USBC Legacy Awardee Karin Cadwell Calls for Recognition of Structural Racism

(Ed. Note: Our Milk Way blogger Jess Fedenia is on parental leave for the months of July, August, and September, 2016 to welcome a third child into the family. During Jess’s leave, members of the Healthy Children Project, Inc. circle are taking up the blogger role.)

On August 7, 2016, the United States Breastfeeding Committee awarded legacy awards to the following legendary members of breastfeeding intelligentsia in the U.S.: Kimarie Bugg, Karin Cadwell, Miriam Labbok, and Marsha Walker. [After this post was published, we were saddened to learn of the death of Miriam Labbok on August 13, 2016. Dr. Labbok’s legacy is beautifully described here.]

This week’s post contains the Karin Cadwell’s acceptance speech, followed by remarks by USBC chair Jeannette Crenshaw regarding Karin’s work. Heartfelt congratulations, Karin, from your colleagues at Healthy Children Project for this recognition of your leadership, scholarship, and your amazing capacity to speak the truth!

20160807_162108 (1)USBC Legacy Award Acceptance Speech, Karin Cadwell, RN, PhD, ANLC, IBCLC:

First, I want to thank you for the honor of this award. I am humbled by the recognition of my years of service to mothers and babies here in the United States and in countries around the world. When Jeannette (Crenshaw, Chair of the United States Breastfeeding Committee) interviewed me about receiving the Legacy Award it gave me the unusual opportunity to take stock and consider the trajectory that brought me here.

I was breastfed because my mother and father were immigrants to this country. Breastfeeding was what they knew. So, my first experience breastfeeding my own baby should have been easy. I was

Breastfed myself!

Well educated!

Well nourished!

Well hydrated!

Well motivated!

But it wasn’t easy.

The hospital policy was

               Day 1: 1 breast 1 minute every 4 hours

               Day 2: 1 breast 2 minutes every 4 hours

on up to day 5 – BOTH BREASTS, 5 minutes on each side, every 4 hours.

When I brought the baby home on day 5, I followed the instructions and nursed her on each breast for 5 minutes at 6pm and put her in the crib. She cried. I checked the discharge instructions to be sure I had gotten them right – Do NOT pick the baby up or feed her from 6 at night to 6 in the morning- OR ELSE! (The scariest or else was that she wouldn’t have friends in kindergarten.)

While she was crying I decided to unpack baby clothes sent to me by a relative who thought (wrongly as it turned out!) that she would no longer have any use for them. On the top of the first box was an original and well-worn copy of the Womanly Art of Breastfeeding. I probably was only a few pages in when I picked up the baby and nursed her. The next morning, I walked to the pay phone on the corner and called up my mother. She drove 10 hours to come and get me.

There was a lot of social justice in the milk my mother gave me and I have been compelled to ask why breastfeeding, an act that is necessary to the survival of a species, is so difficult. I have spent more than 40 years travelling around the country giving lectures and workshops, facilitating problem solving with mothers who are struggling with breastfeeding, done research, written books and articles and served as a mentor to you women coming up in the field. In the asking I always found more work to be done,

               As a teacher trainer for ICEA

               As a breastfeeding counselor for CEA-GP

               As a founder of ILCA and NABA and NABA REAL

               As convener of Baby-Friendly USA

               As chair of international Baby-Friendly Coordinators meetings

As a founder of the Breastfeeding Leadership Roundtable which became the United States Breastfeeding Committee

As a facilitator of the US submission of the WBTi.

Since 1991, the Innocenti Declaration has been my map:

               Baby-Friendly in the US :  √ (check)

               A National Multi-Sectoral Breastfeeding Committee – √ (check)

Imaginative Workplace Legislation – hmmm more is needed, especially for non-hourly employees and we need PAID MATERNITY LEAVE!

Legislating the International Code on the Marketing of Breast Milk Substitutes. USBC has a group working on that! I’m hopeful.

But equity…..we have a long way to go to achieve equity. There are surmountable hurdles….but hurdles nonetheless. Hurdles of individual and structural racism. I believe that individual racism feeds into structural racism. As a teenager, I thought these were easily overcome.

I hopped on the bus inspired by Mrs. Peabody, our governor’s mother, to sit-in and integrate lunch counters and restaurants. But it’s not as simple as I thought it was as a high school girl. I was SO young and naïve. But not now.

Which races of babies have the highest rate of mortality in the US?

 African American (11/1000) and Native American (7/1000… US Average 6/1000).

Which US babies have the highest risk of dying from pneumonia?

Native American and Alaska Native babies are 4 times more likely to die from pneumonia.

Which babies have the highest risk of becoming diabetic?

Native American babies. And diabetes is significantly related to higher death rates in later life.

