Celebrating World Refugee Day

This summer, we are revisiting some of our previous publications as they relate to various celebrations. World Refugee Day was honored on June 20 this year. As such, we are resharing our 2019 piece “Initiative empowers refugee and migrant women”.

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Before Florence Ackey, MSW knew what public health was, she was inquisitive about prevention. Having lost her 12 year old cousin during her young childhood, she found herself perpetually asking “How can I make things better?”

A lifelong investigator and learner, Ackey completed two years of law school in her home country Niger followed by completion of the University of South Florida Master’s of social work. She is currently pursuing a second master’s degree and will begin her doctorate in public health in fall 2019. She recently completed the Lactation Counselor Training Course (LCTC).

Ackey serves as the State Refugee Health Coordinator for the Florida Department of Health Immunization, and Refugee Services. In this position, she connected with a woman who would inspire her to found Refugee and Migrant Women’s Initiative (RAMWI), a not for profit 501(c)(3) which serves and empowers refugee and migrant women during their resettlement.

This particular woman would come to Ackey’s office almost every day and sometimes simply sit with her. Despite a language barrier, Ackey eventually learned that the woman was lonely and depressed; she couldn’t have children, and her husband was out of work.

These circumstances caused great strife, but connecting with Ackey uplifted her spirit.

Mindful of her mental health, Ackey helped cultivate a social circle around this woman. At the same time, Ackey was driven to incorporate a practical component to the gatherings,  so she taught the women to crochet.

“We made a lot of scarves,” she remembers. “We sold them and [the woman] was able to raise enough money to pay for two months rent. It changed her confidence.”

Ultimately, their informal, weekend meetings grew too large for home meetings, so RAMWI was created. Today RAMWI, run entirely by volunteers, has served over 400 families over roughly six years.

“It’s just beautiful to see how far we’ve come,” Ackey says.

Refugee and migrant women suffer from things like trauma, discrimination and anxiety.

Ackey explains: Often the story goes that the woman arrives with her husband and children from their home country; the husband finds work and grows a social life and the children go to school and make friends. In the meantime, the woman is left alone at home, sometimes too uneasy about the unfamiliarity of their new settlement to leave the confines of her home. Even when her family returns from their daily routines, she’s further isolated because their experiences become less and less common and relatable.

In light of this phenomenon, RAMWI offers corresponding, age-appropriate workshops for mothers and children in order to bridge conversation topics.

“The mom is no longer left alone; she has something she can contribute,” Ackey explains.

RAMWI offers its social, support network and classes and workshopsin a way that allows women to integrate into their new communities while still preserving their cultural identity. For instance, RAMWI’s Annual International Fashion Show during Welcoming Week offers refugees and migrant women the opportunity to share pride in their culture through clothing.

Participants pose during the Annual International Fashion Show during Welcoming Week
Photo courtesy of RAMWI

The show usually represents about 48 countries with over 80 participants.

Monthly support groups cover topics like women’s health, grief and coping mechanism, U.S. healthcare system and resources, nutrition, safety, domestic violence, disaster preparedness, life balance and personal finances among other topics.

Ackey emphasizes that female empowerment doesn’t need to be granted externally.

“Women have the power within in them to freely give,” she begins.

She goes on to describe a visual installation she’ll present at an upcoming RAMWI session to illustrate this idea.

Ackey asks participants questions like ‘Have you helped someone without anything in return?’ or ‘Have you paid a genuine compliment to someone?’ Each time a participant answers ‘yes’, she pokes a hole with a thumbtack into a blank board. The holes initially appear to be randomly placed, but when a light shines through the back of the board, the silhouette of a decorated city appears. The installation represents the seemingly small acts of women impacting entire communities.

This month, RAMWI members will assemble 240 care packages for the homeless.

RAMWI participants at a monthly meeting
Photo courtesy of RAMWI

When it comes to infant feeding, migrant women often look to formula as a status symbol. It’s a mindset Ackey encounters often, but she says the lactation counselor training course has equipped her to become a better healthy infant feeding advocate.

Ackey has also found that hospital staff generally do not take the time to discuss and educate migrant women about breastfeeding. She predicts this is sometimes due to language barriers.

“It’s easier to give them formula and go,” she explains.

Mothers are often happy with the “gift” of formula and all of the “swag” that can come along with formula feeding.

