week, National Midwifery Week, Cardiovascular Professionals Week, Medical Assistants Recognition Week and so on.

In an effort to celebrate the critical work of community doulas, Williams dreamed up the first-ever Community Doula Week (#CDW2022), a weeklong campaign (March 29th – April 5th) to highlight the unique and life-saving support community doulas offer birthing people and their families. 

In partnership, BirthMatters and HealthConnect One are facilitating #CDW2022; acknowledging the importance of community doulas through public awareness, affirming the critical support community doulas offer amidst a maternal health crisis and advocating for fair and sustainable pay for community doulas through community building through daily events:

  • Instagram Live #CDW22 Kick-off
    March 29, 2022 @ 11am ET
  • Virtual & In-person Viewing of A Doula Story
    March 30, 2022 @ 12pm ET
  • Twitter Chat with #CDW22 Partners: Challenges & Successes
    March 31, 2022 @ 1pm ET
  • Community-Based Doula Conversation: Past, Present, Finding Our Way Forward
    April 5, 2022 @ 1pm ET

Williams reports that community partners, former clients and funders gathered together for the in-person A Doula Story screening. While she admits the film has elements that are outdated, it proved to be a powerful tool for connection. 

“We had a lot of people in the room who know us as community doulas, but we don’t have a camera following us,” Williams begins. “So it was great for them to see [our work] from that lens.”

At the screening event, Spartanburg Mayor Jerome Rice also signed the proclamation that designates March 30 as Community Doula Day. 

 

Photo by Mustafa Omar on Unsplash

World Doula Week is celebrated from March 22 to 28 and encompasses all doulas and doula organizations around the world. Community Doula Week hones in on the culturally-congruent care that community doulas provide. Williams and her colleagues explain some of the unique features of community doula work which sometimes differ from independent doula work:  

“Community-based doulas have at least one commonality with the birthing person, which improves outcomes for underserved communities.

They remove barriers by meeting families prenatally and postpartum in the home.

In addition, community-based doulas address maternal health disparities and help create positive childbirth experiences and work towards improved birth and infant health outcomes.

Community-based doula services are long-term, starting in early pregnancy and often continuing until six months postpartum.

The pay source is also often different for community-based doulas. Funders invest in organizations that pay community-based doulas for the services. In some states, doula reimbursement covers the cost of community-based doula services.” 

Williams says that she gathers community doulas are rejoicing to know that their work is being noticed. 

“This beautiful work needs to be captured,” Williams says of making this work visible. 

Courtney Brown (BirthMatters Fellow), Brown University wrote in Elevate community-based doula work, “It’s difficult to encapsulate the full impact of a doula, but I will try: a community doula is a pillar of support, a friend you can call on, and a source to inspire strength.”

Photo by Larry Crayton on Unsplash

The maternal infant mortality national health crisis is upon us and must be addressed immediately. BirthMatters, HealthConnect One, and their allies and other advocates affirm that community-based doulas are a lifeline for families and a missing link to addressing this critical issue. [https://drive.google.com/drive/folders/1eGCWBaqDKd3LoUxIIS1UnD4NLvZZSoDi

Don’t miss A Community Doula Conversation: Past, Present, Finding our Way Forward on April 5 as we close out Community Doula Week. Register here

You can connect with BirthMatters and HealthConnect One beyond Community Doula Week here and here.

CLC works to fill in the gaps of typically disjointed maternal infant care

It’s likely you sympathize with these caregivers’ strife if you drive a car and have children. I for one, have not mastered car seat installation without profanity, sweat and terror. 

Of her many accomplishments, as a child passenger safety technician, Ashley Ertel, LCSW, BCD, CLC, CPST can quell caregivers’ concerns over their car seat woes. I wish our paths had crossed some years prior to writing this blog, saving me from those episodes of pure frustration and worry. 

As part of her Latch2LATCH program, Ertel offers complimentary child passenger safety (car seat/booster) checks. In her role as a lactation professional, she can assess a nursing dyads’ latch, and LATCH is an acronym for Lower Anchors and Tethers for CHildren, a method of using straps or connectors on the car seat that connect to metal anchors in the vehicle. 