Which babies could benefit most from the miracle of mother’s milk?

African American, Native American and Alaska Native babies, since being breastfed reduces the risk of mortality in general and of contracting diabetes and pneumonia.

Which babies are the least likely to be breastfed?

African and Alaska Native and Native American babies

Which race of women is most likely to have breast cancer diagnosed at a later stage and die of breast cancer?

African American women who die of breast cancer at the rate of 28/100,000. The US average is 20/100,000.

Which race of women is most likely to have metabolic syndrome and die from the resulting heart disease and stroke?

If you guessed African American women you are right!

Who are the women that breastfeed at the lowest rates in the US?

 If you thought it was African American, Native American and Alaska Natives, you would be correct!

Which women could benefit the most from having breastfed?

If you thought it was African American, Native American and Alaska Natives, you would be correct again!

I believe the low breastfeeding rates among African Americans, Native Americans and Alaska Natives is because of STRUCTURAL RACISM.

Several states have recently had their restrictive voting laws overturned. The rationale for passing these restrictive laws was given as “voter fraud” however, it was demonstrated that the legislators had requested data about African American and Native American voting practices before knowingly and systematically legislating to disenfranchise these peoples.


They say “voter fraud”.  I’ll say “structural racism”. The courts agreed with me!

Which hospitals are least likely to be Baby-Friendly in the US? 

According to Lind and colleagues at the U.S. Centers for Disease Control and Prevention (2014),  hospitals that serve African American families.

To those who say that “Baby-Friendly is too hard (too expensive) (too whatever),” I’ll say “structural racism”

Groups that put forth restrictive licensure legislation or diatribes against other professional lactation care givers when they know (and have admitted publically) that they are not a group representative of the population of the US, are enforcing structural racism.

When I hear that lactation legislation will improve “access to care” but the sayers are not able to articulate what this really means, I’ll say “structural racism.”

When I hear that licensure is for “protecting the public” but that sayers are not able to articulate what this really means because what it really seems to mean is “protecting members of your club” (that is known to be, let’s just say, not-representational), I’ll say “structural racism”.

The problem is (as been written before me so articulately) that

“When you are accustomed to privilege, equality feels like oppression.”

Until we face structural racism head on–acknowledge it, name it–we cannot work on it. Breastfeeding rates will continue to climb at the barely noticeable pace they are now. Mothers and babies will continue to be denied their right to optimal health.

As Doctor King so wisely told us

               “Injustice anywhere is a threat to justice everywhere.”


Jeannette T. Crenshaw, DNP, RN LCCE, IBCLC, NEA-BC, FAAN, Chair, United States Breastfeeding Committee introduced Dr. Cadwell’s award with the following remarks:

Karin Cadwell’s introduction to breastfeeding came from a person near to her heart, her mother. In a time when not many women were doing so,  Karin’s mother  nsisted on breastfeeding her from birth, and in fact, while they were still in the hospital, Karin’s mother’s milk was used to help an extremely ill baby in the hospital at the same time as them. The baby survived and went to school with Karin, and as she grew up she identified as the mother of a “milk goddess.” When she gave birth to her first child, she struggled to follow the hospital and obstetrician’s guidelines on breastfeeding. When she found a fatefully placed copy of The Womanly Art of Breastfeeding in a box of donated baby things, she quickly knew she would dedicate her life to making sure women had access to breastfeeding support. As she says, “how could I, the daughter of a milk goddess, a well-educated, well-read, well-motivated woman, a woman with every privilege, how could it have been so hard for me to breastfeed?” That’s the question she has been asking and answering ever since.

When people who have been on the long journey with USBC look back at our growth, Karin Cadwell, together with fellow Legacy awardee Marsha Walker, are appreciated for their role in recognizing the need to form a multi-sectorial organization to elevate breastfeeding in the United States, as called for in the international Innocenti Declaration.

When Karin is asked to look back on her accomplishments in the breastfeeding field, she promptly informed me that she doesn’t look back, she just looks forward at “the work there is still to do.” She speaks of continually finding new challenges and continually responding to new generations and their needs.

Like her organization,  the Healthy Children Project,  Karin’s legacy and mission is one that holds space and creates opportunities for others to succeed. Her vision of the idea that babies have a right to good health right from the beginning of their lives inspires women coming up in the field, both as a role model and a mentor. Her close colleague,  Cindy Turner-Maffei points to Karin’s “amazing mind, amazing heart, and amazing commitment to serve all families” when speaking about her legacy. In 25 years, Karin hopes the legacy Award will go to people who have worked for legislation to hold in place all of the current and future achievements of the breastfeeding field, ensuring a world where breastfeeding is protected and supported.


Reflections on Karin’s Contributions to the Field with Cindy Turner-Maffei

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