Below is a paper that I just turned in and filed with my department. I had to submit a ‘research competency’ paper as part of the requirements for my graduate program for the MA (think thesis), and chose to extend the conversation I started about my views on IBCLCs, who I think are very problematic for several reasons as you may have already read and as you will further see. This is an introduction — a starting point. There is much more to this conversation that I will introduce.
This article is under review with Nothing to Lose But Our Chains: Black Voices on Activism, Resistance and Love as well as Transforming Anthropology. Do not cite without permission.
Acquanda Y. Stanford
Uncovering Imperialist White Supremacist Capitalist Patriarchy in Professional Breastfeeding Services: The Greater Complexities of IBCLCs
Black American feminist and cultural critic, bell hooks, coined the term imperialist white supremacist capitalist patriarchy to highlight a non-prioritized system of domination that originates within the United States. Imperialism, white supremacy, capitalism, and patriarchy, hooks argues, culminate, and work in unison with one other with the desire to ‘go out’ and dominate based upon a history of white rule, violence, and the subjugation of people and cultures and is what constitute the framework of this force. The United States with its reputation across all facets of imperialist white supremacist capitalist patriarchy has been used to fuel this scenario within the U.S. boundaries and abroad. Imperialist white supremacist capitalist patriarchy manifests in various ways, and especially with new establishments that are seen to promote breastfeeding via professional services.
Prior to the emergence of this phenomenon of professional practices within more medicalized contexts, breastfeeding had been a tradition that has sustained the human race, with overarching dominant sentiments that wavered between disdain and acceptance. For Black women, breastfeeding harbors a form of community autonomy as well as a distinct injustice and a complex narrative. Forced wet nursing during the colonial period, Black women were made to use their milk to feed a slaver’s baby during chattel slavery and is at the root of this history. This was done in order to alleviate the physical and social discomfort of more affluent white women, and many believe that Black women were most often only able to provide their milk to their own children surreptitiously and sporadically. But breastfeeding was also a primary component of autonomy Black women had while working as midwives both before and after the Civil War. The midwife, who was a prominent figure in communities, worked to ensure a woman was cared for and that her body produced proper milk for her baby. After emancipation, Women of Color from the U.S. and elsewhere gained employment via wet nursing, yet when anti-immigrant sentiments surfaced and stigmatized these women, the belief that a woman’s personality could be transferred from her breastmilk to the child led to the castigation of this practice (Boswell-Penc, 2006), essentially becoming a segue toward the acceptance and even favoring of artificial infant formula which was a nascent yet burgeoning idea. Though the picture remains complex when it comes to understanding the legacy of Black and African American women and breastfeeding, what is known is that this has greatly impacted the breastfeeding rates for generations.
According to various reports, including the Center for Disease Control and Prevention (CDC), Black women statistically rank lowest in all areas of breastfeeding. Racial and Ethnic Differences in Breastfeeding Initiation and Duration, a 2004-2008 National Immunization Survey, conducted by the CDC, highlighted these disjunctures, showing that in all stages of infant feeding from birth through 12 months, non-Hispanic Black women ranked lowest, with 54.4 percent breastfeeding at birth, 26.6 percent at six months, and just 11.7 percent at 12 months (MMWR). Lack of breastfeeding produces disastrous consequences. This gap means that in addition to a history of enslavement Black people in this country remained compromised and disproportionately impacted with maladies that an increase in breastfeeding can help thwart. Not only would more breastfeeding help counter physical ailments such as ear infections, gastrointestinal infections, upper respiratory infections, childhood diabetes, and help decrease Sudden Infant Death Syndrome (SIDS) by 50% (Milligan et al) among countless other positive outcomes, some believe that psychological damages stemming from a history of forced separation between Black women and their babies could be restored by the physical closeness breastfeeding requires. Other injustices could also be highlighted. For example, a Black feminist perspective looks at how Black women’s bodies have been castigated and maligned, and motherhood has been deemed inferior. Even though breastfeeding alone does not combat these stigmas, this and more could all be centered at this site, potentially creating a new narrative and frame of reference for Black women.
