So here's what happened: I was asked to do an interview for Lactation Matters, the blog for the International Lactation Consultant Association. The interview was posted on the ILCA.org website on April 1, 2014. It got a few comments, all was well. Several weeks later, after I thought it would get no more comments, I got a couple of very thought provoking questions. I gave it 24 hours to consider and then took a stab at answering those questions. My reply must have resonated with folks because over the next 24 hours, I got comments from around the globe. A remarkable conversation ensued. I have tried to copy the conversation in its entirety here. Here is the original interview.
Sherry Payne, MSN, RN, CNE, IBCLC, is the Executive Director of Uzazi Village, a nonprofit organization devoted to decreasing pregnancy related health disparities in the urban core of Kansas City. She is also the facilitator of the upcoming 2014 Lactation Summit: Addressing Inequities within the Lactation Consultant Profession. Ms. Payne speaks frequently around the country to professional audiences on topics related to lactation and birth disparities (including the upcoming 2014 ILCA Conference). One of the many barriers that aspiring IBCLCs of color face is acquiring clinical hours. The Uzazi Village Lactation Consultant Mentorship Program is an innovative solution, connecting aspiring International Board Certified Lactation Consultants® (IBCLC®) from the Kansas City community to the Uzazi Village Breastfeeding Clinic, which provides free services to area families.
Ms. Payne was recently interviewed by Marie Hemming, IBCLC, a member of the International Lactation Consultant Association® (ILCA®) Medialert Team.
Marie Hemming: Why did you start the Lactation Consultant Mentorship Program?
Sherry Payne: I started this program with the idea that we needed more IBCLCs of Color. I am currently the only IBCLC of Color practicing in my city (though I am the third African-American IBCLC to be
certified in my community). This has become a top priority for Uzazi Village – making accessible pathways for lactation educators and peer counselors to become board certified professionals, and then linking those professionals to families in our community who need those services. We already had our free Breastfeeding Clinic up and running two days a week and four volunteer IBCLCs to run it. It was not too difficult to add the mentorship program to it. Three of our IBCLCs qualify to be mentors and there were always plenty of women at our door inquiring about how to become a Lactation Consultant. The research tells us that recruiting and diversifying the ranks of IBCLCs should be a part of the strategy for overcoming disparities in lactation in the African-American community. That’s what we are attempting to do.
MH: Tell us about the Breastfeeding Clinic and how it serves families in Kansas City.
SP: Clients are referred from community-based prenatal clinics and local hospitals that serve low income breastfeeding women who otherwise would not be able to access the lactation support they need. I talk to the local lactation consultants, nurse midwives, pediatricians, doulas and other care providers about our clinic. We receive referrals from Women, Infants, and Children (WIC) and home visiting
programs such as Healthy Start and Nurse Family Partnership. We have three to five moms in clinic and home visits each day and we spend an average of two hours with each client on everything from sore nipples, to milk supply issues, to relactation and weaning. We also offer two breastfeeding support groups: La Leche League on Troost, and the Chocolate Milk Café. Our support groups and breastfeeding classes also draw
local women into the clinic.
MH: How does the Mentorship Program work?
SP: The interns need to accumulate 300 or 500 hours and we ask that they work at the Breastfeeding Clinic a minimum of one day per week every other week. If they come to every clinic it will take them four to six months or it may take them as long as 10 months to get their hours if they come less often. They are also encouraged to take the WHO/UNICEF Breastfeeding course which is offered every quarter. The interns pay a fee for the
program on a sliding scale depending on income.
The program is just starting out, however, we have our first intern beginning in May 2014, with two other candidates seeking placement. We are currently working on getting hospital placement for our interns to do part of their hours. We are also in talks with a
local community college to package all the required
courses to create a one-stop shopping curriculum for our interns. We hope to be able to simplify things by having classes and clinical experiences all in one program.
MH: What are some of the other barriers that aspiring IBCLCs of Color experience? How is Uzazi Village helping to break down those barriers?
