Warning: Long read, but oh so worth it:
Q & A with Sherry Payne, MSN, RN, CNE, IBCLC: An Innovator In Lactation Equity
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
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
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
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
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:
15 Responses to Q & A with Sherry Payne, MSN, RN, CNE, IBCLC: An Innovator In Lactation Equity
Now here is the discussion that ensued when I posted it on my facebook page:
Bblessed Freddye, Kathy Kendall-Tackett, Steffany Kerr and 43 others like this.
Kc Homebirth This is a great explanation. My question would be why we cant create an inclusive model? Say in the midwifery community? Why cant we find a way to encourage our group to be as diverse as our real world?
Hall Family I think many of us Caucasians have never considered how it would feel to be somewhat interested in doing something, but upon seeing the "type" of person who commonly does that thing decide, "Oh, XYZ must not be for white people." Maybe, for example attending a "black church." Certainly, it would not be illegal to attend, nor would we be rejected by the congregants, but because we perceive, "This isn't somewhere My Type would go," we would not be likely to go there. Just as a pregnant black mother might attend one breastfeeding meeting, not see any other women of color and decide, "Oh. I guess breastfeeding isn't for My Type."--Amy
Elizabeth Schmidt Arnold white privilege is. . .never having to constantly move through the world educating other people about their privilege. It must be exhausting confronting microaggressions on a daily basis. I have nothing but respect for you.
Sabrina Bias So give us concrete ways we can be more open to people of color. I hear women are not comfortable with us but HOW do we change that?! I hear we exemplify racism just by being white, that does not help us to reach across the way. If we don't know what we are doing wrong we can't fix it.
Corina Hossle Wonderful explanation, Sherri Wells...Thank you for doing all you do, not the least of which, is educating those of us with white privilege to see it clearly!
Sherry Payne Cheryl Gates, I ask myself that everyday and I think its because we're all messed up in the head about our legacy of bigotry and oppression that we can't get passed it without open honest dialog about race and race relations, and we've been avoiding that for nearly 200 years... Hall Family- nice example TaNefer, thank you I look forward to our future meeting as well. Will you be at ILCA this year? Sabrina, why burden me with work that is yours to do? Corina,, you are welcome.
Laura M. Perez Sabrina - it's the white women who are not comfortable with the women who don't look like them. It is not the other way around since we women who are of African, Latin American, Asian, Native American, and Arab heritage know how to live in white dominant spaces because we have no other choice.
Read Tim Wise. Attend anti-racism workshops. Make friends with people who are not white in an honest and uncomfortable way - be honest and say "I don't understand racism and I want to be able to. I will make mistakes, I will say and do things that are inappropriate, but I am willing to learn from my mistakes." There will be some people that will be willing to hang in there with you. Others won't. Look up ant-racism resources, including literature and devote a large chunk of your time in your life and space in your brain to healing from the racism that you have been forced to perpetuate.
Read Tim Wise. Attend anti-racism workshops. Make friends with people who are not white in an honest and uncomfortable way - be honest and say "I don't understand racism and I want to be able to. I will make mistakes, I will say and do things that are inappropriate, but I am willing to learn from my mistakes." There will be some people that will be willing to hang in there with you. Others won't. Look up ant-racism resources, including literature and devote a large chunk of your time in your life and space in your brain to healing from the racism that you have been forced to perpetuate.
Sabrina Bias I was raised in predominately black neighborhoods. I have black friends. I dearly love all people of all race. I do ask these questions! I am NOT uncomfortable with any person of color! I guess there is not anything overtly more I can do.
Sherry Payne Rachel, I have personally witnessed your struggle to answer these questions and seek reasonable solutions. I applaud you in your efforts. Sabrina, there is everything you can do, since so far as I can tell from your own words, you have done nothing. You are angry and defensive. I understand- these are difficult truths to hear. Sit with your own feelings for a while. Feel sorry for yourself if you must, but don't convince yourself you are the true victim here. Then when you are ready with an open heart and listening ear, come back and join the conversation.
Elizabeth Allemann I am so very glad to live now and to have Sherry Payne as a person I call a friend. And right now, I am feeling grateful to facebook so Sherry can speak her uncomfortable and loving truth to a larger audience, including me. I feel ya, Sabrina, and I believe in you and your journey. I realize that there is so very much work to do.