Today, we are in a period where providing milk from a woman’s body to her baby is seen as the healthiest way to nourish an infant. Breastfeeding has become highlighted in multiple settings, with women ‘returning’ to this natural tradition. But there are still gaps in Black communities. Blacks and others alike say that an increase in African American professional services, adding more figures with those who have formal knowledge specifically related to breastfeeding, would provide crucial groundwork for a greater understanding of their culture, and consultants who ‘look like us’ would be around potential breastfeeders and produce positive outcomes, since African American women would be more receptive among those who they could relate to. Bolstering breastfeeding promotion are individual advocates as well as Non-Governmental Organizations such as the World Health Organization (WHO), UNICEF, and various hospitals who implement ways to encourage more breastfeeding education with the hopes that women will adopt this tradition. In 1991, for example, both the WHO and UNICEF launched the Baby-Friendly Hospital Initiative, with an effort to ‘improve practices that protect, promote, and support breastfeeding (who.int). A baby-friendly hospital is recognized by 10 steps that are part of the guidelines instituted by the WHO and UNICEF, and require hospitals to create an environment where breastfeeding becomes the primary method of feeding a newborn. This is done by training staff members, encouraging breastfeeding on demand – rather than nursing on a fixed schedule, discussing breastfeeding with pregnant women, and ‘rooming-in’ – keeping a baby in the same room as mother after delivery rather than moving it to a nursery (babyfriendlyusa.org). These, along with other steps will help ensure breastfeeding becomes part of the cultural norm. Baby-friendly hospitals are one facet of a larger endeavor to promote breastfeeding. In the past three decades additional efforts have been made to divert attention from manufactured infant formula and find ways to impart knowledge on individuals in order to promote more breastfeeding. Most notably this has been done with the eruption of International Board Certified Lactation Consultants (IBCLCs).
Towards the latter part of the 20th century, increasing awareness and so-called scientific data highlighting the various health benefits of human milk as opposed to artificial infant formula, which was greatly promoted instead of breastfeeding at the time, is what led to this newfound establishment (ibcle.org). To heighten this interest and encourage breastfeeding among pregnant women and those who recently birthed, medical professionals began working with local advocates with an effort to increase the population’s understanding of human milk as well as a mother’s desire to breastfeed and to offer hands-on assistance (iblce.org). In 1985 the International Board of Lactation Consultant Examiners (IBLCE) geared specifically toward breastfeeding education and promotion formalized and IBCLCs became the product of this initiative. A rigorous set of criteria, including enrolling in formal education classes in anatomy and physiology, nutrition, biology, cultural sensitivity and others, as well as taking lactation-specific courses and apprenticing for approximately one year to gain hands on experience is required. Once these requisites are completed the candidate then sits for a difficult and costly exam that is administered only one day per year around the world. Upon acquiring a favorable score, the individual is allowed to place ‘IBCLC’ behind his or her name for a certification that is recognized internationally, for period of five years. IBCLCs have been deemed the ‘Gold Standard’ in clinical breastfeeding support and lactation management. They have been viewed as adding a level of empowerment for women who make up the greatest majority of this enterprise, allowing them to participate socially and economically within the community. Their ability to effectively apply learned skills in latching a baby to a breast, offer information about infant nutrition, diagnose and treat women for ailments such as mastitis, engorgement, and other areas concerning breast health, including assisting women in reaching their breastfeeding goals is what has relegated these clinicians to the top of the lactation hierarchy. Mothers in large numbers, as well as some fathers and other advocates often rave of the help they have received. Many state that without this assistance initiating and sustaining breastfeeding would have been more complicated, if not entirely unsuccessful and this has been the overarching sentiment, as more and more breastfeeding professional services are on the rise. Worldwide there are more than 28,000 IBCLCs (IBLCE.org) and new certifications mean this number increases each year. The vast majority – over 50 percent – are located in the United States (IBLCE.org) with a notable amount in Australia and Canada. Lactation Consultants are employed in various sectors, and apply their specialized breastfeeding knowledge to their current work as registered nurses, dieticians, and obstetricians, while others work in government offices, non-profit organizations and private sectors, charging between $90.00 and $150.00 per consultation visit. In my own participation in breastfeeding advocacy I wanted to join the ranks of IBCLC. Once I learned of the severe disjuncture in Black breastfeeding, my desire to help curb the staggering amount of inequities caused by a lack of breastfeeding was at the forefront of this desire. I believed this avenue would not only provide an opportunity to have a literal hand in curbing social and health-related ills associated with the lack of breastfeeding, but I was also certain that since I grew up in an environment where breastfeeding was the cultural norm I would be able to recruit other people of African descent into this field, since the numbers of Black IBCLCs are few.
