Dear all:

Here in the United States, we have what I consider to be a species wide crisis.  An epidemic or perhaps since it has lasted so long a endemic health problem for almost the entire population of humans born in the United States.

It is perhaps  a chicken and egg argument -- Jennifer Tow would start with prior generations which influence the environment in which babies are conceived -- which then influences the environment for fetal growth -- which then influences birth -- which then influences feeding --- which then influences the family diet and socialization -- which then influences the next generation of families socially and physiologically.  

BUT we need to break the cycle.  Breastfeeding Coalitions banded together with a really great You-Tube about baby friendly births on one piece of the problem and included birth doulas as super heros.  I doubt anyone would deny the value of birth doulas. http://www.youtube.com/watch?v=N9KptD3t110&feature=youtu.be

Neverthless, this video illustrates why blanket statements that "doctors", peer counselors, and educators are not sufficient to deal with the problems resulting from artificial birthing practices and artificial feeding.  

At the present time in the United States, 95% of the births are in baby UNFRIENDLY hospitals.  Does anyone in their right mind really think this will be fixed next year? Or in the next five years? or even in 10 years?  For a simple public health problem such as vitamin A deficiency that does have a SILVER BULLET vitamin A capsule solution (and also a longer term more sustainable solution but more complex solution of increasing consumption of vitamin A rich foods), which I watched from 1985 to 2000 -- it took all that time to improve the vitamin A status in SOME populations. The modeling for the silver bullet was fairly successful, the modeling for the sustainable more comprehensive solution was barely beginning.  This problem needed many different types of "practitioners".  Governmental health care systems, local and international nongovernmental organizations, health care workers, social marketers, horticulturalists, water and sanitation experts, logistical experts, health educators, small business enterprise, and (even though they were caught price fixing) vitamin producers. The only one that I see hasn't really worked well in this picture were the food fortification specialists including genetic engineers.  Almost universally that approach failed.

In this picture, there were many levels of expertise.  No one in their right mind would argue that health care workers who distributed vitamin A capsules on national immunization days needed a 90 hour course and supervised practice for 1000 hours. Nevertheless, no one in their right mind would deprive the women in Bangladesh who spent far more time learning from horticulturalists which types of plants were rich in beta-carotene, which types of plants were more likely to survive, how to enrich the soil, how to protect the plants from pests (had a good laugh when the USAID Nutrition Director saw the pot plants that were used as fencing and pest control), how to manage their income, and how to train OTHER women to plant similar gardens.  Would anyone say that these women didn't deserve more in depth ON THE JOB training?  Would anyone say that these women could learn this from a five day lecture and a role play pretending to put plants in the ground?  They needed support for years and because of this ongoing support they were able to reach many many women in their villages.  And finally, marketing programs assisted women in Tanzania to use the sweet potatoes that were richer in beta carotene to create and market new recipes for sweet potatoes -- such as the sweet potato pancakes that became popular as snacks in the local markets.

We have a long-term crisis on our hands that has affected generations of families.  This requires many different types of breastfeeding helpers.  Lumping them all into one category merely pits one type of worker against another type of worker.  It would be a silly argument to say that since you can fix vitamin A deficiency with a pill -- all you need is an army of health care workers with a five day training course, when gardening goes well beyond fixing deficiencies in vitamin A by creating women-owned small enterprise, 

Given that 95% of births are in baby unfriendly hospitals, the problems we are now encountering deserve more than just a five-day course and a role play.  Any self respecting La Leche League Leader will tell you that you need far more than a role play to become the type of peer counselor that enables women to gain confidence in breastfeeding -- you need experience and empathy and the capacity to put yourself in others shoes.  The problems we are now encountering deserve more than just training doulas, midwives and hospital delivery staff about how to initiate breastfeeding.  Even if we were able to achieve baby friendly in a year -- the duration rates for breastfeeding are abysmal.  We need helpers that move beyond birth.  

And since we are in such an epidemic and endemic of abysmal infant feeding practices, the problems we face are both complicated (requiring many steps for a solution with a simple outcome) and complex (solutions for problems that are morally, ethically or philosophically ambiguous) to quote Carol Garhart Mooney citing her friend in "Theories of Attachment".  

On and individual basis, there are many mothers that require solutions for problems that are complicated and complex.  In this framework, how can one argue against having individuals that are far better trained to handle situations that are complicated and complex?  

In fact, we do not need a one size fits all breastfeeding helper that is trained from one single educational program.  We need many varied different types of helpers in an all hands on deck approach.  

The lessons I saw from Cambodia where NGOs initially were falling all over each other -- is that when one respects what others have to give and looks for opportunities to COMPLEMENT each others talents and skills rather than DIMINISH or ATTACK the specialized skills other groups provide, it is much easier to actually make a difference.

And this is where recent marketing attempts to diminish the role of the IBCLC into "just like any other breastfeeding helper" and which has already had a negative impact on many private practice IBCLCs in urban areas in the United States is morally reprehensible.  No breastfeeding helper should be diminished by declaring them "just like any other".  They should be valued for their own specific and important role in the endemic epidemic.

Sincerely,  

Susan E. Burger, MHS, PhD, IBCLC

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