Nikki Hunter Greenaway Thank you Ms. Sherry Payne. I am truly inspired by your work. I do hope I get to attend one of your workshops one day.
Kc Homebirth These are the conversations we need right now! I feel open but needing more information. Willing to learn but not sure what to learn. I think if we sit with what is uncomfortable and keep at it we can get there. I think that we have a uniquely loving community here and its fertile ground and time.
Sherry Payne But you can see why we've avoided it for 200 years. Enough anger on all sides to go around. It is difficult to sit and listen lovingly to someone else's pain and accusations (on both sides of the line). Come hear PaKou Her's presentation at the Missouri Midwives Association Retreat and then let me know if you think we are ready for this conversation.
Sabrina Bias Sherry Payne I am sorry to have asked genuine questions here. You tout that we are racist by something out of our control, our skin color. I understand as a white woman I have no clue the issues those of color face, however I have never been that 'priveledged white' person. I am not taking a victim role. I am genuinely asking questions as my passion is to serve all women and I do not want to offend unknowingly!! Please lets not say ' all you white folks don't want to include black folks' but then refuse to enlighten us with real ways we exclude. The only thing you mentioned was pictures on the walls of offices. What else?
Sherry Payne Sabrina, the exclusion is in the outcomes. Pictures on the wall is not the exclusion I was alluding to. The exclusion is in twice as many Black babies dying before their first birthday as Caucasian ones... The exclusion is in the low birth weights and rates of prematurity. The exclusion is in the lowest breastfeeding rates. The exclusion is manifested in global poor health outcomes that the healthcare system perpetuates.
Crystal Ferguson I'm glad that you are offering these paths for those under represented groups. However, it's unfair and (forgive me) a touch racist to assume that all white women are racist simply because we're ignorant. I don't feel strange helping or mentoring someone of a different skin color, religion, heritage, or language. I embrace the challenge. I learn. But again, maybe I don't understand enough. And I'm OK with that. I can simply keep stumbling forward.
Chula Doula White people need to understand that it's not actually about you as a person, it's the structural racism that you benefit from, unknowingly and I'm sure in some ways unwillingly, especially if you're being asked to be accountable for a privilege you didn't choose. As a light skinned Latina myself I can seeing the glaring differences between how I'm treated and how my darker Latina or black sisters are treated. What I do with my privilege is speak up, stand up against racism, challenge myself and others to question things "that are just that way". I begin to imagine something different, commit to making the changes within me and around me. If anyone has any true sense of awareness about race in the United States, you would know that the majority of people giving birth here are people of color, yet in almost ALL birth related spaces (lactation, CBE, doulas, midwifery) the issue of racial health disparities is not CENTRAL to the learning process, nor is it brought up to do something about it. Women of color are tired of having to make the effort to save ourselves, but until those who benefit from whiteness/ perceived whiteness, like myself, until we don't make it our business to address these issues, they will not be resolved. In the end how does it benefit you to be offended by our claims of racism and wanting to address it? Again, remember when addressing racism we are talking from a structural point of view, not each of you individually. And again though, what exactly are you doing to address racial health disparities and making your spaces more accessible? Just saying everyone is welcome doesn't cut it anymore mamas.
Sherry Payne Terri, you are welcome at Uzazi Village. Yes, we are hosting 1 meeting (out of hundreds) that is open only to birthworkers of color, but that is to nurture, fortify and sustain them for the tough work they do in their home communities. The goal is not to exclude you but to include us- in ways we often are not included as birthworkers working in communities of color. I don't apologize for hosting a Black Midwives and Doulas Retreat. We need it. We need to band together for fortification to continue to fight the battle for health in our communities that others are content to let be.
Sherry Payne Thank you Crystal for your willingness to keep stumbling forward. It is how we all learn.
Sherry Payne Yes, Colleen, please share. It is already burning up cyber airwaves around the country...
Crystal Ferguson Thank you, Chula Doula. That helps. And Sherry Payne, again, thank you for what you do.
Sherry Payne Alright Sabrina, and Terri and others. Here is something you can do. I have extended an invitation to the senior midwives of my city to host a reception in honor of the birthworkers of color coming here from around the country for rest and restoration. You KC locals are hereby invited to help Cheryl Gates host that reception. Contact her to plan a menu and come and serve and get to know other birthworkers of color (as KC has so few of us) This is the context in which you will be included to the Black Midwives and Doula Retreat. Come to serve us, meet us, hear our stories, clean up and leave us your blessings and then let us get on with the difficult work we must do to help our neglected communities. Whose up for that deal?
