Unintentionally Disenfranchised?
Posted March 4th, 2013 by Sahira Long and Kim BuggIn August 2012, US Surgeon General Dr. Regina Benjamin and HHS Secretary Kathleen Sebelius announced that insurance companies would be required to cover lactation services as part of a provision of the Affordable Care Act that breastfeeding advocates nationwide applauded. While there are kinks still being worked out of the provision, the result would be countless women would have access to a breastfeeding specialist and more likely to reach their personal breastfeeding goals.
Breastfeeding duration rates in states across the nation would be brought closer to the Healthy People 2020 goals. One of the kinks is that many state Medicaid plans and private insurance companies do not recognize breastfeeding specialists because they are not licensed. Therefore, breastfeeding advocates across the country are working to find a solution.
While in Atlanta for the inaugural W.K. Kellogg Foundation’s First Food Forum: Growing a Movement So All Children Thrive, we first learned of a bill being proposed in Georgia, titled HB 363. This first-of-a-kind forum brought together individuals from around the country who are all working to increase breastfeeding while addressing racial inequities in order to improve the lives of vulnerable children. Reaching Our Sisters Everywhere (ROSE) is a Georgia-based non-profit that seeks to enhance the overall mental and physical health of African American women, babies, and their families by working collaboratively to encourage, promote, support and protect breastfeeding throughout the United States. ROSE aims to do just as its name implies with culturally-appropriate breastfeeding encouragement and support.
When we first heard about Georgia’s HB 363, we thought it might help reduce some of the breastfeeding disparities seen in Georgia by providing easier access to a lactation specialist. After reading the text of the bill, we are not so sure that will be the case.
Currently, there are approximately 900 certified lactation counselors (CLCs) and 300 International Board Certified Lactation Consultants (IBCLCs) in the state of Georgia. As with any profession, there are variations in the skill levels among both groups. Thus, GA HB 363 seeks to license only IBCLCs who are approved by a board the bill will establish. This board will be composed almost exclusively of IBCLCs.
The bill is problematic because if passed, the CLCs in Georgia—some of whom have more than 20 years experience—would be committing a criminal act—a misdemeanor—to even call themselves breastfeeding specialists. CLCs would also not be allowed to practice their current profession except on a voluntary basis if they do not operate under another license or in a federally-funded program such as Women, Infants and Children (WIC). The group of Georgia CLCs is more racially diverse than the group of IBCLCs. The passage of this bill will inherently decrease access to lactation care and potentially increase disparities. There has to be a solution that does not come with such exclusionary measures.
Martin Luther King, Jr. once stated that “injustice anywhere is a threat to justice everywhere” and that “our lives begin to end the day we become silent about things that matter.” ROSE cannot keep silent about the injustice that experienced CLCs in Georgia will face if HB 363 is passed with the offensive and divisive language it currently includes. Please stand with us in raising your voice against this bill.
5 Comments
May 5, 2013 at 10:02 am by Susan Burger, MHS, PhD, IBCLCIn New York City, the New York Lactation Consultant Association welcomes all CLCs to work with us to pass the exam to become IBCLCs through mentorship. Our in New York City, our Board has included many CLCs who became IBCLCs and not one of those regretted the process of getting more training and supervised mentorship than the five day course with a few role plays for their CLC training. Our Membership and our Board are diverse ethnically and socioeconomically.
Certainly, I think anyone of any income or racial background is completely capable of meeting the requirements to sit for the exam for becoming an IBCLC. The requirements do not take nearly as long to fulfill as most other health care credentials.
Mothers deserve care that is based on evidence, based on experience, and based on empathy. I would hope that anyone who supports breastfeeding would want to pursue the path towards excellence in care and not dissuade talented individuals of any ethnicity or economic group from seeking in depth training. Mothers of all ethnic and social economic groups deserve excellent care especially when they have complex and complicated breastfeeding problems. This means that there should be some standard of care. While there are many CLCs who probably would meet the standards of the IBLCE, I have many many others who have merely sat through the five day course with role plays and never really worked with mothers before hanging out a shingle. The problems created by this type of CLC not only harms the reputation of CLCs and (because many tell mothers that they are lactation consultants) the reputations of IBCLCs, but more importantly this does a great disservice to mothers and their babies. Currently, there is no recourse for parents if a CLC provides inadequate care. There IS recourse if an IBCLC provides inadequate care.
The issue at hand is making the training more accessible. One progressive suggestion to overcoming one barrier is to promote “telementoring” for those who live in areas where IBCLC mentors may be scarce.
Another suggestion would be to create pathways for those who already have a great deal of experience to demonstrate that their experience actually incorporates an evidence based approach. Have you ever considered approaching the IBLCE for a mechanism to assess the experience of those who have been CLCs for 20 years or more so that they can sit for the exam? With a little creativity, this would be entirely doable.
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Susan Burger, MHS, PhD, IBCLC Reply:
May 5th, 2013 at 10:26 am
Sorry, I want to correct an important typo which entirely changes the meaning of one of my sentences. I meant to write “I have MET OTHER CLCs who have merely sat through the five day course…” not “I have met many many others who have merely sat through the five day course..”
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What could we do do to show our support?
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March 5, 2013 at 2:42 pm by JennieThis is why we must stay vigilant and prepared. Thanks for sharing this information. The National Association of Birth Centers of Color (NABCC) is a group dedicated to increasing and supporting birth centers, clinics and maternity care practices of color in order to eliminate disparities. Standing with you, ROSE!
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March 4, 2013 at 4:10 pm by Terry Jo Curtis IBCLCWe are with you ROSE
We have to stick togather and come up with a solution to capture more breastfeeding services in our community,using our own culturally sensitive lactation workers of color.
Teaching each other,and helping to instill a sense of self confidence.This is the only way we can make our message stick.It will have to be with the messenger,and a little sisterly love.
Indiana Black breastfeedfeeding Coalition
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