Surely birth and infant feeding culture varies greatly among the women in RAMWI, but Ackey has found that immigrant women tend to share the common value of a strong mother -child bond which stems from their collective upbringing, she explains.

Mother and child, one of Ackey’s favorite photos
Photo courtesy of RAMWI

She shares that this “it takes a village” mentality is reflected in the way they feed their babies.

“Women take care of all the children,” says Ackey.

In some cases, women breastfeed children that are not biologically their own in the spirit of shared duties, but for survival in other circumstances.

“Women breastfeed other children especially from some African countries,” Ackey begins.

She recalls one woman who adopted a child she picked up on the road next to the dead body of his mother. Ackey makes clear this imagery isn’t representative of the entire refugee population, but it is a story that embodies how the women she works with will raise any child.

Amidst the tragedy and hardship that many of the families have faced, there’s so much beauty and hope within RAMWI.

“Hope can, and will heal the world,” its mantra.

One volunteer said:  “The thing I love the most is the environment of support and empowerment that RAMWI creates for women from all over the world…the women learn from each other…form a bond that as women is something that connects you no matter where you are from.”

For Ackey, success is achieved when a woman makes a choice because she has been fully informed and she’s aware of all of her options.

Visit https://www.ramwi.org/ for more information. Connect with RAMWI on Facebook here.

Other relevant pieces

Prioritizing infant and young child feeding in emergencies during National Preparedness Month and beyond

To know is to do: retired nurse dedicates time to humanitarian aid in East Africa bringing awareness to the paradox of direness and vibrancy

A collection of stories by and about those in the AANHPI community

Caesarean Doulas: Implications for Breastfeeding at 24th Annual International Breastfeeding Conference & Nutrition and Nurture in Infancy and Childhood: Bio-Cultural Perspectives

Breastfeeding, peace and justice

Babywearing as a public health initiative

Continuing the conversation about language use in perinatal health

What is ‘appropriate’ language? What one might consider distasteful, hurtful, impactful, another may consider harmless or meaningless.

Photo by Miguel Á. Padriñán

Take this exchange offered by Ravae Sinclair, JD, CD (DONA), LCCE at the early 2020 International Breastfeeding Conference for example:

A white-presenting lactation professional working with a black mother and her baby shortly after birth exclaimed something along the lines of, “Awww, look at him, he looks just like a little thug!” commenting on the slight sag in his newborn hospital cap.

“Little thug”– a heavily loaded term generally carrying negative connotations– was understandably a trigger for the mother. She shut down no longer feeling safe in the space and asked to be discharged early. Most likely, the lactation professional did not intend to offend, but the impact of this short exchange has much further reaching consequences than the intention itself.

We have explored the impact of language to a relatively great extent here on Our Milky Way. You can check out these pieces for examples:

In a recent exchange, Nikki Lee added to this ongoing conversation about language in maternal child health. She shared an observation about how “the media rarely misses a chance to plant negative seeds in the public’s mind about breastfeeding”.

Citing an example from a PubMed alert that morning– Sudden Death in a Breastfeeding Woman with Arrhythmogenic Mitral Valve Prolapse— Lee commented “I ask you, how in the world does the infant feeding method have to do with the death of this mother? She had some kind of cardiac defect; pregnancy and labor place huge stresses on the cardiovascular system. What would you think and how would you feel if you saw a headline ‘Sudden death in a formula feeding woman with arrhythmogenic mitral valve prolapse’?”

Julie Smith’s, et al 2008 paper Voldemortand health professional knowledge of breastfeeding – do journal titles and abstracts accurately convey findings on differential health outcomes for formula fed infants?  “showed a surprising ‘Voldemort effect’ in the studies examined; formula feeding was rarely named as an exposure increasing health risk in publication titles or abstracts.” The authors conclude that “ If widespread, this skew in communication of research findings may reduce health professionals’ knowledge and support for breastfeeding.”

In her own reflection on the use of language in perinatal support, Donna Walls, RN, BSN, ANLC shares her guest post Our words need to send a supportive message- how can we do it? this week on Our Milky Way.

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As a child I often repeated “sticks and stones can break my bones, but words can never hurt me”. As an adult, I know this is not true. Words are powerful. In our breastfeeding advocacy world, words can be used to build a new mother’s confidence, or they can be used to undermine it. Below, I offer you some of my pet peeves,  words and phrases we commonly use without  thinking about their impact.

