USBC Deputy Director Amelia Psmythe Seger’s ‘The Four Pillars of Infant Nutrition Security in the United States’

Our headlines are overloaded with tragedy, perversion, inequities, the unthinkable yet preventable.

Journalist Mary Pilon says in Throughline’s Do Not Pass Go episode “It’s a shame to waste a crisis. A crisis can also be a moment when you look at things and make changes and improvements.”   

And so, from that vantage point, we are honored to be republishing United States Breastfeeding Committee Amelia Psmythe Seger’s piece The Four Pillars of Infant Nutrition Security in the United States originally published here last month. 

“We will get through this because we must. Together we must ensure we build an infant nutrition security system worthy of parent’s trust,” she writes. 

In celebration of World Breastfeeding Week and National Breastfeeding Month on the horizon, there’s no better time than now to take action.  #TogetherWeDoGreatThings

 

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The Four Pillars of Infant Nutrition Security in the United States by Amelia Psmythe Seger, Deputy Director USBC

Throughout its 22-year history, the U.S. Breastfeeding Committee has been working towards the policy, systems, and environmental changes that build a landscape of breastfeeding support.

The catastrophic infant formula shortage demonstrates the value of this work and the need to build a robust infrastructure for infant nutrition security in the U.S. that holds all families in care.

This infrastructure includes four pillars: Parents, Programs, Policies, and a Plan for emergencies.

Parents:

Parents are critical stakeholders in infant nutrition security. The Parents pillar includes people of all races, genders, caregiving roles, routes to parenthood, immigration status, religious or political views, and infant feeding methods. Everyone who loves and cares for a young child belongs. Welcome.

Parents deserve the full support of a robust national infant nutrition security infrastructure. Without it, many are forced onto painful and difficult paths of infant feeding and care. The U.S. needs equitable programs, policies, and a plan for emergencies that centers on the most impacted.Parents and caregivers whose infants rely on formula are the highest priority right now. They need help finding formula, advice on switching between formulas, reassurance that reliable supplies are on the way, and an answer to the question: what should I feed my baby if I cannot find formula?  With appropriate caution, the American Academy of Pediatrics (AAP) published an article on what to feed babies of different ages and situations in an extreme emergency (such as this). Babies under six months should truly only consume human milk or infant formula. In considering very short-term alternatives, the stakes are so high that a physician should monitor the baby.

Parents who are breastfeeding or feeding human milk are in anguish right now, too. Many are feeling pressure to share their milk without acknowledgment of how hard this society has made it to establish and maintain milk supply. Few families have access to lactation support providers, paid family leave, and workplace accommodations to pump breast milk during the workday. In this context, many turn to formula as their backup plan, and it is very scary for them to see that their safety net is in tatters. To answer questions related to human milk, the Academy of Breastfeeding Medicine (ABM) published a guide. This ABM guide addresses pregnancy, low milk supply, re-lactation, options for donation or safe milk sharing, and healthcare guidance and training.

Additional burdens or blame should never be placed on the families and caregivers whose hands are literally full of babies and toddlersWhen capacity allows, however, the collective potential power of parents is significant. Consider if parents insisted on being at the table with the commercial milk formula industry, playing a role in ensuring industry quality, safety, and ethics. They are key stakeholders, after all, so this should be encouraged. Parents could also insist the U.S. enhance our nonprofit milk banking system to ensure an affordable, plentiful donor milk supply for medically fragile infants and those whose parents cannot or do not wish to breastfeed. This would diversify the infant food supply and provide parents with more options.

Programs:

Federal programmatic funding needs to be expanded considering setbacks caused by the pandemic, including the current infant formula shortage.

Federal funding supports quality improvement investments to implement maternity care best practices in hospitals, especially while recovering from pandemic-induced breakdowns in those settings.

Expansion of this funding supports state and community efforts to advance care coordination and strengthen lactation support through policy, systems, and environmental change interventions to reduce or eliminate breastfeeding disparities along the fault lines of income and race.

Federal investments enhance and deepen partnerships to integrate infant feeding and lactation support services into emergency response systems and food security programs during acute disasters and prolonged public health crises.

