Breastfeeding in shelters

Among the many effects of the novel coronavirus, the pandemic has exposed our nation’s deficiencies: emergency unpreparedness, racial health disparities, our “highly polarized, fragmented, and individualistic society…” (I would add arrogant), and the failure of capitalism.  In marginalized populations, poverty, health inequities, and other burdens are amplified during an outbreak or other emergency. 

Long before the pandemic hit, individuals and advocacy organizations have been ringing the alarm, calling for better access to education, better healthcare, and equity and justice for all.

Of these trailblazers is Powerhouse Nikki Lee RN, BSN, MS, Mother of 2, IBCLC,RLC, CCE, CIMI, CST (cert.appl.), ANLC, CKC, RYT whose recent endeavor includes creating and implementing the 10 Steps to a Breastfeeding Friendly Shelter

In her role at the City of Philadelphia Department of Public Health, Lee noticed the challenges breastfeeding people face in shelters. 

The barriers are a result of our cultural attitude toward lactating people and misunderstandings about their bodies and needs. 

Lee talks about issues of privacy and ‘fairness’ in a shelter. Organizational dress codes often require residents to dress modestly, so when a person exposes their breasts to feed a baby, other residents can wonder why they’re not allowed to wear short shorts. Parents can express concern about the teenage boys in their families seeing breasts while a baby is being fed.

There’s the concern over safe milk storage and the mythology around reimbursement through the Child and Adult Care Food Program. Shelter staff may believe that if a mother breastfeeds, the facility will lose money to buy food because the allotted amount for infant formula isn’t getting used. Lee clarifies that if a mother breastfeeds, the institution will have more money to spend on food.  

Just like in the rest of the US, there tends to be a push for formula feeding because the baby’s intake is easily measured, and staff are more comfortable with what is familiar, i.e. bottle-feeding

Lee continues, “There is a genuine honesty from people who don’t understand anything about breastfeeding, ‘Why are we breastfeeding?’ ‘Why are we bothering?’”  Staff in hospitals have been educated about breastfeeding over the past few decades; staff in shelters have not.

So when she conducts trainings, she starts at the rudimentary level of ‘what are mammals?’ 

“All the worst mythology that you can imagine is in the shelter,” Lee says. “All the worst in how society treats mothers and babies gets magnified in shelters.” 

With the problem identified, Lee says she started “from scratch in a way,” looking for a written policy to support breastfeeding people.  Early on in her search, she followed up on a news story featuring a homeless mother in Hawaii. She posted inquiries on Lactnet, CDC listserv, international online forums, Facebook groups, and reached out to shelters at random wondering if they had breastfeeding policies . 

“Nothing,” Lee reports. “There is probably a shelter somewhere that has a policy, but after two years of a global search, I wasn’t able to find it.” 

In all her search,  Lee found one published document— a Canadian study looking at the factors that influence breastfeeding practices of mothers living in a maternity shelter– that could be helpful. 

Lee wrote the first draft of the 10 Steps to a Breastfeeding Friendly Shelter with policies like the Ten Steps to Successful Breastfeeding and Ten Steps to Breastfeeding-Friendly Child Care in mind. 

She sent it out to colleagues at CHOP’s Homeless Health Initiative for feedback, and for quite a while, there was none. Lee’s colleague Melissa Berrios Johnson, MSW,  a social work trainer with HHI, and the convenor of its breastfeeding workgroup subcommittee, helped to make the policy reality. 

Partner agency Philadelphia Health Management Corporation (PHMC) received a grant that funded research which took the policy to four different shelters for staff and resident feedback. 

“Everyone, residents and staff alike, felt this policy was important and feasible,” Lee says. 

PHMC’s next step was to identify a shelter staff member to become a breastfeeding champion. This champion would be provided with free breastfeeding training, and receive an honorarium.

As program oversight changed though, “breastfeeding champion” became a job, with a list of responsibilities. So far, Lee says they’ve only found four people out of 10 shelters who are willing to take on the task.

