Saturday, April 18, 2015

Caretakers' rights to support what is best for their family

Dear Friends:

I just attended the CORE Group meeting near DC with hundreds of representatives from NGOs that work around the world. The good news is that since I last attended, about 15 years ago, breastfeeding has become a normative part of general thinking. The sad part is that it seems that resources have shifted pretty much to complementary feeding without much mention of the vital importance of supporting continued breastfeeding for health, nutrition and for extended LAM use.
Let's get the word out that there is no complementary feeding without well established exclusive then continued breastfeeding AND that parental understanding of cues and responsive feeding is mandatory for child and adult health, nutrition and development.  I truly believe, based on evidence and experience, that we must support  women and families to do what is possible rather than exhort them to do what is not sustainable.

Optimally,  mothers, fathers and other caretakers are involved in the life of the child, actively responding positively to infant cues and young child needs. This begins to address the rights of the child. But to succeed in this, and to fulfill this responsibility, parents and caretakers have the right to support for the time and the means to be there for the child.  We need to push for paid parental leave and for adequate livelihoods globally.

Wednesday, February 11, 2015

Saddened by a great loss in the world of breastfeeding...

I was informed just today of the heartbreaking news of the death of my colleague and friend, Sylvia R. Pager, MD, MS, FAAP, FABM, IBCLC (AAP Hawaii Chapter Breastfeeding Coordinator) last week. 

She had a stroke on Thursday afternoon after testifying in support of the Paid Family Leave bill. 

Dr Pager served as the Chapter Breastfeeding Coordinator for the AAP Hawaii Chapter. Dr Pager was involved in a variety of breastfeeding-related projects and initiatives. She provided legislative testimony (and lobbied) for Breastfeeding. She kept her chapter informed of national breastfeeding movements such as ‘Ban the Bags,’ which was finally implemented in Hawaii’s level 3 perinatal center (Kapiolani Medical Center for Women and Children). Dr Pager worked closely with her state breastfeeding coalition to organize and host a number of breastfeeding conferences statewide. In addition, Dr Pager interfaced with local Blue Cross Blue Shield insurers regarding payment for breastfeeding services supported by the Affordable Care Act.

Personally, I have lost a great friend with whom I made plans for retirement visits.  She worked with all of her being to make a difference in the lives of mothers and children near and far.

Rest in peace, my friend.

Monday, January 12, 2015

Paying Moms for their Milk - a slippery slope

There is no question that human milk saves human babies. But when a mother cannot produce sufficient milk for her infant, what are the options? Certainly, for the very premature, there has been a bit of a resurgence of nonprofit milk banks, especially HMBANA (Human Milk Banking Association of North America) in the US and Canada. Conceptually, this is for milk sharing and pasteurization to attempt to avoid any disease passage to these most vulnerable infants.

There has also been a resurgence in milk sharing. Again, when between consenting adults, this also can play an important role.

But, as with all things where there is a possibility of profit,  the slippery slope of commercialism comes in. Don't get me wrong - I believe in enterprise. However, when the profit motive slips in to health care and wellness activities, or for purchase of human cells or organs, we have many many additional considerations to explore.

There is another word for when women accept payment for their bodies. And the women involved in this trade are forced into it due to poverty of one sort or another.

When we ask for women to sell their milk when their child is still nursing, we are asking that the the milk, even if there is surplus, be denied to their own child. Conversely, one might say, this may be the only product a poor woman has to sell, and why not allow payment for their careful collection and sharing of excess milk? We pay for the sweat of the brow, shouldn't we pay for other productive work? When a poor person is offered money for something they can spare, especially in this country, where WIC can provides a "substitute" for free for them to feed their infant, offering payment may seem generous.....or coercive.

The heart of the issue to me is one of availability full unbiased information and free choice among choices in a system that is free of fiscal or personal or health system coercion. Unfortunatley, ours is not such a system.

Black Mothers' Breastfeeding Association of Detroit has taken a stand on this. If you would like to know more, please visit:


Wednesday, October 22, 2014


Dear Friends:

CGBI is so pleased to be part of the new Abt Associates CDC contract to support the achievement of the BFUSA designation by another 100 hospitals. We hope to increase the emphasis on equity with the inclusion of Dr. Diane Rowley as an ongoing advisor (not in this picture, sorry). Our CDC leadership has been very supportive and we are all ready to roll.

From left to right: Dorothea Calhoun-Smith, Kathy Parry, Amanda Corbett, Beth Mainwaring, Miriam Labbok, Greg Randolph, Trish MacEnroe (on camera), Jennifer Matranga (tiny camera below Trish), Pat Shifflet, Catherine Sullivan, Donna Elliston, Cynthia Klein, Kori Flowers; Representing Abt Associates, CGBI, and CPHQ

We have tentatively named ourselves IMPact4Breastfeeding: Improving Maternity Practices through Action, Collaboration and Training by the 4D Pathway for Breastfeeding Success...but this is just very tentative (I like it!)
We may not be Next Top Models, but we are a bunch of hard working dedicated folks and we made a lot of progress and had a lot laughs.
With many thanks to CDC for its support, HERE WE GO!!


