It has been 10 years since we authored our first blog post here on Our Milky Way. Ten. Years. This milestone is accompanied by a myriad of emotions!
I’m so proud of our collection of publications, promoting fantastic work by fantastic people.
I am stunned by the elusiveness of time; I first took the Lactation Counselor Training Course (LCTC)– which propelled me into this work– when my first child was only a few months old and now she is 11.
I am deeply grateful for everything I’ve learned from our participants and my colleagues and mentors who have shaped this blog. It’s such a thrill to connect with people across the continent and across the oceans, and I consider it such a privilege to have spent time with all of the beautiful minds featured on this blog.
I am both discouraged and encouraged. Scrolling through a decade’s worth of stories leaves me inspired by maternal child health advocates’ tireless work and triumphs both big and small. Lactation spaces have been carved out and employers have adopted breastfeeding-friendly policies, breastfeeding murals have been painted, generous human milk donations have been made, babies have gone skin-to-skin in the operating room, World Breastfeeding Weeks have been celebrated, important research has been conducted and published, and the accomplishments go on and on!
I’m also disheartened by the darker spaces where negative forces are at play like conflict among care providers, our culture’s disconnect between birth and breastfeeding, systemic racism, no paid parental leave, and the pervasive industry influence in infant feeding and beyond. These, among other forces, leave the United States consistently dangling near the bottom of the WBTi World Ranking list.
Despite our country’s poor performance in supporting healthy beginnings, I still find myself with a sense of wonder and cautious optimism for what the next decade holds for familial, community and global health.
In celebration of Our Milky Way’s 10th birthday, we’re launching a series called “Breastfeeding is…” For ten weeks, we will revisit a topic that describes breastfeeding. This series was inspired specifically by our 2013 piece Breastfeeding is… where Healthy Children Project faculty emeritus Barbara O’Connor, RN, BSN, IBCLC, ANLC discusses what breastfeeding can be and the cultural forces at odds with positive health outcomes.
Join us in celebrating and honoring healthy infant feeding by sharing what breastfeeding means to you. You can post in the comments below, find us on social media @centerforbreastfeeding, or email us at info@ourmilky.org.
What’s more, I am so pleased to announce that we will be giving away an online learning module with contact hours each week of our 10 week celebration. Here’s how to enter into the drawings:
This week, in the body of the email, tell us what breastfeeding means to you. Subsequent weeks will have a different prompt in the blog post.
We will conduct a new drawing each week over the 10-week period. Please email separately each week to be entered in the drawing. You may only win once. If your name is drawn, we will email a link with access to the learning module. The winner of the final week will score a grand finale swag bag.
Some days Susan Gold, RN, BSN, ACRN misses her ignorance. Since 2003, Gold has embarked on over 30 trips to various locations in East Africa where she teaches sexual and reproductive health and offers humanitarian aid.
Recalling one of her first visits to a clinic in Nairobi, Kenya, Gold describes a young mother, around 18-years-old, who arrived holding her severely malnourished infant against her breasts infected with such severe mastitis that her skin had split. This mother had been thrown out of her home for being HIV-positive and was breastfeeding and formula feeding her baby.
[Some background: Infant feeding has been complicated by the HIV epidemic. In the early 2000s, Gold explains that HIV-positive women were taught to formula feed to lower the risk of transmission to their babies, but with little to no access to clean water, babies were becoming severely ill. What’s more, in societies where breastfeeding is the norm, exclusive formula feeding is often an indication of one’s HIV status, which remains highly stigmatized. And formula is expensive, so many mothers choose mixed feeding, increasing the rate of HIV transmission, because formula irritates the GI system and gives the virus a pathway. By 2010, WHO issued new recommendations that stated that all mothers who tested positive should receive effective antiretroviral treatment (ART) which could lower risk of transmission during exclusive breastfeeding to virtually zero. In 2016, WHO extended the recommended duration of breastfeeding for HIV-positive mothers to 24 months. Effectiveness is dependent on consistency though, and Gold explains that mothers can develop resistance because there isn’t always access to ART.]
Gold was able to give the mother antibiotics, but the care that she and her infant required was beyond what Gold could offer. Considering the dyad’s condition and Gold’s limited resources, she says she’s certain that they died.
Reflecting on the suffering she witnessed and lives lost, that’s when Gold misses her ignorance most, but she says, “To know is to do.”
“For me it’s not a news story I can ignore, it’s names and faces,” she remarks.
Most recently, Gold spent several weeks in Dar es Salaam, Tanzania on a Nelson Mandela Fellowship Reciprocal Exchange Fellowship Grant where she partnered with Dr. Omari Mahiza, a pediatrician at Amana Regional Referral Hospital, focusing their efforts on combating pediatric malnutrition and education on family planning.
Shattering stereotypes
Gold has found that most Americans hold a “shallow view” of the continent. Her frustration with the stereotypes associated with Africa runs deep.