“There are some folks in shelters working hard to make things better,” Lee says. “They are those champions, most of whom have breastfed themselves.”

Currently, Lee and colleagues are in the process of developing training for staff members and ironing out how to help staff implement the policy.  

Lee’s and co-authors Alexandra Ernst MPH, and Vanesa Karamanian MD, MPH landmark paper about the 10 Steps to a Breastfeeding Friendly Shelter has been submitted to the  Journal of Human Lactation (JHL)

At present, COVID has put all of this work on hold.

A time for renewal

On one of my favorite walking routes, there is a beautiful oak tree that shades the street corner. Its sprawling roots heave through the sidewalk. One day, a dreamy song played through my earbuds, and as I walked toward the tree I felt the urge– almost like a spiritual calling– to touch its sturdy bark. Making contact with its trunk, a tickling, buzzing static traveled through my arm and zapped my ears like some energy had traveled through the cord on my earbuds. Stunned, I stepped back and gazed up at the oak’s gangly branches overhead, for a second believing that I’d connected with some otherworldly force. The sun shone down on the scene, casting a stark outline between the tree’s branches when I realized they were intertwined with telephone wires overhead.

Human innovation and nature entangled. 

April 22, 2020 marked the 50th anniversary of Earth Day and as this video points out, while we breathe through masks, our planet breathes a sigh of relief.

Healthy Children Project faculty, Master Herbalist, Certified Aromatherapist and author of  Growing Green Families: A Guide for Natural Families and Healthy Homes Donna Walls, RN, BSN, IBCLC, ICCE, ANLC agrees that Earth Day this year has a “different look.” 

“Around the world we are seeing the rebound of the earth when there is reduced human impact,” she says. “We see fish returning to the waters of Venice, kangaroos jumping in the streets of Sydney and comparison pictures of Los Angeles two months ago and now with clear, blue skies.” 

For the first time in decades, air pollution has cleared enough to reveal mountaintops from over 100 miles away. (Find pictures here and here.)  

Walls wonders if these spectacular phenomena will motivate humans to better care for our planet moving forward. 

She explains: “Being a maternity nurse for many years I usually go directly to ‘how does this impact new families?’ Maybe this is the opportunity to educate families on a cleaner life for our children, grandchildren and the planet.”

In 2013, Walls pioneered Miami Valley Hospital’s Green Team in an effort to provide safer, toxin-free products for families. 

“Anyone who says healthcare is not about cleaning up the environment is not well,” she laughs.

The Green Team worked to eliminate disposable diapers, formaldehyde-layden mattresses and unsafe, employee hand soaps, Walls reports. They found a clean, safe line of products and ultimately saved money.

Looking ahead, Walls poses: “At this time of renewal for the earth, can we make it the beginning of a new way of thinking, starting with the care and feeding of the newest members of the human race?” 

The environmental cost of infant formula milk is well documented in some countries. 

For instance, “For the UK alone, carbon emission savings gained by supporting mothers to breastfeed would equate to taking between 50,000 and 77,500 cars off the road each year,” recorded in research by UKRI Future Leaders Fellow at Imperial College London

IBFAN and BPNI published Formula for Disaster , a document that details infant formula’s detrimental impact on the environment and by contrast, breastfeeding’s sustainability. 

WABA also includes information on “the most ecologically sound food available to humans”– breastmilk. 

Bethany Kotlar, MPH, Program Manager, Center of Excellence in Maternal and Child Health at Harvard Chan School Center of Excellence writes in Amidst the COVID-19 Pandemic, We Must Remember Maternal Health, “The pandemic gives us the unique opportunity to reassess the cracks in our society…” 

We’ve been granted the opportunity to reevaluate our responsibility to our planet and pledge to protect it so that we may continue to receive its bounty and find solace in its beauty. 

“Treat the earth well. It was not given to you by your parents—it was loaned to you by your children.” —Native American proverb