Dear all:

When I worked in International Nutrition I had plenty of opportunity to look at the health care 
systems within which we were trying to implement effective nutrition programs. So I am constantly 
thinking about why it is so tough for women in Manhattan.

I see huge gaping holes in the care that women receive for breastfeeding Unites States that need 
to be filled to help women to come closer to the meeting the WHO goals (among the many other 
societal, cultural and work barriers).

I totally agree that we need more breastfeeding medicine specialists.  I've been on a run this week 
sending lots of clients to our beloved breastfeeding medicine specialist, but I'd love to have more 
in Manhattan to work with.  

I do not really see any fix for the situation that occurs in the hospitals in Manhattan until such 
time that our health care system changes in a way that enables staffing nurses to an adequate 
level and encourages more than drive-by lactation.  I KNOW that many of the hospital lactation 
consultants are highly dedicated and do the best they can within the structure that they have to 
work.  It simply does not permit them sufficient time to give the care that women tell me they 
want and that I believe they deserve. 

Then, there are hardly any private practice lactation consultants in Manhattan.  There are just a 
handful that work full time and not as a part time moonlighting endeavor.   That to me, is absurd 
in a city the size of Manhattan. I see many problems in our support groups that would not have 
occured if these women could have found timely care.  Neither I, nor my peers can solve this 
problem by seeing more clients.  We would simply burn out.  

So, given the time it takes to become an IBCLC, the dearth of women interested in becoming an 
IBCLC, the limitations on generating enough income as an IBCLC even here in Manhattan, and now 
a possible reduction in our autonomy, I'm not sure how this gap will ever be filled.  Except 
perhaps developing further the idea of "Breastfeeding Coaches".

Best regards, Susan Burger, MHS, PhD, IBCLC

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