Other desires for more representation among groups of Color also brought along criticisms of the IBLCE and the International Lactation Consultant Association (ILCA). The grievance by Communities of Color has been that the criteria involved in becoming certified are unfair. They argue that the ways to secure this title are the for privileged and elite, which translates to the white middle-class woman, since money and access are needed to work toward this endeavor, and Women of Color are impacted by greater barriers and social circumstances that interfere with these. Black lactation advocates have criticized the certifying entity, stating that the requirements are too stringent: access to education, work, and the ability to obtain clinical apprentice opportunities are much more complicated for them, moreso, than others who do not face the consequences of racial and gendered marginalization. Black women are disproportionately impacted by a social environment that interferes with who is even in our homes and affords us the ability to obtain these credentials. Historically, Black women have been placed in predicaments where they have been the head of households, having to work and be away from family and have had greater difficulty accessing privileged endeavors such as volunteering for months without pay. Additionally, the predominantly white staff that makes up the administrative realm causes division in formal practices: these skewed perspectives influence how information appears on tests and what is relayed to clients. Many people who advocate for great diversity among IBCLCs suggest that increasing the numbers within this sector would allow more opportunity for groups to participate: more input and voices from these margins would assist with erasing health injustice. In response, there have been recent efforts on the part of the IBLCE and ILCA to examine their set of criteria, in order to create what they believe to be more equity within the institution. One way has been a formal summit to draw attention to these discrepancies. In August 2014, in Arizona, United States, the IBLCE and ILCA convened an ‘equity’ summit, asking for those who feel marginalized to highlight this and ways to restructure the curriculum. Various individuals came together to highlight ‘real-life experiences, obstacles, and challenges of underreprepresented people in the U.S. and across the globe’ (ILCA.org). In order to offer an opportunity toward certification for these communities, the IBLCE changed its criteria, reducing mandatory apprentice hours, and created different avenues toward reaching the education goals.
But breastfeeding professionalism is too often romanticized. It is too often seen as a facet of care, nurturing and community empowerment, rather than a site to trace domination and a U.S. attempt to expand the bounds of its desire for a global empire. At first glance professionals appear to work toward a positive outcome for promoting the breastfeeding tradition. Looking deeper into history, however, it becomes apparent that this newly coveted terrain in medicalization not only causes trauma at the local level by removing knowledge from the people, but is exceptionally problematic within and between various layers. This paper examines the infiltration of imperialist white supremacist capitalist patriarchy as it manifests with the rise of breastfeeding professionals. It looks specifically at the IBLCE and the proliferation of IBCLCs. I will examine how, on the surface this newfound establishment may reflect an avenue toward strengthening a bond between mother and child, helping women reach their breastfeeding goals and creating a culture of acceptance on all levels of human lactation. Layers beneath this veneer, however, expose ‘blind spots’ that harbor a lengthy legacy of domination that remains a part of all facets. IBCLCs appear to work at countering the disruption of the physiological function caused by the interference of infant formula milk, but they only cause an increase in social discord on a local and global context. This means that not only does the IBLCE produce more inequity within this profession, but also it encompasses a legacy of injustice in creating a hierarchy and inevitable oligarchy where breastfeeding knowledge becomes consolidated, available only to those who have access and privilege. For Black women, IBCLCs pose an additional layer of destruction. A history of state-sanctioned intervention directly related to the breast has been faced by this group, and the mainstream biomedical model of healthcare has been built upon the dispossession of Black women and dismemberment of a shared autonomy once held by Black midwives. This devastation continues to manifest via this facet of reproduction, and is damaging to those in the United States, and abroad. I suggest that it is only through community participation and sovereignty, highlighting ways to create more radical awareness about breastfeeding within their own everyday understanding, is how communities can shield itself, and return this natural, healthy tradition and power back to their community.