Voices for the underserved; speaking up about unuttered breastfeeding barriers

IMG_3141This year, my family and I participated in our first Big Latch On for World Breastfeeding Week. Nursing your child can be an incredible experience in itself, but to be surrounded by the love and support of other mothers nursing their little ones was such a fulfilling encounter.

IMG_3145With my darling Willow blissfully latched, I scanned the crowd of unfamiliar faces surrounding us engaged in such a familiar act. Not only did we match in our neon attire, we sat united feeding our beautiful babies from our beautiful bodies on a beautiful day for the world to see. Fathers, partners and other supporters stood close by, smiling and snapping photos to remember and share this healthy, natural, proud moment.

While I celebrate and extol successful nursing relationships, I quickly remember the slew of Booby Traps too many women and babies encounter that sometimes make breastfeeding unpleasant, traumatic and nearly impossible.

Increased recognition of these barriers from our government and communities has allowed for a slight increase in breastfeeding initiation rates in our country. This is great news.

However until every mother reaches her healthy infant feeding goals without struggle, we still have work to do- snarly, uncomfortable, complicated work to do.

348f220Kimarie Bugg MSN, MPH, is President and CEO of Reaching Our Sisters Everywhere Inc. (ROSE), a nonprofit developed to decrease breastfeeding disparities in the African American community. She also serves on NICHQ’s Best Fed Beginnings expert panel and works closely with the United States Breastfeeding Committee (USBC).

Bugg illuminates some of the unspoken, edgy barriers to breastfeeding that I hadn’t been conscious of; the issues rooted in racism and division within the lactation community that all too often affect women with some of the lowest breastfeeding initiation and duration rates.

Color and its implications

As a white woman,  I have very limited consciousness about issues embedded in prejudice. My superficial awareness is better explained by the wise Angelique Chelton of Hearthside Maternity Services.

She writes in An Uncomfortable Encounter With Racism: “The very fact that I don’t think much about the color of people around me- and how their color (or mine) may be affecting their lives- is a sign of my privilege. I don’t *have* to think about it, because my color doesn’t cause me pain in this society.”

Much differently, Bugg has personally felt the painful stings of bigotry.

After she birthed her twins, Bugg sought the breastfeeding support of the women and organizations around her; her family lived several states over.

“It was miserable,” Bugg remembers desperately calling around for help during her early days postpartum.

“I lived on the wrong side of the track so no one was interested in assisting me,” she recalls.

Fortunately and unfortunately, the only help Bugg received was from a WIC clerk who was helpful in affirming Bugg’s ability to feed her babies.

“I don’t want others to be as miserable as I was,” Bugg takes from her battle to find breastfeeding support.

Even with Bugg and other dedicated birth and lactation care givers working diligently to change the infant feeding landscape, there remains a racial gap in breastfeeding trends.

“A lot of things that are just innate racism have to do with why the gap is not narrowing,” Bugg says.

She reminds us that there are hospitals who segregate insured and uninsured patients.

Further, our nation suffers from a severe lack of culturally relevant lactation professionals.

Culturally appropriate care

Kimberly Seals Allers is an award-winning journalist and a leading commentator on African American motherhood and breastfeeding issues and explains this barrier in Lactation Consultants Need to Diversity Yesterday.

“One obvious solution to closing the breastfeeding gap is getting more African American faces in the room who can relate to black moms,” she writes. “Organizations need to step up efforts to focus on cultural inclusion.”

Bugg reports new committees have been added to USBC to represent a “different kind of voice” where there “has always been concern about lack of diversity.”

Involving culturally relevant lactation professional breaks down trust barriers, Bugg explains while making clear that she and other advocates “would never say that every African American mother has to have an African American lactation specialist.”

Still, “the African American community has become accustomed to people being rude and lying and dismissing us,” Bugg explains. “Those walls are almost eliminated or at least much easier to get through when things are are culturally effective or culturally sensitive.”