Source: United States Breastfeeding Committee

First, maybe the most common and certainly one of the most harmful is talking about “milk coming in”. We know that the number one fear of new moms, especially first-time moms, is not having enough milk. In the first days after birth,  there aren’t often  visible signs of milk production. New parents have often heard about engorgement and how breasts get so full, they look like they are ready to explode. But, they see no signs of exploding breasts in the first one to two days after birth. They may be able to express drops which is encouraging but no big reassurance that there is plenty for their baby.

We often see at about two days of age the occurrence of “cluster feeding” when their quiet, precious newborn seems ravenous and so, so hungry. Many moms think, or unfortunately are told, that this is a sign of not having enough milk. This is not even slightly, vaguely true but rather a normal newborn feeding pattern. We dutifully tell this anxious mother not to worry; her “milk will come in” in a day or two. The not-so-subtle message is that there is no need to worry about not having milk now, that  it soon will come in.

What has happened is that we have reinforced her biggest worry about not being able to adequately feed her baby. I don’t believe for a minute that this is intentional on our part, really just one of those things we have always said and never really examined the consequences.

I sometimes feel sorry for underappreciated, often ignored colostrum. Maybe it’s time we change the language. So instead of saying “your milk will come in”, might I suggest we instead say “the milk you’ve been making for your baby while you were pregnant is there for the first feeds. It is newborn milk, sometimes called colostrum, and this small volume is all your baby needs in the first hours and days. When you nurse frequently in these first days the newborn milk will change over to mature milk and you will see an increase in the amount as your breasts will become fuller, firmer and heavier.” You can of course  come up with your own wording just as long as new parents get the message that there is milk NOW- not “coming in” later!

Source: United States Breastfeeding Committee

My second pet peeve is judgey diagnoses of flat nipples. Way too often when prenatal breast assessments are done, there is a diagnosis of flat nipples, usually based only on the appearance with no regard to assessing function. Once these misunderstood nipples are labeled, the mother is deemed not quite right for feeding. Silly exercises and gadgets are recommended to make already elastic skin behave appropriately. First point: nipples are erectile by nature, some stand up a lot, some a little. Sadly most new mothers have seen artificial nipples and think they should look like these, not ever recognizing that we have the real nipples so why aren’t bottle nipples more like ours?! When counseling mothers, ask the mom if she notices her nipple erecting in cold weather or with sexual/manual stimulation.

As a clinical lactation care provider for many years, I would often be saddened by the words used to make a mother feel her nipples weren’t quite right, not good enough. I have seen too often women struggling with breastfeeding because they were told even before the baby’s birth that the chances were slim for successful breastfeeding; bad nipples would certainly cause problems.

I am quite sure males are not discouraged about the abilities of their erectile tissue at the onset of sexual activity. This is not to say that there may not be challenges  with inverted nipples; they may cause challenges  when they are retracted enough to not ever be stimulated or stretched for hormonal release, but flat nipples will evert. They just want to do it their way. We need to remind moms that the nipple their baby will prefer is attached to their favorite person.

Third, let’s talk about the term engorgement. By definition, engorgement  is not normal. It is a state brought on by interruptions in the expected initiation of lactation [Source]. Unfortunately, the term is used by professionals and families to mean a fullness in the breasts. Signs of engorgement include hot, reddened, uncomfortably swollen breasts which can be hard for a newborn to correctly latch to the breast. This needs to be distinguished from normal signs of lactation when breasts become rounder, fuller, firmer and heavier. Too often a mother may complain about her breast “engorgement” and interventions are recommended to help reduce the discomfort and swelling when in reality she just needs to be reassured that what she is feeling is normal and actually a good sign that she is producing milk. So, my request is that when a mother talks about her concerns about engorgement, our response needs to be to ask something along the lines of “what exactly are you feeling?” as well as the usual questions of frequency of feedings, adequate output and signs of comfortable  latch.

Source: United States Breastfeeding Committee

Our words can have a profound effect on the success or failure of breastfeeding. A huge part of our job, our responsibility to our patients and their families is to build confidence in their ability to nourish and nurture their newborns. Be aware of the message that is being sent and choose words that will build confidence, be generous with realistic praise and couch our intervention suggestions with success in mind. Ask for parents’ input; we want them to know their thoughts are important to the process!