SP: Barriers for aspiring IBCLCs include accessing the educational components, finding mentors, and completing the hours. Women of Color will of course be much less likely to find mentors that look like them, and normative culture mentors may be uncomfortable bringing a Woman of Color into their practice. (I am actually experiencing the same difficulty in my midwifery training.) Many aspiring IBCLCs of Color are found in the ranks of WIC Peer Counselors, but there is no clear cut pathway to move them into the ranks of IBCLCs. It is the presence of these types of barriers that compelled me to create a program at Uzazi Village. International Board of Lactation Consultant Examiners® (IBLCE®) requirements often presuppose educational attainment that peer counselors may not possess, leaving them stranded at the bottom of the professional and economic rungs.
MH: You were invited to Washington DC by the United States Breastfeeding Committee to discuss continuity of care with advocates from around the country. If you could change one thing about our healthcare system to improve breastfeeding outcomes, what would it be?
SP: The Affordable Care Act makes provision for reimbursement for lactation professionals. I would like to see reimbursement for ALL levels of breastfeeding support professionals – direct compensation for the work we do, particularly WIC Peer Counselors. We need our WIC Peer Counselors in our communities. Lactation consultants are most often isolated in hospitals and accessing them is difficult, if not impossible, following hospital discharge. Private practice IBCLCs are cost prohibitive to access among the women we regularly see. Peer counselors have had the greatest impact on increasing breastfeeding rates in our community – they do most of the front-line work and yet they receive the least amount of recognition and pay. I would like to see Peer Counselors and Certified Lactation Counselors compensated by insurance companies for the valuable service and support they offer. This does not take anything away from the board certified professional, but enhances and refines his or her role. We need all levels of expertise.
MH: Of all of the things that you have done, are there one or two things that stand out as being most effective in helping the moms that come to Uzazi Village?
SP: The Chocolate Milk Café, which is a mother-to-mother support group for African-American women, has been groundbreaking. It is designed to meet the needs of our urban moms and has been one of our most successful programs. At Chocolate Milk Café, mothers can attend with their babies and have a safe environment in which to discuss their breastfeeding issues. We are starting to replicate this model around the country.
MH: You are breaking new ground with your work at Uzazi Village, is there someone who has influenced you or mentored you in your own career as a lactation consultant & natural birth educator?
SP: Lots of people have invested in my success over the years, but my primary mentor in lactation has been Charlene Burnett, BSN, RN, IBCLC. She mentored me when I was an L & D nurse, but I worked at a different hospital. She received special permission from her hospital to mentor me 500 hours in a year. I could not have done this without her. She is one of my LC volunteers and she is the Director of Lactation Services at Uzazi Village. We have named a scholarship after her: the Charlene L. M. Burnett IBCLC Scholarship, set aside for a candidate of color in the greater metropolitan area of Kansas, Missouri who has met all requirements to sit for the IBLCE exam. It is our small way of thanking her for all that she has invested in Uzazi Village.
MH: What advice would you give to others hoping to increase access to lactation services for women of Color?
SP: Be creative, assess your community assets and find a way to connect what you have to what women need. When I’m considering a project large or small, I always call to mind the words of the late tennis great, Arthur Ashe: “Start where you are, use what you have, do what you can.” Finally, if you are not a woman of color yourself, join your efforts to someone who is. Allies are important to the cause, but they must take their lead from someone who is a member of a community of color. At Uzazi Village, we counsel many allies around the state and around the country to place women of color in central roles when doing outreaches to communities of color. On our website, you’ll find the success stories (
Uzazi Champions) of those we have worked with to improve lactation rates in other communities of color.
Marie Hemming, IBCLC is the mom of three breastfed children (now 20, 16 & 15 years of age). She developed and taught a 20-hour breastfeeding class at the Florida School of Traditional Midwifery. She is currently volunteering as an IBCLC and lay community counselor at Birthline of San Diego, serving families living in poverty.
Now here are the interview comments:
Now here is the discussion that ensued when I posted it on my facebook page:
WIC Peer Counselors in the United States are typically paid with federal dollars. I am having trouble understanding why a government employee would need to be reimbursed. Absolutely agree that there is a place for all of the various lactation helpers that educate and support mothers. Each helper provides a different level of care. Mothers and their support systems cannot have too many helpers.
