Thanks Lynn (from South Africa) for your comments about the "international" relevance of the IBLCE exam. It is a subject about which I feel passionately, and constantly strive to address in my capacity as the IBLCE Regional Administrator serving Asia and the South Pacific (including Australia). IBLCE is very conscious of international issues and they are covered well in the Organisational Goals and Strategic Plan. Lynn, I will respond to you privately at more length, but I will briefly address here a few issues you have raised. Those interested in this topic may also like to read the article I wrote for IBLCE News in JHL June 1995 - The "I" in the IBLCE. The exam questions and slides/photos are contributed by IBCLCs from all over the world. The Exam Committee each year has at least two non-Nth American members, and the exam is checked the IBLCE Board, which also has delegates from Australia, Europe and the UK. In addition, the draft exam goes through various editing (and translation) processes by non-US subject matter experts. Part of this process is to remove bias for candidates in non-western or developing countries. Where necessary, a culturally adapted version of the exam is offered, but the degree of difficulty is the same. Yes, candidates isolated from access to quality up-to-date knowledge, and those working in places where outmoded practices are still the norm, are at a disadvantage. But mothers deserve the best, so IBLCE will not compromise standards by producing an easier exam for the disadvantaged. In my region, Hong Kong and Singapore have been very active in recent years, and interest is growing in Japan. In all these places, it is usually one person's crusade to improve lactation management and education that has got the ball rolling - There are certainly some unsung heroes out there! Once there is a group of IBCLCs they tend to support each other, but while numbers are small it is much harder. Australia has about 1100 IBCLCs (1 per 237 babies born each year - the highest ratio in the world). A further 283 candidates sat this year, including 24 recerts. ALCA (full membership open only to IBCLCs) is the main professional support group, with several smaller Colleges of LCs opened more recently. Ros Escott [log in to unmask]