Reference Cadwell, K. and Turner-Maffei, C.  Pocket Guide for Lactation Management. 2022. Jones and Bartlett. Burlington, MA.

Glints of hope and control in a burning world

As I gathered my thoughts for an Earth Month and infant feeding installment, I got an email notification that Valerie McClain had published something new on her Substack. Of course I hurried over, because her pieces are always illuminating. She writes in Standing on the Precipice:  “We are self-destructing on our Mother Earth, and she may be the last woman standing amidst the rubble and miles of corpses.”

Photo by Tatiana Syrikova: https://www.pexels.com/photo/anonymous-little-kid-touching-tree-with-hand-3932861/

In all of the pieces and years past that we have covered the connections between infant feeding and planetary health, it never actually occurred to me that there might be a scenario where Mother Earth outlives us. This will surely strike some of you as naive, absurd, delusional, or something else considering what has happened and continues to happen on our planet. Even so, I envisioned humans dying alongside our planet, our self-destruction agonizing and inevitable, as we claw, infect, and deplete Mother Earth with our beastly antics, taking down the innocent in our path to complete decimation. 

On a recent trip to The Museum of Modern Art, I was shaken out of this sense of Doom and flurry of eco-emotions. Victor Grippo’s lead containers with beans first spoke to me, metaphors “for the force and persistence of life”. This display coupled with Niki de Saint Phalle’s phrase “What is now known was once only imagined” infused me with a little glint of hope that I’ve been craving. 

Then on a Throughline episode about consumer protections and trust in and accountability from companies and elected leaders, I heard the voice of Ralph Nader. He offered: Cynicism is “a cop-out. That’s an indulgence. That’s an indulgence of quitters that makes them feel good. Because when you’re cynical, you’re obviously smart, aren’t you? You think you’re smart. No, you’re not smart. You’re playing into the hands of the corporate supremacists. You’re playing into the hands of the few who want to control the many who could easily outvote the few and make the corporations our servants, not our masters.” This offered me a shift in perspective too.

Source: https://www.gifa.org/en/international-2/green-feeding/

Among the hopeful is coverage of the Green Feeding Tool by Kristi Eaton. Eaton quotes Julie Smith, co-creator of the tool: “…with the Green Feeding Tool—designed to provide policymakers, climate scientists, advocates and others with clear data about how increasing support for breastfeeding can help save the planet—we have the evidence to support action.”

Now, consider this headline: Breast milk can expose babies to toxic ‘forever chemicals’

“For decades, physicians and scientists have touted breast milk as liquid gold for its immunological benefits.

But nursing parents with considerable exposure to cancer-linked ‘forever chemicals,’ or PFAS, may unwittingly be exposing their babies to these compounds as well…” the author begins. 

The article acknowledges contaminated water could be a potential source of PFAS which infant formula is often mixed with. The author also includes that “the benefits of nursing likely outweigh the potential risk of PFAS exposure through breast milk.” [Note the language used here. There are generally no benefits to breastfeeding. Instead, there are risks associated with not breastfeeding.] 

Nikki Lee asks some important questions: “Why doesn’t formula get tested for these chemicals?  Do folks believe that somehow cows are protected against pollution?”

As with anything, there will be risks associated with any variation of infant feeding. 

Healthy Children Project’s Karin Cadwell points out that if toxins are being detected in human milk, it means we need to reconsider the products being used in industry.

Photo by willsantt: https://www.pexels.com/photo/woman-breastfeeding-her-toddler-under-the-tree-2714618/

The author of Study Finds High Levels of Toxic Chemicals in Mothers’ Breast Milk quotes Erika Schreder, science director at Toxic-Free Future who shares a similar sentiment: “’If we want to make pregnancy and breastfeeding safe and free from PFAS, we really need to eliminate the use of these chemicals and products, so that we can have clean food, clean air, and clean water… We really don’t believe that responsibility should be placed on individuals when we need regulations to end the use of these chemicals.’”

In the predicament(s) we find ourselves in, I’d like to leave you with a few more of McClain’s words: “A mother cannot control events such as: wars, sieges, shortages of infant formula and pitocin, fires, floods, hurricanes, tornadoes; but she has a semblance of control in her and her baby’s world through breastfeeding. Dependency on always having access to infant formula, health care, freedom from human or environmental violence, should be tempered with the reality that there may be times, when all the civility of life vanishes.” 