This funding supports critical national monitoring and public reporting activities, including annual analysis of the National Immunization Survey (NIS), administration of the bi-annual Maternity Practices in Infant Nutrition and Care (mPINC) Survey, bi-annual production of the National Breastfeeding Report Card, and administration of the longitudinal Infant Feeding Practices Study. All of which is especially needed in light of recent updates to the Dietary Guidelines for Americans, which, for the first time, provides nutritional guidance for infants and toddlers.

Policies:

Due to major policy gaps, families face obstacles that make it difficult or impossible to start or continue breastfeeding. Policymakers must choose to prioritize the policies and investments for infant food security so that we never find ourselves in this situation again.

Critically needed policy solutions are waiting for Congressional action:

  • Establish a national paid family and medical leave program. The FAMILY Act (S. 248/H.R. 804) would ensure that families have time to recover from childbirth and establish a strong breastfeeding relationship before returning to work.
  • Ensure all breastfeeding workers have time and space to pump during the workday. The Providing Urgent Maternal Protections (PUMP) Act (S. 1658/H.R. 3110) would close gaps in the Break Time for Nursing Mothers Law, giving 9 million more workers time and space to pump. Contact your legislators about the PUMP Act!
  • Invest in the CDC Hospitals Promoting Breastfeeding program by increasing funding to $20M in FY2023This funding helps families start and continue breastfeeding through maternity care practice improvements and community and workplace support programs.
  • Create a formal plan for infant and young child feeding in emergencies. The DEMAND Act (S. 3601/H.R. 6555) would ensure the Federal Emergency Management Agency can better support access to lactation support and supplies during disasters. Contact your legislators about the DEMAND Act!

Additional areas for policy development

The U.S. has not regulated the marketing practices of the commercial milk formula industry, unlike 70% of the world, which has implemented at least some part of the WHO’s International Code of Marketing of Breast-Milk Substitutes. In the absence of regulation, these marketing practices are predatory.

Diversify the nation’s production of infant formula. Plainly it is a mistake to allow 42% of the infant formula in this country to be produced not only by one company but by one factory of that company. Infant formula companies are part of an infant food security system, but we don’t have to be so dependent on that industry.Enhance the national network of nonprofit donor milk banks. Support innovative partnerships across existing structures, taking a cue from a national model such as what exists in Brazil. Consider: Red Cross has the infrastructure to support donor screening; WIC offices or community health clinics could be donor drop-off sites; more hospitals could provide space and equipment for donor milk processing and distribution, as some have done. Models exist to create an affordable and plentiful alternative to commercial milk formula when a parent’s own milk is not available.

Plan:

All nations should have a robust plan for infant and young child feeding in emergencies that includes three phases: preparedness, response, and resiliency. The USBC-Affiliated Infant & Young Child Feeding Constellation has published a Joint Statement on Infant & Young Child Feeding in Emergencies (IYCF-E) in the U.S. context.
Emergency preparedness includes building a lactation support provider directory and a system to track the inventory of national resources such as infant formula.Emergency response for infants, young children, and their families must include priority shelter, trauma-informed care, lactation support providers in every community; access to breast pumps, and milk storage and cleaning supplies; non-branded infant formula, clean water, bottles, and cleaning supplies.

Emergency resilience includes trauma-informed care that centers on the needs of communities that have been historically undersupported, and disproportionately impacted in emergencies.

Every system is perfectly designed to get the results it gets. The insufficient system we’ve had, led to this crisis. It was predictable, and thus it was preventable.

Now that there’s a mass mobilization of activity – from neighbors driving many miles to find spare formula tins, to the President invoking the defense production act – we must collectively build the resiliency to support a community during a flood, a region during a power outage, or a nation during a pandemic and supply chain crisis. We will get through this because we must. Together we must ensure we build an infant nutrition security system worthy of parent’s trust.

Children’s book celebrates the joy of natural-term breastfeeding

Monica Haywood is a researcher by nature. When she became pregnant with her daughter, she read all of the baby books. 

She read about prenatal vitamins, proper nutrition, prenatal appointments, etc., etc., etc. 

“I wanted to do everything right,” Haywood says. 

Sometime during her second trimester, her focus narrowed in on breastfeeding. She was familiar with the stories her mother told about breastfeeding her, but she wanted to know more. Haywood attended La Leche League of Louisville meetings and scoured websites for infant feeding information. 

She felt prepared and laid out a plan to breastfeed her baby for three months. 

