Dismantling racism, discrimination, and bias to achieve health equity in lactation care

What is health equity?

The concept of health equity is that each human being has an inherent right to “a fair opportunity to attain their full health potential and that no one should be disadvantaged from achieving this potential.” (WHO)

In everyday reality, there are multiple systems and individuals and institutions actively working to limit certain populations from reaching their full health potential. And when these systems, individuals institutions go unchecked and unexamined, the direct result is increased rates of chronic health conditions and shortened life expectancy in oppressed populations.

Oppressed populations include groups of people whose culture, physical appearance, gender identity, and personal practices do not fall into what their society’s dominant culture has deemed to be acceptable and preferred. Because these determinations are not superficial, oppressed populations would be unable to change or assimilate to join dominant culture, and dominant culture is unwilling to expand its definition of acceptable and preferred to include members of oppressed populations.

What is the lactation consultant’s ethical responsibility?

The IBLCE Code of Professional Conduct states that the IBCLC is to “Treat all clients equitably without regard to ability/disability, gender identity, sexual orientation, sex, ethnicity, race, national origin, political persuasion, marital status, geographic location, religion, socioeconomic status, age, within the legal framework of the respective geo-political region or setting.”

In order to achieve ethical integrity, we must take active steps to design and implement policies and procedures that fulfill two purposes:

• preventing us from causing harm to any family because of our biases

• removing bias-based barriers to care for the families in our care

While all humans have biases, it is the unexamined biases of those in dominant culture that cause the most widespread harm. This harm may occur on an individual basis, in a specific interaction with a client, and it also occurs through participating and elevating systems and structures that cause harm. Anytime you perpetuate a bias-based stereotype or use language of oppression, you cause harm. The more aligned you are with dominant culture, the harm you cause will have a more amplified effect.

What can we do?

As a profession, we should be working together to work towards three specific goals:

• Reducing race-based disparities in health and mortality outcomes in childbirth and the first year postpartum for oppressed families and their babies. This work can be done on local, national, and international levels.

• Increasing access to the IBCLC credential for non-dominant candidates. This means eliminating barriers to education and mentorships through institutional scholarships and grants, as well as individual action.

• Elevating members of non-dominant culture to leadership positions in our professional and advocacy organizations, and as speakers and lecturers on clinical topics at our conferences.

This takes time, money, and commitment from those in dominant culture, not just to read books and listen to podcasts, but to submit to leadership and ideas that make them uncomfortable. People like me will lose power and status—but I hope we can see that those losses are more than worth it to save lives and allow every person the freedom to reach their own health potential.

Organizations I Support

• The Melanated Mammary Atlas

• Black Lives Matter

• Black Mamas Matter

• Perinatal Health Equity Foundation

• Hispanic Health Council

• Native Women’s Wilderness

• Trans LifeLine

• Trans Women of Color

• Tip It Forward

• Asian Americans Advancing Justice
• ProPublica

Don’t see your organization listed here? Please contact me to be added. I financially support the organizations I endorse.

Recommended Resources

 

Dismantle & Rebuild

• Harvard Implicit Association Test

• Racial Equity Tools

• How To Be An Anti-Racist by Ibram X. Kendi

• National First Food Cohort Addresses the Value of Peer and Community-based Breastfeeding Support

• Pod for the Cause Action Center

• Center for Social Inclusion: Talking about Race Toolkit

• Removing Barriers to Breastfeeding: A Structural Race Analysis of First Food

• The Sliding Scale: A Tool for Economic Justice

• Asian American Feminist Collective

Trans Rights are Human Rights

• Providing Transgender-Inclusive Healthcare Services

• Supporting the Transgender People in Your Life: A Guide to Being a Good Ally

• All Your Questions About Gender-Neutral Pronouns Answered

• FAQ on pronouns

• Everything You Ever Wanted to Know About Gender-Neutral Pronouns

• 64 Terms That Describe Gender Identity and Expression

Bias and Healthcare = A Deadly Combination

• “Why Even Bother; They Are Not Going to Do It?” The Structural Roots of Racism and Discrimination in Lactation Care

• Barriers to Health Care for Transgender Individuals

• Hidden in Plain Sight — Reconsidering the Use of Race Correction in Clinical Algorithms

• Removing Barriers to Breastfeeding: A Structural Race Analysis of First Food

• Cultural Humility: People, Principles, and Practices (Community Action Partnership)

• Meeting the healthcare needs of transgender people

• Health Care System Fails Many Transgender Americans

The Historical Roots of Racism in the United States

• RACE: The Power of an Illusion documentary series and resource page.

• What is Systemic Racism? (video)

• Dog Whistle Politics: How Coded Racial Appeals Have Reinvented Racism and Wrecked the Middle Class by Ian Haney Lopez

• Racist History of American Political Ads (video)

• How racism entered mainstream politics and turned the middle class against itself (video)

• The Sum of Us by Heather McGhee

• Stamped from the Beginning by Ibram X. Kendi

Watch

• Kimberly Seals Allers on Facebook

• Humans of New York (the series)

• Red Table Talk

• Franchescha Ramsey’s MTV Decoded

• Who, Me? Biased?

• Black Feminism & the Movement for Black Lives

Podcasts

• Speak Out with Tim Wise (single episode)

• Seeing White (episode series within the Scene On Radio podcast)

• 1619 from the New York Times

• About Race

• Code Switch

• Intersectionality Matters

• Birth Bruja

For white people who want to do better

• Unpacking White Privilege and Prejudice (video)

• Anti-racism resources for white people

• Levels and Types of Oppression

• “White Privilege: Unpacking the Invisible Knapsack” and “Some Notes for Facilitators”

• How White Parents Can Talk To Their Kids About Race