549936

editorial2014

JHLXXX10.1177/0890334414549936Journal of Human LactationMerewood

Editorial Journal of Human Lactation 2014, Vol. 30(4) 393 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/0890334414549936 jhl.sagepub.com

Climate Change Anne Merewood, PhD, MPH, IBCLC

As lactation professionals, we spend much of our time engaged in the change process—negotiating, persuading, and encouraging colleagues, institutions, and clients to bring about change for better futures for babies. We see change, we make change, and we wouldn’t be in the breastfeeding business if we didn’t believe in change, at both individual and institutional levels. Now, as lactation professionals, we have a new challenge: to make change within our own profession. This was the message—the requirement—communicated at the 2014 International Lactation Consultant Association (ILCA) Conference and at the subsequent summit, Addressing Inequities within the Lactation Consultant Profession. We must change to survive, as individuals, as professionals, and as an organization. At the ILCA Conference, the United States Lactation Consultant Association (USLCA) announced its decision to diverge from ILCA. Although the separation was professionally controlled and described as “unbundling,” it would be naïve to overlook the potential financial implications. The bulk of ILCA’s membership resides in the United States. With a split, and 2 separate membership fees, if US-based members join only USLCA, ILCA will suffer financially. JHL will also suffer financially; with our stringent World Health Organization (WHO) Code-compliant advertising, we rely largely on membership fees for support. Journal of Human Lactation (JHL) provides the evidence base for this young profession and, with a newly released, continually increasing Impact Factor (now up to 1.977, its highest ever), is currently the top-ranked breastfeeding journal in the world, the top-ranked nursing journal at SAGE Publications, and the top-rated benefit for ILCA members. As the evidence-based voice of the profession, JHL needs financial support from ILCA members. Hold those thoughts. The day after the ILCA 2014 conference, the Addressing Inequities summit raised the roof with rarely heard voices and a devastating message on lack of access to the International Board Certified Lactation Consultant (IBCLC) qualification. IBCLCs and non-IBCLCs spoke up about lack of mentorship opportunities, inconsistency in course accreditation, lack of access to examination sites, and paucity of administrative support, even in the developed nations of Europe and North America. We heard the lone voice of China’s single IBCLC (yes, there’s only 1) and, most unacceptable of all, we heard about outright

discrimination, from within the profession, against actual and potential IBCLCs of color, and from other minority groups. If you didn’t leave that summit thinking we must change, you didn’t listen. The confluence of these 2 events was random but fortuitous. Some non-US IBCLCs expressed relief that the US-based organization had gone its own way, hoping that this would de-emphasize overrepresentation of the United States within ILCA. The new ILCA president, Australian Decalie Brown, spoke with heart about the need to listen and to lead. The climate is changing, and we need to adapt. As the storm clouds dissipate, the way forward for ILCA is clear. The organization must embrace its international title and work toward true integration, and ILCA members in the United States and everywhere must commit to supporting this, working together, not only because it’s the right thing to do, but to ensure survival. Our profession may be young, but our membership is aging. We have taken little action to fight for equity. We need a new, updated, more accessible approach to the ILCA conference, with proactive outreach to previously uninvited speakers, who should present not only on minority issues but on breastfeeding, because it is their field. We need to ensure that courses across the world are equitably accredited and that mother-to-mother breastfeeding support groups in underprivileged settings are valued as highly as peer groups from the dominant culture on the IBCLC pathway. We need to revisit former ideas and consider new ones, to offer alternate, stepping-stone pathways to the IBCLC qualification, which currently tries to offer all things to all lactation professionals— and in reality offers too little to too few. As lactation advocates—and we are all lactation advocates by default—we have our roots in revolt against the status quo. We fight for breastfeeding when and where no one else did or does. ILCA built the road on organizational WHO Code compliance. We are not entrenched Luddites; we are forward thinkers. We fight for change, in our work, on a daily basis, and now we must unite to fight for change within ILCA and across the profession. It’s not altruistic, it’s necessary, to secure the financial, equitable, and ethical integrity of our work and our evidence base, because we are needed in all nations and across all sociodemographics, to ensure the health and welfare of mothers, families, and babies, wherever, whomever they may be.

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