“Little did I know, the journey was slightly different,” she laughs. “You can read, read, read, but be prepared to pivot on things that you may have read about.”

Baby Noelle was born in 2017 and instead of breastfeeding for the planned three months, Noelle and Haywood nursed for 34 months. 

Haywood says that while exclusive, natural-term breastfeeding was sometimes challenging like balancing her baby’s needs and self-care and managing other people’s perceptions mostly, breastfeeding created a sense of empowerment and bonding. 

Haywood shared another connection with Noelle through her love of books early on. 

“She was only a couple months old and my husband and I were reading books to her,” she shares. 

“[Reading] helps with language development, and we also thought it was important to find books that she could relate to… characters that look like her and that can relate to her experience,” Haywood continues.  

She found that most children’s breastfeeding books were geared toward weaning, but she was looking for something that celebrates the breastfeeding journey, something that could capture what she and Noelle were doing. 

And when she couldn’t find it, she created it. Haywood wrote Noey Loves Nursing, a colorful book that commemorates her nursing journey, celebrates a diverse character,  and educates and brings awareness to extended breastfeeding. 

“I wish I could get it in the hands of every breastfeeding mother!” Haywood exclaims. 

The book is highly admired by younger readers including her daughter who Haywood says is really excited by the book. 

Another young reader, Blake, shares his reading of Noey Loves Nursing @readingwith_blake

“When I saw [the video],  it literally brought me to tears,” Haywood says. “It’s just awesome.” 

Before COVID-19, Haywood enjoyed sharing Noey Loves Nursing at in-person gatherings like LLL Louisville’s Live Love Latch during National Breastfeeding Month and Healthy Children Project’s International Breastfeeding Conference. She’s also shared her story with local WIC offices.

This summer, Haywood adapted to Zoom and Facebook Live events to celebrate Black Breastfeeding Week and National Breastfeeding Month with her book. 

Haywood looks forward to the United States Breastfeeding Committee’s (USBC) National Conference in 2021 where she hopes to bring her mother and Noelle– three generations sharing their breastfeeding journeys. 

The second edition of Noey Loves Nursing will be released later this year or in early 2021. Get connected with Haywood on social media @noeylovesnursing, @monicareneeinc and on Facebook.

Musings on unity beyond National Breastfeeding Month

This year’s National Breastfeeding Month (NBM) celebration has come to an end, but our momentum as maternal child health advocates– striving for equitable care for all– powers on. 

The 2020 NBM theme, Many Voices United, called on us to come together to identify and implement the policy and system changes that are needed to ensure that all families have the support and resources they need in order to feed their babies healthily. 

Photo by Tim Mossholder on Unsplash
Colorful Hands 1 of 3 / George Fox students Annabelle Wombacher, Jared Mar, Sierra Ratcliff and Benjamin Cahoon collaborated on the mural. / Article: https://www.orartswatch.org/painting-the-town-in-newberg/

Achieving this shared goal requires daily self-work and individual introspection so that our collective can be as effective as ever. No matter how socially-conscious, open-minded, anti-racist, (insert adjective), we think we may be, we still have learned biases and prejudices that require near constant attention. Much like I remind my children to brush their teeth every morning and every night, as a white, binary woman, I must remind myself to examine my biases and my privilege daily.  

With NBM’s theme of unity in mind, this Upworthy video features an art installation that demonstrates our society’s interconnectedness. With a piece of string, the installation shows an intricate, densely-woven web created by individuals wrapping thread around 32 poles with identifiers arranged in a circle. 

“You can see that even though we all have different experiences and we all identify in different ways…We are really one,” the project’s creator says in the video. 

The sentiment and the product are truly beautiful and fascinating. While appreciating the beauty of unity, it’s important to keep our critical thinking and progressive attitude sharp, refraining from slipping into too comfortable a space where change cannot happen.  

Recently, I’ve seen a few statements on unity circulating social media that I’d like to embrace with a “Yes!” Instead, I find myself reacting, “Yes! But…” 

My worry is that these well-intentioned mantras we live by– much like some might argue certain microaggressions are well-intentioned– are also dismissive. 

  1. We all bleed the same blood. 
  1. Children are not born racist.
  1. I will teach my child to love your child. Period. 

