IBCLCs: Improving Public Health Through Culturally Competent Care

Breastfeeding is a key piece in the puzzle of infant health. All infants need feeding, and human milk is the optimal choice that provides ideal nutrition and supports growth and development. But systemic barriers often make it difficult for families within some racial, cultural, or socioeconomic groups to breastfeed, according to the U.S. Centers for Disease Control and Prevention .

Highly knowledgeable lactation care providers around the globe are working to bridge the breastfeeding gap. International Board Certified Lactation Consultants (IBCLCs) are healthcare professionals equipped with the knowledge and skills needed to support breastfeeding families. IBCLCs undergo both educational and clinical training that empowers them to help breastfeeding families with cultural sensitivity.

Three ways IBCLCs improve equity:

1. Understanding barriers and solutions

Identifying breastfeeding disparities is the first step. IBCLCs’ education and experience tailoring their support to families’ unique backgrounds make them well-suited for the task. They can identify barriers marginalized groups may face and offer practical ways to address them.

What does this look like? IBCLCs work directly with families to educate why breastmilk is considered “liquid gold” and its benefits to the newborn and the breastfeeding parent. IBCLCs can answer questions and help families navigate cultural obstacles, access resources, and understand breastfeeding rights when it comes time to return to work.

IBCLCs are also leaders in educating staff in birthing facilities nationwide. IBCLC Brooke Gilliam, for example, is an IBCLC who works closely with the CDC’s EMPower Best Practices program in her role at the Carolina Global Breastfeeding Institute. EMPower helps designated trainers educate labor and delivery, postpartum, and newborn nursing staff on successful breastfeeding at more than 125 birthing facilities.

In addition to improving skill sets of maternity care staff, EMPower encourages staff at U.S. hospitals and birthing centres to analyse data through an equity lens, revealing barriers that may have otherwise gone unseen. The growing awareness of disparities has led to a rise in exclusive breastfeeding rates in some hospitals. 

2. Establishing a trusted, respectful environment

Strong relationships are a crucial part of breastfeeding, both between families and their newborns and between families and IBCLCs. The level of care that IBCLCs implement in hospitals and birthing centres strengthen family-infant bonds, especially among groups that face barriers to breastfeeding.

IBCLCs work in a variety of settings, from hospitals to private practices, adhering to the Code of Professional Conduct for IBCLCs, which includes an emphasis on culturally appropriate services that meet families’ individual needs. When addressing disparities, IBCLCs are responsible to tailor their support based on the best available evidence.

Many IBCLCs strengthen family-infant bonds at large scales. Dr. Clifton Kenon, Jr. is an IBCLC and international breastfeeding advocate who led efforts to bring the Baby-Friendly USA Baby-Friendly Hospital Initiative, a worldwide program to help families confidently breastfeed, to several Indian Health Service hospitals. To make them Baby-Friendly, Clifton helped implement clinical standards that enables families to initiate and maintain breastfeeding, such as discussing the importance of breastmilk and encouraging families to room with their infants for 23 or more hours per day. His leadership resulted in up to 80 percent increases in breastfeeding rates on some reservations.

3. Fostering a diverse workforce

Cultural competency is key, so it is beneficial for lactation consultants to reflect the families they support. IBCLCs are a diverse and international group, with over 37,000 in 134 countries as of 2024.

The Human Lactation Pathway 2 Program at the North Carolina Agricultural and Technical State University (NCAT) prepares students to become culturally sensitive IBCLCs. The program is designed to facilitate greater numbers of IBCLCs who can address larger equity concerns in breastfeeding care, such as lower breastfeeding rates among Black families.

Janiya Williams, IBCLC, director of NCAT’s program and the CEO of a lactation support group for families of color, oversees coursework for this program and instructs the Cultural Diversity and Communication in Healthcare I & II courses. “The purpose of these courses is to expose students to their own conscious and unconscious biases…and ultimately provide them with a firm foundation in culturally sound care,” she says in her article on creating equity in lactation.

IBCLCs play a pivotal role in helping families put together the puzzle pieces to reach their breastfeeding goals.