Colleen Moira Donovan-Batson Sherry, as usual, what a wonderful explanation, and I bet I'm not the only one to think I'd love to share it. Would that be okay?
This thread illustrates what PaKou Her so clearly teaches in her trainings, how we are all at different places on a continuum of recognizing our white privilege and how it has developed just by existing in our society. I sometimes hear white women say 'well I wasn't raised like that' without acknowledging that just being present as a member of American society is the foundation of our racism. This is so ingrained it takes real work to rise above, and is different from the bigotry we typically associate with the word racism. I know I'm continually learning and working to identify my behaviors based in white privilege. Anyway, I highly recommend trainings with PaKou!
I think we can substitute 'midwife' or 'doula' in place of LC in this thread.
Thank you for all the work you do for families Sherry, and for helping us understand with your kind explanations. Let us know if we can share!
This thread illustrates what PaKou Her so clearly teaches in her trainings, how we are all at different places on a continuum of recognizing our white privilege and how it has developed just by existing in our society. I sometimes hear white women say 'well I wasn't raised like that' without acknowledging that just being present as a member of American society is the foundation of our racism. This is so ingrained it takes real work to rise above, and is different from the bigotry we typically associate with the word racism. I know I'm continually learning and working to identify my behaviors based in white privilege. Anyway, I highly recommend trainings with PaKou!
I think we can substitute 'midwife' or 'doula' in place of LC in this thread.
Thank you for all the work you do for families Sherry, and for helping us understand with your kind explanations. Let us know if we can share!
Cynthia Good Mojab If you are white and struggling with this conversation, you are not alone. Most whites have not yet started on a difficult-and-rich journey open to them: that of learning to see and help dismantle white privilege with a motivation of justice and a valuing of our common humanity. In the beginning, because we have lived that privilege, it is virtually impossible to see. And, to see it means that how we see ourselves, our family, our society, and our beloved breastfeeding-related institutions will be fundamentally challenged by new information that is painful to accept. This initiates the very-human and universal process of cognitive dissonance which unconsciously will invoke our brain's rejection of the new information so that we can remain cognitively comfortable. So, if you are white, like I am, and are struggling with this conversation, one thing that can help is to learn to become comfortable with being uncomfortable--become OK with spending time in the space of your offense, anger, confusion, fear, and so on WHILE looking for learning opportunities that exist. For example, if you are participating in the 2014 GOLD Lactation Online Conference, look for my presentation "Unpacking the Invisible Diaper Bag of White Privilege: An Overview of Racial Inequities in Breastfeeding Support": http://www.goldlactation.com/conference/presentations/59. I also gave a longer interactive version of this presentation at the Black Mothers' Breastfeeding Association's excellent National Seminar last week (http://events.r20.constantcontact.com/register/event...). And, please realize that the answer to the question, "What can I do?" cannot be answered in a facebook post or one presentation session. How you, in particular, can help dismantle institutional racism in breastfeeding support will come to you (and evolve) as you move through a lifelong journey one awkward and uncomfortable (especially at the beginning) step at a time. And, while you will definitely continue to revisit feeling uncomfortable, scared, angry, etc. along the way (because you will keep learning things that challenge your worldview and invite you, yet again, to engage in a paradigm shift), as you learn, you will also feel that you are reclaiming your full humanity by doing your part to help dismantle racial inequities in breastfeeding support.
www.goldlactation.com
White lactation specialists and white-dominated breastfeeding institutions in the US and other societies are vulnerable to manifesting racial bias—e
Stacy Yeag Huddleston Phd diversity and inclusion are different. Ask yourself how many women of color have I encouraged to do my job. How many are in the meeting rooms when key decisions are being made lastly. Is my location accessible to the women of color and does staffing reflect that community?
Sherry Payne Shannon, the thought of the KC Midwives bringing food and humbly serving the Midwives of Color brings tears to my eyes. So full of gratitude. The symbolism is huge, just huge.