Let’s break those down starting with “We all bleed the same blood.”  Some things to consider:

First, Ashley May for The Thirbly writes,

“Black breasts do not exist separate from Black bodies and the situated existence we navigate in this world nor the racialized experience of motherhood. Racism and classism intertwine to act as a containment, working to make some of us feel as if we are walking in quicksand. Add to this the complexities of new motherhood and the needs of the postpartum body and now we have a cocktail for failure. Literal milk plugs. So, although her precious body may be able to produce milk, her situation prevents her and her baby from receiving it. Even the intention to breastfeed cannot save the milk of the mother who cannot find time for pump breaks as she works the night shift as a security guard. Or, perhaps she cannot figure out why pumping is not working, but she doesn’t have the time to seek the educational or financial resources to help her problem solve.” (underline added by OMW) 

Racism affects People of Color (POC) at a cellular level. Studies show that the experience of racial discrimination accelerates the shortening of telomeres (the repetitive sequences of DNA at the ends of chromosomes that protect the cell) and ultimately contributes to an increase in people’s risks of developing diseases. 

It’s epigenetics; the environments POC of are growing in affect their biology.  

Children are not born racist, but white children are born into a racist society that they will benefit from. 

From the very beginning, white children have a better chance of survival than Children of Color; African Americans have 2.3 times the infant mortality rate as non-Hispanic whites

What’s more, Black children are three times more likely to die when cared for by white doctors, while the mortality rate for white babies is largely unaffected by the doctor’s race, a recent study found. 

White children are born into being part of the problem and just the same, can be part of equitable solutions. 

I will teach my child to love your child. Period. 

Love is action, and even if it’s easier said than done, there are so many ways to teach our children about race, inequities and injustice. Afterall, “If Black children are ‘old enough’ to experience racism then white children are ‘old enough’ to learn about it.” – Blair Amadeus Imani

  • Be careful what you say. As a young girl on my way to ballet class one day, my mom, while locking the car doors,  pointed out the barred doors and boarded windows in the neighborhood we rolled through. 

“That’s how you know this is not a safe neighborhood,” my mom warned me. 

No questions asked, I noted the building facades, and then I noted the Black people. Because there wasn’t any further conversation, I made the connection that Black people must be “not safe” and ultimately, that there must be something wrong with Black people if they’re confined to neighborhoods “like this.” 

Imagine the impact we could make if we showed our children that there is nothing inherently wrong with Black people that ending racism can’t solve.

As a nation we are apathetic, made apparent by a recent poll. The survey shows that only 30 percent of white people have taken concrete action to better understand racial issues after George Floyd’s killing. 

The poll also shows that White Americans are also the least likely to support the Black Lives Matter movement, with 47 percent expressing support.

Is it because we don’t claim it as our problem? Is it because we misunderstand the problem? Is it because it’s easier to point fingers at others than ourselves? 

I’d like to leave you with this video of writer Kimberly Jones where she provides a brief history of the American economy told through an analogy using the board game Monopoly. I urge you to watch it, and then watch it again, and again, and again. 

There is no time for complacency within these truly abhorrent systems. When we start to lose sight of that, envision the tangle of yarn from the aforementioned unity art installation and remember that vastly different experiences are networked together.

Revive. Restore. Reclaim. Happy Black Breastfeeding Week!

 The final week of National Breastfeeding Month is upon us, closing out strong with Black Breastfeeding Week: Revive. Restore. Reclaim (August 25-31). 

During Black History Month, Nichelle Clark of SonShine & Rainbows Lactation wrote in her piece Breastfeeding As An Act Of Resistance For The Black Mother

“Black History Month in the breastfeeding community is normally littered with posts and articles about the dark history of African American Breastfeeding in this country. I firmly believe that in order to understand where you are going, you must first understand where you have been. However, Black Mothers in today’s society face a very different dilemma: actually being Black History.” 

Joy R. Gibson, MSEd is an early childhood educator and advocate and the mother of five, ranging from age 18 months to 13 years. She gave unmedicated birth to all five of her children in Pittsburg, Pa.,  practiced the Lamaze method, and talked to her babies as she labored with them. 

Joy R. Gibson, MSEd

“We can’t wait to see you,” she gently called. 

Gibson went on to breastfeed all of her children until they self-weaned. 

“I think [breastfeeding was] best for my babies, and I love the bond that it creates. I love when it gets to be that one-on-one time to focus on the child,” Gibson shares. 

