Why
Black Breastfeeding Week Is Important
For many families across the
nation, the end of August marks the end to the long lazy bubbly days of summer
and a return to regimented schedules and academic pursuits. It also marks the start of Black
Breastfeeding Week- August 25-31. Black Breastfeeding Week was created last
year by three African-American breastfeeding advocates; Kimberly Seals Allers,
a journalist and author of the Mocha Mom Manuals, Kiddada Green, founder of the
Black Mothers Breastfeeding Association, and Anayah Sangodele-Ayoka, co-author
of “Free to Breastfeed; Voices of Black Mothers” These three ‘titans of lactation’ saw the
need to celebrate African-American mothers in their choice to breastfeed their
babies, and launched a nation-wide promotion.
Black Breastfeeding Week was
born with great fanfare, and great backlash. Many demanded to know why Black
women should get their own ‘breastfeeding week.’ What many don’t know and
understand the dismal landscape for
breastfeeding in the African-American community. According to the Centers for Disease Control,
from 2004–2008, (latest data available) the percentage of women who initiated
breastfeeding was74.3%for Whites, 54.4% for Blacks and 80.4% for Latinas. (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5911a2.htm)
While the number of women who elect to breastfeed their babies has increased in
recent years, the disparity between White mothers and Black mothers still
persist. These numbers indicate a need
for greater social, familial and healthcare provider supports, especially for
African-American women.
I am an Internationally
Board Certified Lactation Consultant, and a woman of color. I run a free community-based breastfeeding
clinic in the urban core of my city. I
work daily in the trenches with African-American mothers who want to breastfeed
their babies but find it difficult to connect with community resources without
extraordinary effort on their part. Some women are fortunate to be able to access
breastfeeding assistance with relative ease.
Some women have support groups right in their own neighborhoods. Some women can afford to pay professionals
to come to their homes and provide guidance and instruction. This does not describe the women I work
with. The women I serve, mostly
African-American, often live at or below poverty level. They may be generationally impoverished, or
situationally impoverished but one thing is for certain- all this access to
breastfeeding help that health care professionals deem imperative to
breastfeeding success is not accessible to them.
The women I serve don't have
easy access to breastfeeding support groups, except perhaps at their local
hospital. But even those are not without
challenges. The women I work with tell
me (because I always ask) that they may go their entire hospital stay without
anyone mentioning breastfeeding; that their babies are given bottles of formula
without their knowledge or consent; and that nurses actively discourage them
from breastfeeding. Among professionals, we call this 'provider bias.' It is rampant in healthcare. Physicians, nurses, even IBCLCs don't help
because they either a) don't believe African-American women will breastfeed
their babies, or they b) don't believe these women will be successful at it. It
is also because health care providers may lack proper knowledge about
delivering care in a way that is culturally appropriate and acceptable. For
example, talking to an African-American woman about breastfeeding without
drawing her partner or mother into the conversation could be a problem. Knowing and understanding who her champions
are and engaging them in the process is
vital.
For the brave few new
mothers that garner the courage to
venture outside their communities to find help and support they so desperately
need, they may or may not find
acceptance waiting for them when they get there. Last month on the ‘Black Women Do Breastfeed’
Facebook page, an African-American woman shared how she got up the courage to
attend a meeting in another community, and while she was there, no one spoke to
her or acknowledged her presence. -I
know what you're thinking, that would never happen in “our” neighborhood,
right? Perhaps it wouldn't. -But look
around at your breastfeeding support groups.
How diverse are they? -How
comfortable would you feel in a gathering if the racial mix was reversed?
African-American women have
yet to find a place for themselves in the breastfeeding landscape. That's where Black Breastfeeding Week comes
in. We are actively creating a space for
ourselves by declaring our own stake in breastfeeding, holding our own private
celebration. The Facebook page and
website engages women from around the country all year long with local and
national events, updates, and articles, videos and other educational materials. African-American women can send in their
breastfeeding photos and have them posted.
They may not see breastfeeding images of themselves in the media
otherwise. How does this week work across the nation? It's imperative to
promote breastfeeding in the African-American community so that mothers and
babies can share in the many short and long term health benefits. Black Breastfeeding Week is here to stay to
show African-American women that breastfeeding is for them and their babies.
Black Breastfeeding Week is important because we need to help all women become
successful in meeting their breastfeeding goals and too many of us, have been
left out of the picture.
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