Hall Family Shannon, as a representative of KC Breastfeeding Support Group, i'll commit KCBSG to help where possible. I make a decent dessert... ;-)--Amy
Cynthia Good Mojab It's really important in conversations like these for us all to be speaking the same language. When whites think about racism, they usually think of interpersonal racism: individual acts of racial bias, bigotry, hate, and prejudice. When people of color think about racism, they usually think of institutional and systemic racism, which has to do with pervasive and inescapable racialized outcomes in access to opportunity, services, resources, power, and so on at the institutional and societal level. Please see Dr. Camara Jones' excellent article, "Levels of racism: a theoretic framework and a gardener's tale," at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1446334/, if you'd like to better understand different types of racism.
www.ncbi.nlm.nih.gov
The author presents a theoretic framework for understanding racism on 3 levels: institutionalized, personally mediated, and internalized.
Cynthia Good Mojab And, here is a short video clip of Dr. Jones on the levels of racism using the gardening analogy: https://www.youtube.com/watch?v=ktj4jGmUs6Y#t=12
Camara Jones discusses the 3 levels of racism
Sherry Payne Sabrina just sent me a private PM to tell me I was wrong to accuse her of playing the victim and calling her angry and defensive. She is right. I don't know her personally. I have no right to make assumptions about her or her motivations. She has every right to come to this forum and ask her sincere questions and to receive a respectful answer. So in this public space, I offer my sincerest apologies to my sister, Sabrina. I was wrong to address you so harshly and to make assumptions about you that could have no basis in fact. You have been unfairly treated and for that I apologize. So many of my sister birthworkers have showed me tremendous kindness and welcomed me into their embrace even though I was different and didn't appear on the surface to have much in common with them. The same grace that has been shown to me, I need to extend to you. Will you forgive me?
Hall Family That was a touching apology, Sherry. I appreciate your sharing that publicly. I hope seeing that exchange of grace will encourage more of us to face our fear of rejection and ask hard questions that may make us all uncomfortable. I appreciate Sabrina's willingness, too, to engage further, rather than just write someone off.--Amy
Laura M. Perez While I appreciate your apology, Sherry, the assumptions you made were based on Sabrina's words and I would make a similar assessment as you. My assumption is that Sabrina was also raised working class or poor (as was I), so it's understandable that she may feel that the concept of privilege is unknown to her in this oppressive classist and capitalist society we live in.
In these conversations, must risk saying and doing the wrong things to get to our core beliefs and truths. It's painful, heart wrenching, soul changing, and deeply transformative, hopefully. Thank you for starting this conversation!
In these conversations, must risk saying and doing the wrong things to get to our core beliefs and truths. It's painful, heart wrenching, soul changing, and deeply transformative, hopefully. Thank you for starting this conversation!
Cynthia Good Mojab Privileges (being white, male, heterosexual, cisgender, able bodied, ....) and oppressions (sexism, classism, racism, heterosexism, cisgenderism, able-ism, ....) intersect in ways much more complicated than just canceling each other out. For example, while I grew up in poverty, my family's white privilege still had a positive impact on my life. We lived in a small garage that had been turned into a very humble home in a moderately wealthy district that would have never been rented to my mother had we not had white skin. And she was employed at a job she never would have had if she had not had white skin. Living in that district allowed me academic opportunities I would never have had otherwise, which positively influenced the entire trajectory of my life. Yes, my experience with poverty included being oppressed by classism and lack of access to many opportunities that my family simply could not afford and that oppression and lack of access meant much struggle that those who grew up in a more well-to-do family would not have to face. But, in spite of those struggles, I still also experienced (and still experience) white privilege--which I never was taught to see in childhood but have learned to see as an adult.