I am a little concerned with the fact that there are IBCLCs willing to advocate for other credentials to be reimbursed by insurance companies and to be compensated. IBCLCs should be proud of their credentials. It is an expensive credenital to obtain and to maintain. IBCLCs do provide a higher level of care since they have a more extensive knowledge background, should provide evidence based lactation care, and have hundreds of hours of mentoring clinical experience vs just taking a course. Insurance companies typically only reimburse for professionals that are licensed.
I believe in the IBCLC profession, but I also believe that IBCLCs need to stand together to advance the profession forward.
Here in my city, while the suburban women enjoy their birth center births with hand picked doulas to support them and midwives to deliver them and private practice LCs to come visit them at home afterward (along with their postpartum doula), the women of the urban core can expect no such level of services. They typically wait 3-4 hours for a 10 minute doctors visit (a doctor they’ve never seen before and probably won’t see again.) They’ll deliver in hospitals where they are bullied and mistreated and looked down upon (or looking to escape that fate, they’ll just ‘drop in’ to one of the suburban hospitals where they’ll really be treated in a punitive manner). They’ll receive precious little assistance with breastfeeding because the nurses think “those people don’t breastfeed” and they may or may not ever see a lactation consultant because often hospitals don’t staff IBCLCs adequately if at all. They’ll also return to work in as little as two weeks, because their families can’t go without the income, probably with a boss that does not support pumping breaks.
Inequitable care is an everyday reality for my community. I hold membership in many professional organizations and they are all very concerned with ‘advancing their profession’. There needs to be a realignment of values that places advancing the cause of underserved communities and decreasing inequities in care as a core focus. Thankfully awareness is growing. I am not advocating for another credential to the harm of my own- I am advocating for my community to have access to lactation support- on any level they can get it, and that those individuals willing to stand in the gap, be adequately compensated for it.
Nearly two years ago Lactation Matters had its first blog on inequities in breastfeeding support: http://lactationmatters.org/2012/09/25/reducing-the-breastfeeding-disparities-among-african-american-women-a-commentary-from-rose-inc-2.
I’ll repeat here a portion of my comments made in September 2012: “There is plenty of work to go around: Lactating women are everywhere, and they deserve competent, passionate information and support along the way. [T]he only real raging debate is: Why is it so hard for every mother, everywhere, to find easy access to this very simple yet essential support from counselors or healthcare providers? [B]reastfeeding barriers must be tackled on a macro level (with national and international public health policies that recognize breastfeeding as the biologic imperative), and on a micro level (developing accessible community-based breastfeeding support … literally in one’s backyard). When families do have a need for the specialized skill and expertise of an IBCLC, such allied healthcare should be readily available, and easily reimbursed.”
In 2014, I’d add: the Affordable Care Act in the United States has opened the door for preventive healthcare services to be made readily available, as a public health objective, to breastfeeding families. Not every mother needs an IBCLC. Most parents can be helped with compassionate, well-informed peer support, like that offered by volunteer lay counselors, WIC peer counselors, or those who have taken any of the dozens of short-term classes that are available (and LEAARC-approved) as good breastfeeding management education.
If a WIC peer counselor or other parent-supportive counselor is reimbursed for her work … and offering such reimbursement means breastfeeding support is better dispersed into the community (where families are!) … this not diminish the right of the IBCLC similarly to be adequately compensated when higher levels of clinical expertise are required, and for that care to be covered by insurance.
The better question is “HOW to pay?,” not WHO to pay. We ALL ought to be paid for whatever level of care we are giving to the family. To repeat: There is plenty of work to go around. It just makes sense to provide adequate levels of compensation and reimbursement, for *all* levels of care.