“It’s either starving children or a safari,” she begins. “It’s so painful for me to see that displayed so many times. There is such a tendency [in America] to dehumanize people who are not like us… We set ourselves as the standard. Their culture is not a failed attempt to be our culture. Success doesn’t have to look like us or be measured against us.”
Alongside her humanitarian work, Gold hopes to shatter the stereotypes, to bring awareness to the paradox of direness and vibrancy in East Africa.
Gold reminisces: “I love the African sun on my face, the bright colors and motion, the culture that is built around the family and friends, that you’re never expected to do it alone, the generosity of spirit, the sounds and smells, the warm welcomes and the optimism.”
Acutely aware of “an inherent imbalance of power” and the concept of White Saviorism, Gold uses the Swahili term Tuko sawa, which means “We are all the same”, as the foundation of her work.
We all want healthy children and families and a future with opportunities to provide long, healthy, prosperous lives, she expounds.
Beyond this core belief, Gold says that she always develops relationships with the people she works with.
“I educate myself on the origins and current status of their culture. I don’t tell people what to do, I share my experiences and expertise. I always learn from them.”
Doing more with less
Ingenuity is something she’s gathered from working alongside East Africans.
For instance, Gold was struck by the engineering of incubators for very sick babies at St. Joseph’s Hospital in Moshi, Tanzania.
If there is electricity, she explains, the heat is controlled by the number of light bulbs lit. The wood absorbs the heat, the aluminum components absorb and reflect heat, the mattress absorbs heat but also protects the baby, and the lid retains the heat but allows for monitoring of the baby. Mosquito netting is fashioned around the system.
Gold notes that Kangaroo Mother Care (KMC) is practiced for almost all premature babies, but it’s not common among sick babies. [Read about skin-to-skin efforts just north of Tanzania here: https://www.ourmilkyway.org/skin-skin-gulu-uganda/]
Hunger: hidden and stark
A recent Lancet Global Health Publication, Revealing the prevalence of “hidden hunger”, released estimates of two billion people worldwide with one or more micronutrient deficiencies, noting that this is a gross underestimate. The hunger and deficiencies that Gold and her colleagues witness are rarely hidden and often quite obvious.
A severely malnourished child holds onto one of the toy cars that Gold collects and brings for the children at the clinics.
Breastfeeding is important in the prevention of different forms of childhood malnutrition, including wasting, stunting, over/underweight and micronutrient deficiencies. Tanzania scores quite high in the World Breastfeeding Trends Initiative (WBTi) World Ranking.
Gold observes that all of the women breastfeed in the low-income neighborhoods she visits.
The struggle, she says, is getting enough nutrition for the women to sustain milk production and have energy to feed their babies. During her most recent visit, Gold reports that almost none of the 35 families had food in the home.
Reporters of the new estimates for micronutrient malnutrition point out that processed fortified foods and micronutrient powders can be an easy answer to hunger, but they don’t create sustainability of local and indigenous foods and create conflict of interest issues with industry.
Gold adds that low income community members can’t afford to buy industry developed foods consistently. Lack of access to clean water is also a barrier.
“And you can’t depend on outside groups to sustain you,” she continues.
“We didn’t see any processed food at all because there is no market for it,” Gold says of visiting seven different neighborhoods in the low income region of Dar es Salaam. Instead, small markets with locally-grown fruits and vegetables prevail, but access to protein is a challenge.
As medically indicated, ready-to-use therapeutic food (RUTF) packets of fortified peanut butter issued by UNICEF are given out through health clinics. But Gold notes that sometimes parents sell these packets for money.
A challenge but not insurmountable
North of Dar es Salaam, in Moshi, Gold brings a portable printer that doesn’t require Wifi to the small hospital where she volunteers. She gifts each postpartum mother a printed 4×6 photo of herself and her baby.
“You don’t know how many of these babies are going to survive due to the high infant mortality rate.”
There’s a long moment of silence between us on the video call.
Then Gold expresses her frustration and anger, “The world can fix this, but chooses not to.”
She urges us to educate ourselves and others. Vote for people who have a vision of the world as one world, she says.
Last month, the President signed into law H.R. 4693, the “Global Malnutrition Prevention and Treatment Act of 2021,” which authorizes the United States Agency for International Development to undertake efforts to prevent and treat malnutrition globally.
For those interested in making financial contributions or donations like baby clothes, children’s books, or toy cars, email Gold at talkinghealthoutloud@gmail.com.
Follow Gold’s organization Talking Health Out Loud on Facebook here.
For an interesting discussion on Numeracy Bias, check out this episode of Hidden Brain. Numeracy bias is described this way: “…When you see one person suffering, you feel like, ‘Oh, I can do something for that person.’ But when you hear that a whole country has a refugee crisis, you tend not to get involved because you feel like, ‘Well, this is overwhelming. I don’t think I can do anything about this, so I’m not going to engage.’…It turns out that people who have experienced a high level of lifetime adversity are immune to this bias.”
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.
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.
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.”
“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.
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.
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.
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