Power struggle

Last fall, ROSE issued a beautiful, respectful commentary called Reducing Breastfeeding Disparities Among African American Women to ILCA’s “Lactation Matters“, responding to the “storm…brewing in the lactation community among International Board Certified Lactation Consultants (IBCLC) and the several other lactation certifying organizations to gain the title of grand matron of the breastfeeding world.”

Bugg so appropriately asks, “Why does somebody have to be in charge?”

Competition within the lactation community funnels energy into the wrong places and limits access to quality lactation care for mothers and babies.

Arguably, the same women and children with limited access to lactation services, are the ones who benefit most from breastfeeding.

“African Americans have the lowest breastfeeding rates in the U.S. Yet, they are hit hardest by health problems that breastfeeding protects against: diabetes, obesity, heart disease, asthma and allergies – just to name a few,” according to a Breastfeeding Medicine press release.

I can’t help but reference Chelton’s work again. In Lactation Collaboration and a Hope for Extinction, she writes, “When trade organizations seek to divide professionals (and volunteers!) according to letters after a name and while resentment and turf-warring happen over the bodies of new mothers and their precious babies, we are NOT as strong as we need to be. We are all needed. We are all VITAL to this work.”

Healthy Children Project’s A Renewed Call for Collaboration Among Lactation Professionals responds to the power struggle with the same concern: “All lactation care professionals, no matter what credential they hold, should be working together in the spirit of support and cooperation to ensure the best care and outcomes for mothers and babies.”

Potential to increase access to lactation care

Bugg tells me more about the inspiration for Reducing Breastfeeding Disparities Among African American Women.

“We feel that because of the Affordable Care Act (ACA) and the possibility of funding for lactation management, the people who have been doing it in my community forever would totally be excluded from being able to work and call themselves anything that has to do with breastfeeding or lactation,” she explains.

ACA and its lactation service coverage are tricky to understand.

Bugg and Sahira Long explain issues raised by the ACA and its potential to increase access to lactation care professionals in Unintentionally Disenfranchised?.

For instance, a bill proposed in Georgia, titled HB 363 seeks to license only IBCLCs who are approved by a board the bill will establish, they write.

“The bill is problematic because if passed, the CLCs in Georgia—some of whom have more than 20 years experience—would be committing a criminal act—a misdemeanor—to even call themselves breastfeeding specialists,” Bugg and Long continue. “The passage of this bill will inherently decrease access to lactation care and potentially increase [racial] disparities.”

Simply put, when we limit coverage to one credential, we limit critical support for nursing moms and babes.

In addition to the stated unspoken barriers that many nursing dyads face, Bugg cites cost of lactation care, lack of images of African American breastfeeding and lack of workplace accommodation as cultural barriers to breastfeeding in Confronting Cultural Barriers to Breastfeeding.

Although these hurdles may sometimes seem insurmountable, Bugg remains optimistic about the future of maternal infant health.

Vital support

“I am optimistic because the systems are changing,” she says of policies like the ACA and the Baby Friendly Hospital Initiative.

But Bugg is most excited about the advancements in peer counselor and mother to mother breastfeeding support. While the racial gap hasn’t budged much, peer counseling is palpable in the African American community and improves breastfeeding rates, she reports.

“Mothers are excited to work with one another.”

Moreover, “The Peer Counselling Program is a cost effective and highly productive way to reach a larger number of mothers more frequently. Trained Peer Counsellors, readily available in the community become the lifeline for mothers with breastfeeding questions and issues.” [Retrieved from: http://worldbreastfeedingweek.org/]

ROSE has recently been involved in MomsRising’s blog carnival and Twitter party during Black History Month.

“It was hugely successful,” Bugg reports. “ We reached a lot of African American moms.”

Bugg and her organization are in the process of providing breastfeeding training to 300 WIC employees in Louisiana.

“We plan to make a difference with the work we are doing,” Bugg says. “We don’t plan on doing this forever.”

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