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Dear Human Resources at Duke Health,
It has come to the attention of local lactation providers in Durham and the greater piedmont area that Duke Health requires that IBCLCs (Internationally Board Certified Lactation Consultants) hold the additional license of Registered Nurse. We value Duke's work to become more equitable and inclusive. Thank you for being willing to hear concerns and ensure leadership hears them too. As Duke 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 Duke’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 Black2 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 Duke will consider revising the current hiring policy to align with other leaders3 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.
Sincerely,
Members of the Durham Community
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