Hall Family Cynthia, that was one of the points that I thought was most interesting in your Invisible Diaper Bag presentation. I wonder if acknowledging that concept--that we each may have some areas of privilege and some areas of struggle--may help us (in the lactation/birth world, specifically) become both more unified *and* diverse. Though some of us may enjoy different privilege, all of us nursing moms know what it's like to be female. How many of us--from any background--have gotten the brush-off at (for instance) an automotive shop, simply because we are a woman. (I have.) But, too, I recognize that if I'd been a black woman my treatment might likely have been even worse...whereas if I'd been a wealthy woman, it might have been better.--Amy
Cynthia Good Mojab Exactly, Amy. And, that was how Peggy McIntosh first began grasping her white privilege--via all of her work on male privilege. Here's her pivotal essay, which inspired the title of my "Invisible Diaper Bag" presentation: http://www.isr.umich.edu/.../resources/white-privilege.pdf
Diana Cassar-Uhl Sabrina, if you ever get the chance to hear Sherry speak in person, take that opportunity. Do whatever it takes to get there. Another thing you can do is to acquaint yourself with some reading about the social determinants of health. That in public health research a person's race is a risk factor without any other variables even entering the picture is truly horrific and it is, as has been stated here, a legacy our generation is charged with overcoming and changing. What else can you do? Sherry taught me to get out of the way. To shut up (which I realize I'm not exactly doing here). To let the communities of color develop and apply their own solutions to the problems there -- and to give them whatever support I can as they do so. Maybe I can make a donation. Maybe I can give a signal boost to someone or an initiative that hasn't hit the mainstream *because of institutional racism*. Maybe I can send a relevant study or a news item to a woman of color who has befriended me, and ask about how that plays our in her community -- how it's different from how it plays out in mine.
You can step out of your comfort zone and ask *your children* some hard questions. This has been very difficult for me but my intentions are pure and full of love, so I have faith that, even if I'm "doing it wrong," the fact that I'm doing it at all will have some value to my children as they grow up and take their places in the world. When we go to the museum, I ask them, of the murals and artifacts and stories, where are the black people? Where are the women? Why did only white men know how to read and write when this country was born? Is this OK? I don't let their history lessons in school be the only education they get because it isn't enough. It keeps the status quo but doesn't propel change -- and change is what we need now. I'm OK with not having all the answers. I'm OK showing my children that I'm ashamed of what our ancestors did, that I'm angry and saddened by what some of our national leaders are still doing. We talk about these things (they're 11, 9, and 6 -- there is an appropriate way to offer these conversations no matter what the age of your child is). I'm OK showing my children that I will not tolerate the racism of my parents or my grandparents. I'm careful to not teach them to pull their bags closer when a young black man approaches on the sidewalk (by fighting that which I was taught and resisting the urge to do this myself -- yes, I'm ashamed that this is my knee-jerk reaction, but I know it is wrong and I endeavor to re-learn a more appropriate way of thinking and behaving). When they notice that many of the homeless people in your city are black, I ask them how they think that happened, and talk to them about what I've learned about social determinants of health. I show interest in the black children at their school, in their clubs, in their classes. I encourage them to ask questions and to forge relationships with them rather than to be afraid. Young children aren't afraid to eat lunch with someone who looks different unless we teach them to be. Will these things make a young black mother want to call me for breastfeeding support? No, but I'm really OK with that because maybe what I'm doing will have a ripple effect somehow so that a woman of color can become an IBCLC herself.
Thank you for teaching me, Sherry. Your influence on me continues to be profound.
You can step out of your comfort zone and ask *your children* some hard questions. This has been very difficult for me but my intentions are pure and full of love, so I have faith that, even if I'm "doing it wrong," the fact that I'm doing it at all will have some value to my children as they grow up and take their places in the world. When we go to the museum, I ask them, of the murals and artifacts and stories, where are the black people? Where are the women? Why did only white men know how to read and write when this country was born? Is this OK? I don't let their history lessons in school be the only education they get because it isn't enough. It keeps the status quo but doesn't propel change -- and change is what we need now. I'm OK with not having all the answers. I'm OK showing my children that I'm ashamed of what our ancestors did, that I'm angry and saddened by what some of our national leaders are still doing. We talk about these things (they're 11, 9, and 6 -- there is an appropriate way to offer these conversations no matter what the age of your child is). I'm OK showing my children that I will not tolerate the racism of my parents or my grandparents. I'm careful to not teach them to pull their bags closer when a young black man approaches on the sidewalk (by fighting that which I was taught and resisting the urge to do this myself -- yes, I'm ashamed that this is my knee-jerk reaction, but I know it is wrong and I endeavor to re-learn a more appropriate way of thinking and behaving). When they notice that many of the homeless people in your city are black, I ask them how they think that happened, and talk to them about what I've learned about social determinants of health. I show interest in the black children at their school, in their clubs, in their classes. I encourage them to ask questions and to forge relationships with them rather than to be afraid. Young children aren't afraid to eat lunch with someone who looks different unless we teach them to be. Will these things make a young black mother want to call me for breastfeeding support? No, but I'm really OK with that because maybe what I'm doing will have a ripple effect somehow so that a woman of color can become an IBCLC herself.