Do women of color regularly attend your meetings or just drop in occasionally? Do you have any leaders of color? Do any of your meetings take place in communities of color? Do you ever discuss issues of interest to women of color? Do women of color return and bring their friends? Do your inclusive meetings reflect the percentages present in the population as a whole? For example Black people make up about 12% of the US population, Latinos about 14%. Is that the breakdown that you see in your meetings? 26% or one quarter of your meetings are African-American and Latino women? Or did you perhaps mean that every few months, a woman of color attends one meeting or perhaps that you have one woman of color that attends regularly? I myself attended LLL for seven years as the only woman of color in my group. I had to go to a White neighborhood to do it, because there were no LLL groups in my own neighborhood. I enjoyed the ladies, and got good information, and was successful in breastfeeding several babies over that period of time. But- I had to check my cultural identity at the door to do so. I know what you are thinking, “Breastfeeding is breastfeeding, what does racial identity have to do with it?” The answer is ‘everything’. Breastfeeding is a human behavior and as such exists in a cultural context. I travel around the country teaching healthcare professionals how important it is to understand the cultural context of lactation for African-American women. We are a unique and distinct and diverse culture, with equally unique needs that go unmet in a dominant normative White culture construct around lactation. Groups like LLL send a subtle message: “Breastfeeding is for people like us.” Us being White, middle-class, stay-at-home moms with cloth diapered, amber necklace wearing, attachment style parented babies. Nothing about that description would appeal to the mamas I see everyday in my practice. Like nearly everyone else, LLL subscribes to the fallacy that they are inclusive, BECAUSE they are White, and White is the dominant culture norm, therefore it includes everyone. This of course is racist thinking at its finest. The fact of the matter is that there are disparities in breastfeeding. African-American women breastfeed at much lower rates and for much shorter intervals than their Caucasian counterparts, and the reasons for this are primarily racially-based. Healthcare providers are much less likely to discuss breastfeeding with their African-American clients prenatally. African-American women are less likely to see a Lactation Consultant in the hospital. Nurses are less likely to assist African-American women with their breastfeeding issues and offer a bottle instead. When African-American women go home from the hospital and seek out community-based support, they are likely to find it only in White neighborhoods and not in their own. Oh, and all those providers I just mentioned are likely to be White so that African-American women never see providers who look like them or share their values. This too is racism at its finest. Second question: “why would women of color have a more difficult time acquiring the required hours needed to sit for the IBCLC exam” Same answer as for question No. 1: RACISM.
You are correct in stating that finding mentors is difficult for everyone. Aspiring LCs of color have the additional burden of having very few LCs that look like them. Mentees of color, much like students of color, don’t get mentors because dominant culture mentors are uncomfortable selecting mentees of color. They want to choose someone they think they have commonalities with, someone of course who looks like them. Doing as you state, “finding a way to have a resource for all candidates would be very helpful in increasing the number of IBCLC’s in general which is always beneficial to everyone.” is not true. It would only benefit White people, because your “everyone” really only means White people, and not the ones who are suffering the disparities, who would be locked out of opportunities intended for ‘everyone’. Think about it, that is what we do now- have opportunities aimed at ‘everyone’. As a result, what percentage of LCs in the US are White? (hint: overwhelming, vast majority). We don’t need resources for ALL candidates, we need resources for underrepresented candidates, because they are being locked out of opportunities in a White dominated profession. Fewer professionals of color mean fewer women of color getting what they need. The ugly legacy of inequities and disparities continue. I know I have written an overly long response to your questions and I thank you in advance for both taking the time to read it and hopefully understanding another point of view. I think your questions are important ones, because so many Caucasian Americans are oblivious to the racial norming that keeps everyone else locked out. I believe many people believe as you do, that normative culture is every culture, but sadly this is not so. I hope that you will turn a more critical eye to your own social constructs surrounding lactation support and take the initiative to find out what you don’t know. In the meantime, I’ll keep fighting on the front lines for African-American women to get what they need to ensure breastfeeding success- the same things that normative culture women take for granted.
First let me say thank you for giving such a well thought out, respectful and educational response. I truly appreciate it because I was half expecting to be told I didn’t know what I was talking about, end of story. How else can we all learn if not with intelligent, real conversations that inform but don’t attack?