Sunday, August 31, 2014

As National Breastfeeding Month draws to a close..... and World Breastfeeding Week and Black Mothers Breastfeeding Week are behind us... let's consider what we have gained and lost this year. 

Well, I am SOOOOO happy to say that I see only gains...perhaps with a few burps as to be expected.

This year, the W.K.Kellogg Foundation and the CDC have helped fund the way to a breastfeeding norm for all Americans. THANK YOU!!

This year, the IHS and other federal agencies, including military branches, have increased their support to help hospitals become more breastfeeding-friendly. WOO-HOO!!

This year, North Carolina launched what I believe to be the first state level Breastfeeding-Friendly Child Care Designation. Go Cackalackies!

This year, state and national collaborative are reducing unnecessary induction of labor, which has resulted in so many children born before they were ready. THANK YOU, OBs, who have recognized that these were unnecessary potentially dangerous procedures.

This year, there were fewer teen pregnancies, fewer pregnancies among those not yet equipped to be the mothers they could be. YAY!!

This year, WABA is undertaking - with new vigor - its efforts to create change in the world of breastfeeding. 'In Challah'

This year, WHO and UNICEF have pledged to renew their interest in breastfeeding protection, promotion and support, AND they have acted on it with a new release from UNICEF, and with WHO hiring no other than our Dr Larry Grummer-Strawn to advance the Code.  WOW.

So, dear friends, it has been a very good year.

Best wishes,

Thursday, April 24, 2014

Feel like taking action? Here are some things you can do and use today!

For 33 years, infant formula manufacturers have ignored international standards on marketing, putting profits over mother and child health.

Sign up to take action against formula companies’ egregious violations of the World Health Organization’s guidelines for formula marketing known as “the Code.”

On May 21, 1981, the WHO adopted the Code to end formula corporations’ targeting of women and co-option of health care providers.

Nearly half of the world’s countries have adopted legislative measures to implement the Code, but in the U.S. — as a result of formula industry lobbying — legislation remains out of reach.

Let’s use the anniversary of the Code to hold accountable the entities most responsible for deceiving women — Mead Johnson (makers of Enfamil), Abbott (Similac) and Nestle (Gerber).

Participate in May 21 actions ranging from sending a message online to delivering a petition to Mead Johnson.

Earth Day Infographic, from USLCA

In celebration of Earth Day, the United States Lactation Consultant Association published an infographic entitled "Mother Earth's Top Reasons to Breastfeed," showing the many ways breastfeeding reduces waste.

Breastfeeding Article, from NICHQ

In the NICHQ (National Institute for Children's Health Quality) April 2014 newsletter, Julie Stagg, State Breastfeeding Coordinator and Women's and Perinatal Health Nurse Consultant for the Texas Department of State Health Services, discusses how to grow a breastfeeding initiative from local to statewide.

Racial Equity Resource Guide, from WKKF

The W.K. Kellogg Foundation has created an interactive Racial Equity Resource Guide, including practical resources such as articles, organizations, research, books, media strategies, and training curricula aimed at helping organizations and individuals working to achieve racial healing and equity in their communities.

Sunday, March 02, 2014

Why do these few negative studies receive so much coverage?

Cynthia Colen did a study using data collected for another purpose, with poor definitions of breastfeeding and based on a couple of years recall, she then assess the association of breastfeeding yes/no with a variety of behavioral and a couple of health outcomes later in childhood and adolescence. Not a word about the health outcomes under 4 years of age, nor coverage of the many health areas impacted by breastfeeding, only obesity and asthma.  Further, she combines children by this yes/no feeding so that no matter how many children, the aggregate is one. Then, controling for more than 30 variables and 11 outcomes, there are no significant findings when she then compares within family.

This study does raise several questions, primarily whether this approach to doing sibling studies is appropriate, and whether studying the issue of breastfeeding over a period of decades when the patterns of breastfeeding were mostly quite minimal is appropriate. But the biggest question is why this got so much press interest.

Why? perhaps because it supports industry's contention that there is no benefit to breastfeeding? The forgiving side of me says, well, we have had so much good news about breastfeeding that anything that disagrees is of note. However, most of me says that there are those who strive to get any bad news out and about as much as possible.  For example, this is the first breastfeeding study that is fully covered by the Dairy press, and it is also hyped by certain feminist groups that feel that anything a female body can do is to be dismissed as "biological determinism" rather than as a source of pride and empowerment.

I think that another reason these rare studies get so much press is that we still make it so hard to breastfeed successfully in the US, that folks get a bit energised on both sides. If we had paid maternity leave, which by the way is associated with fewer premature births and more exclusive breastfeeding, there would be little reason for women to have the emotional overlay that we have in the US.

At the Breastfeeding and Feminism International Conference each March, we try to have discourse rather than finger pointing, discussion rather than accusation.

So, until we can help all researchers to look for data with solid definitions of exclusive breastfeeding, and until we have enough data to answer these questions without covering decades of time with all the differences this implies, we will continue to see misleading headlines from the very few studies with negative outcomes.