Thank you for teaching me, Sherry. Your influence on me continues to be profound.
Hall Family Love the above thoughts. I'm so thankful for my friends who patiently talk with me, though I may stumble along as I learn.--Amy
Cynthia Good Mojab Stumbling along while learning is the only possible way to do anti-oppression work, Amy. I know of no smooth, neat, easy path to work toward seeing our own privilege, becoming aware of our biases, correcting our knowledge and worldview, and saying an imperfect and evolving "yes" to a paradigm shift that will enable us to become an effective part of dismantling oppression in our field and society.
Sherry Payne Diana, you humble me, because I thought it was you and not me who was the teacher in this relationship! I'm afraid I have (in a public venue no less) asked White women to 'shut up and listen' to us. Diana, you have been such a good, and faithful friend in our short time knowing one another. I have so benefitted from your overtures of friendship to me. When you sent me that article, it had such a profound impact because I knew everything in it to be true, but I had never discussed those things in Chocolate Milk Café. You have come through again and again with a word of wisdom, or encouragement, a thoughtful question, and even blessing me to be involved covert altruism. You have supported Uzazi Village with your influence and your finances. I feel as though I found in you (and others like Cynthia Good Mojab and Rosemary (Rosie) Senjem and Dawn Thompson to name just a few) true allies that strengthen me and propel my work forward. My work is built on the shoulders of women like you. I'm proud to stand along side you united in our common cause, grateful that we learn from one another. Thank you for taking that initial risk of reaching out to me.
Diana Cassar-Uhl Don't worry, dear Sherry, I heard "shut up" in the best possible way -- to make room for your voice and the voices of those who need to be heard. I won't ever speak for you, but I'll do my part to share your message as you've shared it with me.
Without question, you are my teacher and I continue to be thankful for the time you share with me.
Without question, you are my teacher and I continue to be thankful for the time you share with me.
Kc Homebirth Wanted to update you guys:
Both kc birthnetwork and kc midwives will be represented at the reception in addition to several other volunteers.
Sherry! Im telling you, the time is ripe!
Both kc birthnetwork and kc midwives will be represented at the reception in addition to several other volunteers.
Sherry! Im telling you, the time is ripe!
Sabrina Bias I sincerely appreciate the apology. Thank you. I agree this is a must have conversation. There are many of us who sincerely want to help fix this, we just don't know how. Thanks again for all the honest and real discussion!
Debbi Heffern Sherry Payne, LLL USA has begun a discussion for Leaders who are interested in learning more and working to become more inclusive. Okay to share your message there?
Cindy Taylor So proud and happy this discussion is happening. I remember those LLL mtgs we attended w our mocha babies and feeling as uneasy and subject to the sanitizing effects of the whole process as you describe. I still consider myself a "militant breast feeding advocate" and continue to preach to all the women in my diverse community. I found myself being judged by a bunch of "uppity" women of mixed backgrounds in the past week who simply don't hear anything but negative, ignorant messages on the subject. So keep on keeping on. There is no more important work. I will not shut up about it.
Cynthia Good Mojab http://www.slate.com/.../millennials_racism_and_mtv_poll...
www.slate.com
When you hear MTV, you don’t think “research.” But, for the last few years, the ...music television channel has been building a public affairs campaign to address bias called “Look Different.” Aimed at millennials, it seeks to help them deal with prejudice and discrimination in their lives. And as part… See More
Cynthia Good Mojab Well, I don't know about that, Sherry! But, thank you! I do try to stay grounded in my own challenges with this work which, I hope, helps me remain compassionate with others who are learning alongside me even while I might be challenging them by sharing some of my own learning. There's really no high ground to stand on. Racism is like pollution that we can't help but soak up (in the form of conscious and unconscious racial bias) from the air around us, no matter how much we may wish we could avoid it. Far better to learn to see racism and white privilege (which are two sides of the same coin) and try to help dismantle them than to not see that they exist and unintentionally help perpetuate them through blindness and inaction.
Steffany Kerr As always I learn and grow from your perspective Sherry! I have especially appreciated this thread!!
Sherry Payne Hey everyone, Rachel responded, and I answered her back. Have a look see. http://lactationmatters.org/.../q-a-with-sherry-payne.../...
lactationmatters.org
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. ... See More
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