Ertel’s service doesn’t end here; she’s like the Mary Poppins for parents. Ertel is often acquiring new credentials, muscling to heal the gaps of our nation’s typically disjointed care. 

In 2012, Ertel received her Master’s of Social Work. (Coincidentally, it is not only Women’s History Month; it’s also Social Work Month. Find ways to celebrate the profession and its reach here.) 

In 2013, Ertel joined the Air Force. She’s been stationed in D.C., Idaho and Wyoming with a pending move to Texas.  

Just a couple of years later,  Ertel obtained her independent clinical social worker license in 2015 and went on to become a Board Certified Diplomate in 2019.

That was a full year for her. Having been working for an online therapy group, Ertel saw a need for additional mental health care services and founded the Delta Group. She became a CLC and got certified in dialectical behavior therapy (DBT) too. 

Currently, as an active duty Air Force member, Ertel runs three outpatient clinics: an adult mental health clinic, a substance abuse clinic and a family advocacy clinic which is divided into two subspecialities; domestic abuse/ child intervention and prevention services. In this latter part, Ertel and her colleague tag team, offering in-office latch assessments and weighted feeds and home visits. The program extends to offer guidance from therapists on things like developmental concerns and life changes like adjusting to new siblings.  

Most influential to her work as a lactation specialist was the birth of her son in 2016. After a tumultuous pregnancy, battling a blood clot and bedrest, Ertel says her only goal was “to get this baby out of me and keep us both alive.” Following the birth, still exasperated, she says she didn’t have much of an infant feeding plan; her goal was still as basic as keeping her and her son alive. 

It turned out, through her work on the Air Force base though, that several colleagues were lactation professionals and helped to link her up with Mom2Mom Global, a non profit dedicated to breastfeeding peer support, education, and advocacy for military families. Ertel went on to breastfeed her son for 26 months.

At her next station, Ertel realized that there were no CLCs on base, and none registered on the ALPP website within a 50 miles radius of the base.

“This is horrible!” she remembers thinking. So that’s when she decided to fill the gap. 

Ertel is also in the process of completing a  200-hour  meditation certification as well as a focused course on prenatal meditation, continuing to color in the empty spaces that ultimately illuminate a whole person approach. 

You can find out more about Ertel’s work here including her free, virtual Babies Love Boobs support group. 

Exploring the effects of the Build Back Better Act on maternal child health

Source: United States Breastfeeding Committee

Late last year, Vice President Kamala Harris announced a Call to Action to reduce maternal mortality and morbidity in addition to The Build Back Better Act which includes a three billion dollar investment in maternal health.

After West Virginia Senator Joe Manchin said that he would not support the legislation, the path forward is uncertain. Further, the Call to Action and its materials are vague. Breastfeeding-specific language isn’t at all included.  Maternal child health advocates also have questions about CMS’s proposal to establish a “Birthing-Friendly” hospital designation. The proposed program is scheduled to be published for public comment by April 1. At this point, there will be an opportunity to read and discern the materials. The open comment period of time is unknown. 

Before then, let’s take a look at the individuals and organizations that trudge forward, standing for paid leave policies and other maternal health provisions.

 

Keeping momentum 

In a recent National Work & Family Coalition virtual meeting, Myles Hicks of Time to Care Coalition in Maryland highlighted how the pandemic continues to affect women more than any other group. Hicks and colleagues’ polling shows that 88 percent of Maryland voters favor paid leave legislation.

Source: United States Breastfeeding Committee

The Center for American Progress details this phenomenon through an equity lens in  On the Frontlines at Work and at Home: The Disproportionate Economic Effects of the Coronavirus Pandemic on Women of Color

The United States Breastfeeding Committee (USBC) has a hub for taking action online where folks can easily explore and support legislation that aims to support families. Much the same,   Paid Leave for All has created online action tools for individuals to easily connect with their representatives and show their support for paid leave.

MomsRising’s hub for workplace justice has a compilation of resources specific to advancing equal pay, paid family and medical leave, paid sick days, breastfeeding rights, and other workplace justice policies from local to federal levels.

