Equity in the IBCLC Credential

On March 8, 2021, a group of community advocates requested that Breastfeed Durham and other community groups advocate for the IBCLC credential to be recognized by Duke Health and other surrounding hospitals as a standalone credential. After meeting with our team of lactation support providers and advocates in Durham County and the surrounding areas, we drafted the letter below.

Update-March 17, 2021: All of Duke’s open IBCLC positions have been changed. Please share the job postings widely.

Second Update: In the light of our collective success with Duke, we are prepared to proceed with contacting UNC Rex and WakeMed to request removing the RN requirements for their LC positions. Here you will find the drafts to UNC Rex and WakeMed. We would like to be intentional about continuing these efforts and would like to make space for Wake County advocates to lead this work. We know that change-making work is always most effective and meaningful when rooted within the community. If you are part of the Wake County community and would like to take on this project, please let us know. Otherwise, we are ready to go forward with all of the representation we have (from all over NC!). Also, if anyone has ideas about who might be a good contact at UNC Rex, that would be helpful info. Please provide any feedback you may have to Breastfeed Durham.

Click HERE to add your name or your organization name

Dear Human Resources at [Hospital],

It has come to the attention of local lactation providers in Durham and the greater piedmont area that [Hospital], requires that IBCLCs (Internationally Board Certified Lactation Consultants) hold the additional license of Registered Nurse. We value [Hospital]‘s work to become more equitable and inclusive.  Thank you for being willing to hear concerns and ensure leadership hears them too. As [Hospital], works to become a more equitable space for the community, we ask that the current policy be reconsidered. Requiring a concurrent RN license to perform IBCLC duties continues patterns of structural and institutional racism.

Breastfeeding is considered the “great equalizer,” providing infants with life-long better health outcomes as well as improving health outcomes for parents who human milk feed. The inequities that affect Black and Brown community-members in other health outcome measures, are also found in breastfeeding outcomes. The American Academy of Pediatrics (AAP) and World Health Organization (WHO) recommendations for exclusive breastfeeding for the first six months of life are not attained by the majority of families, especially Black and Brown families. The long history of slavery, settler colonization, criminalization of lay-midwives, and further historical trauma have certainly affected breastfeeding rates in the present; however, current practices such as [Hospital]’s education requirements only perpetuate the inequities.

Unequal access to higher education has led to disparities in who provides care in our community. 80% of RNs in North Carolina are white. Only 8% of NC RNs are Black. We live in a city where 38% of the population is Black and 13% is Latinx. Unreasonably restrictive and expensive requirements for the IBCLC certification have led to similar statistics in the lactation profession. 90% of IBCLCs are white. As Tamar Ringel-Kulka, MD, MPH notes in her 2011 study1, Black Durham parents cite bias from healthcare professionals and culturally incongruous care as affecting breastfeeding outcomes. Hiring Black and Latinx lactation providers is of utmost importance to decreasing inequities in breastfeeding outcomes in Durham.

Many hospitals in the area are utilizing more equitable hiring practices. Hospitals that don’t require an RN license for IBCLCs include UNC, Novant Health, Cone Health, and Atrium to name a few. We hope that [Hospital] will consider revising the current hiring policy to align with other leaders in healthcare across the state.

We look forward to continuing to work together to support families in the community. Please do not hesitate to reach out with any concerns or questions. Thank you. 

Member of the Durham Community  (click here to add your name or your organization name)

USLCA’s letter supporting IBCLC as a stand-only credential: https://uslca.org/wp-content/uploads/2020/02/Support-for-IBCLC-as-a-Standalone-Credential.pdf
1. Community based participatory research of breastfeeding disparities in African American women Infant Child Adolesc Nutr. 2011 Aug; 3(4): 233–239.
2. Enhancing Breastfeeding Through Healthcare Support: Results from a Focus Group Study of African American Mothers Matern Child Health J. 2016;20(Suppl 1):92-102. doi:10.1007/s10995-016-2085-y