She goes on to share that early on, she and her first child struggled to find a comfortable latch. After visiting with a hospital-based lactation care provider, Gibson and her baby were able to work through the challenges. Beyond that, she recalls her babies not appreciating being covered in public while they nursed, which felt more like an inconvenience than a challenge, she describes. 

Gibson felt supported through her breastfeeding journey. 

“Always from family and friends and even from my job when I had to pump,” Gibson says. 

While working in a child care center, Gibson would feed her baby who was also at the center and then return to work. 

Having felt empowered through her birth and infant feeding experience, Gibson says she wants to become more involved in maternal child health advocacy and connect with other mothers through their challenges and triumphs. She is currently involved with Healthy Start, Inc. Pittsburgh/Allegheny County’s Community Health Advocate Training Program where she will be able to exercise her passion and help improve the health outcomes of other mothers in her community. 

The Gibson family.

Gibson is Black History.  Gibson is #ReviveRestoreReclaim.

How will you #ReviveRestoreReclaim Black breastfeeding in 2020? Join the #BBW20 movement and follow @BlkBfingWeek.

USBC also calls upon us to:

  • Raise your voice for breastfeeding families and take action with @USBreastfeeding in support of the MOMMA’s Act! Learn more about the bill:  https://bit.ly/2CUOmE9 #NBM20 #ManyVoicesUnited
  • @USBreastfeeding is launching another free webcast session this week! Learn about the presentations in “Optimizing Support for All Populations” https://bit.ly/NBCCReimagined #NBM20

Spotlight on Infant and Young Child Feeding in Emergencies during National Breastfeeding Month

It’s Week Three (August 16-24) of National Breastfeeding Month, recognized as Spotlight on Infant and Young Child Feeding in Emergencies by the United States Breastfeeding Committee (USBC). 

Among the many effects of the novel coronavirus, the pandemic has truly exposed our nation’s deficiencies; one of them being emergency unpreparedness. 

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

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.

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, as originally reported in Underdeveloped plans for infant and young child feeding during emergencies

WBTi Panel Members

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.

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.

“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.”

Photo by Luiza Braun on Unsplash

Although there are always crises occurring, since being thrust into a global pandemic, our nation has had to reevaluate how we care for families with babies and young children. Especially in marginalized populations, poverty, health inequities, and other burdens are amplified during an outbreak or other emergency. 

Carolina Global Breastfeeding Institute states,  “Any crisis presents an opportunity for positive, sustainable change and coordinated involvement of all. #COVID19 taught us that we are all affected and an immediate societal response is required.” 

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 a 2018 blog post:

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

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

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

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

5. Preparedness is key to ensure babies everywhere have the best opportunity to survive and thrive. 

Parents and care providers can consult Global Health Media’s video How to Express Breastmilk in situations where hand expression is warranted. 

More recently, USBC has compiled a comprehensive resource page for Infant and Young Child Feeding in Emergencies, including COVID-19.

USBC calls on us to take action by urging policymakers to take three actions to integrate infant and young child feeding into emergency preparedness and response efforts:

  • Expand the Federal Interagency Breastfeeding Task Force to include emergency and infectious disease experts
  • Direct the Federal Emergency Management Agency to ensure breast/chestfeeding people have appropriate services and supplies during a disaster or pandemic
  • Enact World Health Assembly Resolution 12.6 related to infant and young child feeding in emergencies

The CDC offers their guide to disaster planning here

CGBI’s Dr. Aunchalee Palmquist leads Lactation and Infant Feeding in Emergencies (L.I.F.E.) Amid the Pandemic Initiative, an active hub of research, policy advocacy, and technical support with recommendations relating to current emergency situations.

The World Alliance for Breastfeeding Action (WABA) has made available an interview between Dr. Felicity Savage and Dr. Amal Omer Salim which touches on proper breastfeeding support during normal and crisis situations. 

Dr. Savage points out that one of the biggest concerns about breastfeeding counseling during emergent situations is actually getting the counseling to parents. Specifically during the Covid-19 pandemic, Drs. Savage and Salim emphasize that separating mother and baby is not necessary to prevent the spread of the infection from mother to child, and make clear that care providers should follow WHO and UNICEF guidelines

#NBM20 

#IYCFE 

#ManyVoicesUnited