National Partnership for Women & Families President Jocelyn Frye offered in the meeting some good news: we are in a moment where we have had a national conversation about care and the economic implications of care. Frye went on to acknowledge the need for robust work/ family policies to address the challenges people have across their lives, especially policies that center women and women of color “because they are integral to what growth looks like” and are the key to the economic stability of families.

 

Reflecting on key components of maternal health in America

Even with an uncertain future of Build Back Better, after reading through some of its maternal health provisions and discussing them with Healthy Children Project’s Jenny Spang, she helped sift through some important points in regard to the legislation and the overall landscape of maternal child health in our country:

  • Effective work is already being done. There are community-led organizations and models in place that are turning out results. For a few examples, Spang points to Kimberly Seals Allers’ Irth App, Commonsense Childbirth’s The JJ Way, and the California Department of Public Health’s efforts to investigate maternal deaths where the state cut its maternal mortality rates in half while the US mortality rate worsened.  It will be crucial to funnel money and other resources available through Build Back Better to these already-established, effective programs.  

 

  • It’s important to get the right players at the table for decision making. In order to make progress, there needs to be a diverse body of representatives to best reflect the needs of American families. 

 

 

  • Let us not forget that birth and breastfeeding are part of a continuum. In terms of insurance coverage, the White House materials issue guidance to states on how to provide Medicaid coverage for a full year postpartum; this is an important piece to be aware of. Currently, there are separate reimbursement processes for mom and baby.

The influence of political moves 

In a collaborative piece published by Ms. Magazine, Jeannina Perez and co-authors created  The U.S. Is in Urgent Need of Childcare Solutions. Build Back Better Would Be a Game-Changer.

Source: United States Breastfeeding Committee

 “Even before the pandemic, many families could not find childcare when and where they needed it. More than half of all families lived in childcare deserts, and those who didn’t faced exorbitant prices. That’s gotten even worse during the COVID-19 pandemic. For those who can afford childcare, extremely high prices take a toll—many families pay more than mortgage payments or rent for care. It’s unacceptable. That’s why the Build Back Better Act will be a game-changer for parents across the nation, lowering prices and increasing the supply of high-quality care at the same time…The Build Back Better Act would be life-changing,” it goes. 

In an interesting parallel, psychologist Wendy Wood featured on the Hidden Brain podcast, talks about smoking cessation programs. Americans were convinced that they needed to stop smoking once the surgeon general’s report came out in 1964, but the sales of cigarettes in the U.S. continued to increase until the 1970s. It wasn’t until the environment was modified– cigarette vending machines were removed, bans on smoking in public places were instituted, and cigarette sales were taxed– that sales started to decline.

“All of that took huge political decision making and commitment to make it happen,” Wood points out in the podcast. 

In 2022, families in America are waiting for huge political decisions around maternal health and family policies to positively affect  health outcomes and quality of life. 

 

Remembering why 

MaryAnn Wilbur, M.D., M.P.H., M.H.S. wrote a gut-wrenching piece called Ms. Omega One about the death of a young, Black mother that went completely unpublicized. Ms. Omega One died just two days after giving birth to her daughter. The piece draws attention to important issues such as the coverage of gun violence and disparities in media reports which must be addressed from an anti-racism lens. Telling  Ms. Omega One’s story also reminds us why we continue to fight for policies and legislation that support families. It’s because policies and legislation shape the reality of families’ lives, and each piece is messily intertwined with the next.  Things like supporting healthy birth options, enabling paid leave, upholding breastfeeding rights, and so on, all support family bonding and mental health. It might be a stretch to argue that the Build Back Better provisions may have saved Ms. Omega One’s life, but it’s not unreasonable to hope that by better supporting families,  we might become a society marked by less stress, less divisiveness, less violence and fewer tragedies.  

 

What to watch for 

  • Congresswoman Underwood’s introduction of FMLA expansion
  • Moving forward after the expiration of  Families First Coronavirus Response Act (FFCRA) tax credit for COVID-19-related paid leave
  • “The U.S. Care Infrastructure: From Promise to Reality” conference  hosted by The Institute for Women’s Policy Research, American University, and the Carework Network which took place earlier this month.
  • Access USBC’s State and Territory Breastfeeding Reports to see how federal investments in infant feeding made a difference where you live in 2020.