We Support the First Foods Racial Equity Cohort
Mom2Mom Global emphatically supports the First Food Racial Equity Cohort Value of Peer and Community-based Breastfeeding Support. This position aligns with Mom2Mom Global’s purpose, as outlined in our mission statement “to provide consistent, high-quality peer support through local chapters and liaisons at U.S. military installations, to increase access to accredited lactation professionals for all military families, and to provide a channel to raise awareness and solutions for the concerns of military breastfeeding families.”
Mom2Mom Global shares the concerns outlined within about IBCLC licensure laws for the following reasons:
1. Military families of color face all the barriers to lactation support that civilian families of color face, compounded by the additional barriers inherent in the military lifestyle. While research suggests that some elements of military lifestyles (higher percentage of married parents, access to affordable perinatal care) may mitigate some of these barriers, this research also shows that breastfeeding initiation rates in the military still fall along racial divides, with Black military families at the lowest rates. The gap in breastfeeding duration rates up to 16 weeks between white and Black military families closely mirrors the racial gap in civilian breastfeeding duration rates.
Mom2Mom Global represents all military families. We therefore support practices or policies that eliminate rather than perpetuate these racial gaps in outcomes.
2. Military families often also belong to underserved populations with limited access to lactation support. Such populations include families of color, families in poverty, and families in remote, rural, or underserved urban geographic areas (“First Food Deserts” as defined by Kimberly Seals Allers). In addition, because of the structure of Tricare (the military health care program) military families may not have access to IBCLCs in any equitable sense of the term if local practicing lactation professionals are not employed by the military treatment facilities. IBCLC licensure law, particularly as written in Georgia, limits or prohibits access to other trained lactation peer and professional supporters.
3. Military spouses face barriers to becoming IBCLCs, and are unable to find paid employment as non-IBCLC peer or professional supporters. This compounds the economic burdens on military families that are forced into single-income households, as outlined by the National Military Family Association. Again, economic racial inequities in the military mirror civilian racial inequities.
In response to the question of how private practice lactation professionals get paid:
We have to change the system.
We have to demand legislative and regulatory change to the way insurance companies reimburse for lactation counseling services, because lactation is not a medical condition that requires management and intervention. It is a normal physiological process that requires support. The physiological process of lactation has not fundamentally changed since mammals evolved. We agree with the First Foods Cohort that it is well-documented in the research literature that peer support is the most effective support at increasing both breastfeeding initiation and duration rates. Indeed, it is on this principle that Mom2Mom was founded.
Furthermore, we have seen what happens when we allow normal physiological processes to become medicalized and incentivized as a way for licensed health care professionals to make money off of women's bodies. The medicalization of pregnancy and childbirth has led to stark outcomes: higher costs, more interventions, and higher maternal and infant mortality in the US than any other developed nation. Women and children of color have significantly worse outcomes than white women and children, with Black women and children receiving the worst access, the worst care, and the worst outcomes. If we acquiesce to the established system of reimbursement, lactation support will also become medicalized, with presumably similar outcomes.
We have to advocate change for the entire system of classification of lactation support services to a wellness and preventive care model. We have to demand insurance reimbursement for what is in the best interest of public health: lactation support for all women and children, with targeted support to the sub-populations that have the worst outcomes (Black, Native American, and Hispanic populations, according to the CDC). To make this change, we have to fight. We have to fight hard., We have to fight loud. But most importantly, we have to fight together. Advocating for licensure of only one type of lactation supporter is problematic because it reinforces the institutionalized racism and misogyny that is inherent in existing systemic inequities. Instead, we need to define a new model. And we need all families, lactation peer and professional supporters, legislators, public health policymakers, and regulatory agencies to all buy into a new model of wellness and preventive care. This is not a quick fix, it will take years and much hard work. But the process has already begun with the work of organizations such as the First Foods Racial Equity Cohort, The Center for Social Inclusion, the United States Breastfeeding Committee, the Department of Health and Human Services, and the National Association of Professional and Peer Lactation Supporters of Color. Mom2Mom Global proudly stands with these organizations in the quest to create equity for all breastfeeding families.
Mom2Mom Global Board of Directors
Amy Barron Smolinski
Angela Tatum Malloy
Heather P. Gant