More for Earth Month 

Industry lies and the Code

Infant feeding and planetary health go hand in hand 

Breastfeeding is eco-friendly 

Goats and Soda’s How do you keep calm and carry on in a world full of crises?



Creative solutions for facilitating traditional Navajo birth

It was a whopping 102 degrees during the day with plummeting temperatures at night in Shiprock, New Mexico on the sacred land of Navajo Nation. The soon-to-be new parents’ camp was set up completely off grid with no running water or electricity.

Indigenous Doula, student homebirth midwife, and New Mexico Doula Association birth equity co-chair Natasha Bowman and her colleague Indigenous Doula and the Executive Director for The Navajo Breastfeeding Coalition Amanda Singer, CLC got to chatting about how they could best serve their client who desired a traditional Navajo birth under these conditions.

Considering their own well-being and the safety of their clients, Bowman and Singer initially joked about hauling Bowman and her fiancé LaDarrell Skeet’s fifth wheel out onto the land. But Skeet helped make it a reality.

The team was able to set up a mobile birthing suite for the new family and their care team complete with air conditioning, clean water and a bathroom. What’s more, the certified professional midwife attending the birth brought along her small trailer too.

“When we do births on the Navajo reservation, we have to think outside of the box,” Bowman explains.

Bowman, who has always been interested in labor and delivery, realized while working with the University of New Mexico’s Birth Companion Program, the lack of Indigenous birth workers. During one training, in a roomful of 40 participants, three were Indigenous.

“I was shocked,” Bowman says. “There has to be a change. There has to be more Indigenous birth workers.”

Later, Bowman attended another training with the Changing Woman Initiative, where she first met Singer. Since then, they’ve been realizing their vision of more Indigenous doulas and birth workers.

Bowman and her partners are continually learning the traditional Navajo ways of birthing and bringing those rituals to their clients.

“Some [clients] are for it, and some are against it because they have always been told they should be birthing in a hospital,” Bowman begins.

She goes on to explain that some of her clients have been scolded and ridiculed by pediatricians, other health care providers and even family and friends for planning a home birth despite the evidence confirming that among low-risk women, planned home births result in low rates of interventions without an increase in adverse outcomes for mothers and babies.

Bowman describes some of the elements of traditional birth which include integrating song, herbal remedies, teas and tinctures, and traditional dress in sash belts and moccasins.

“We believe in the exchange of energy and thoughts,” Bowman continues. “Good intentions, pure thoughts, and lots of prayers.”

It is customary for birth workers to tie a bandana over their heads as well as a Sani scarf, sash belt, or rebozo with an arrowhead tucked inside around the waist to protect the reproductive system.

“It is to protect us from the powerful energy the laboring parent is releasing,” Bowman explains. “It is like armor for us.”

Bowman and Singer and their partners are confronting the health realities in their community through other collaborations too. Their funding partners are The Kellogg Foundation, The Brindle Foundation and United HealthCare. Partnering organizations include Indigenous Women Rising, New Mexico Doula Association, Bidii Baby Foods and Saad K’idilyé, a grassroots organization dedicated to providing traditional teachings to the urban Diné communities around Albuquerque, New Mexico.

Last summer, the Saad K’idilyé Diné Language Nest (SKDLN) opened as a  central urban hub where Saad K’idilyé meets with families, babies, caretakers, and its community.

“A language nest is a community site-based language program for children from birth to three years old where they are immersed in their Native (heritage) language,” as described on their website. “SKDLN is a safe, home-like environment for young children to interact with Diné Bizaad speakers, often elders, through meaningful activities.”

Bowman was able to witness the interactions.
“It was amazing!” she exclaims.

Eventually, Bowman says that she and her colleagues would like to create their own Indigenous Doula training with teachings specific to Navajo birth culture.
In the meantime, they’re celebrating National Breastfeeding Month with Indigenous Milk Medicine Week: From the Stars to a Sustainable Future during the week of August 8 to 14. The breastfeeding coalition will reveal a Navajo translation breastfeeding art piece during this celebration.

And while the fifth wheel doula mobile has stirred up great interest within the community on social media, for the time being, there won’t be an expansion of this service. Bowman and Skeet’s fifth wheel remains on the move though, helping keep the birth team comfortable. Follow its tracks by following the Navajo Breastfeeding Coalition on Facebook.