As for the pediatricians offices, I have been in many as a private practice LC and can tell you all the ones I go into appear to make a real effort to demonstrate that they are wishing to be all inclusive but I do agree that if I were to go in an office that had only black women displayed in posters/informational info and parents I would probably feel out of place. I also work pt in a midwifery clinic that serves uninsured women and most of the population there is women of color so our literature definitely portrays our families because we want to make sure they see women like them breastfeeding.
I had to laugh when you described the LLL meetings are attended mostly middle class, white, married, stay at home, attachment parenting, cloth diaper using moms. Exactly my experience. Both in the LLL meetings I attended in a larger city and the ones I’ve lead in my smaller suburban town. In both places we did have a black woman as one of the leaders at different points and both only left because they moved. I would have to say that both places generally reflected the % of blacks in the area but of course their lives may not have reflected exactly what the other women were living. (although they were also sling wearing, cloth diapering moms). To state the obvious though the meetings are going to be held where it is convenient for the volunteer leaders. They aren’t trying to be exclusive but it does have to be doable for them as moms and volunteers, so they are in white neighborhoods because that is mostly where the women who pursue leadership live. Can’t blame them for that.
In regards to finding mentors, I just can’t imagine not letting someone shadow you because she is a different color then you. At least you have the desire to help women breastfeed in common. I can understand not being 100% comfortable in an environment that is all a different color then me though.
So I can understand that women of color have different needs then the middle class, stay-at-home moms but since the reality is that most LLL leaders and LC’s are white, what can we/I do to address the needs of women of color as best as we are able since I feel I won’t be doing my job if they don’t feel they are getting the best out of me when they need my help.
Topped your long letter with another long one. :) Love the dialog. I’m glad you are doing what you are doing to expand breastfeeding support to more women!
Rachel
Thank you Rachel, good to hear back from you. Your above statement is true, however I CAN blame ‘them’ (LLLInternational and the volunteer leaders) for shortsightedness of vision. The fix for this is simple if not easy. RECRUIT MORE LEADERS OF COLOR (not shouting, just stating the obvious.) If LLLI had really seen this as a priority, they would have made it a part of their very creed, to seek out and expand their (really lovely vision of mother to mother support) to communities who would benefit from it the most. They could have invested money in things like scholarships for leadership dues, promotional campaigns to communities of color, creating special programs to recruit and train leaders of color… I’m just making this stuff up, but you get the idea. LLL is the way it is because it WANTS to be the way it is, exclusive, rather than inclusive. What other conclusion can I draw? Its been around over 50 years and if inclusivity had been a priority, it would have been met by now. Of course I don’t want to just pick on LLL because all the orgs I’m associated with do the same thing. But LLL is a good example, great organization, that does great stuff, but think about it. I was in LLL for seven years. I SHOULD HAVE BEEN PEGGED FOR A LEADERSHIP ROLE!!!! (not shouting, just emphasizing). Why did my leaders not see me that way? Am I not leadership material? Did their own personal biases keep them from seeing me as a leader? Did the values of the organization make them blind to me qualifications? Did they see me as extra work that they didn’t want to invest in? Recruiting me to that office? Mentoring me through the process? I think this is LLL’s fatal flaw. Missing what few opportunities come their way to make inroads into communities of color. You said it yourself. The leaders set up meetings on their own home turf. THAT’S WHY WE NEED LEADERS OF COLOR!!!! (still not yelling at you)
ILCA is in the same boat. There needs to be a PR campaign, a fundraising effort, a recruitment campaign, SOMETHING (that isn’t another taskforce) to push and promote the recruitment and creation of more LCs of color. Rachel, we already know it just won’t happen ‘organically’, right? It will take a concerted effort on the part of leadership in these organizations. Leaders interpret and trickle down the organization’s priorities, values and culture. Only a leader of color can take an organization’s values and distill them in a way that is acceptable and appropriate for his/her community. Is this rocket science? I don’t think so. (I’m not that smart!) Sorry, I didn’t mean for this to turn into a rant.
What can you do, Rachel? Get out there and start recruiting, training, nurturing and mentoring leadership candidates of color (in both LLL and ILCA). Do the work only YOU can do, so that they in turn can do the work only THEY can do.
In earnest and steadfast faith,
Sherry