Research confirms that breastfeeding disparities persist and that lactation consultants play a key role in reducing them. However, there continues to be a limited availability of International Board Certified Lactation Consultants (IBCLCs) in the US with racial minorities in particular facing persistent barriers in the certification process. Through semi-structured interviews with 36 IBCLCs across the US, this study takes a systematic look at breastfeeding disparities through the lens of the IBCLC. Specifically, this study addresses barriers to certification and employment discrimination faced by IBCLCs of color, race-based discrimination against patients, and the ways in which IBCLCs work to both medicalize and demedicalize breastfeeding. Each of these areas can impact breastfeeding equity, and each help to reveal the ways in which race, class, gender and medicine shape views and practices related to lactation and motherhood. Cost and the increasingly university-focused approach of the IBCLC certification process are found to be significant barrier for participants. Race-based discrimination during the certification process and in the workplace is also an ongoing and persistent reality that affects participant’s relationships with patients and coworkers and their ability to secure workplace resources and to advance in their careers. IBCLCs report instances of race-based discrimination against patients such as unequal care provided to patients of color and overt racist remarks said in front of or behind patient’s backs. Finally IBCLCs are found to demedicalize breastfeeding, but they often lack the authority to change breastfeeding policies. They also engage in other work that medicalizes breastfeeding and perpetuate the idea that mothers are anxiety-prone patients in need of professional intervention.

Disparities in breastfeeding are increasing for Black women in the United States despite initiatives aimed at improving breastfeeding outcomes. As a result, Black communities are not being protected, which is reflected in the disproportionate rates of mortality and morbidity for the Black dyad. Much of the qualitative studies in the literature have focused on the patient experience through focus groups or interviews. However, this information typically is not communicated to the same physicians providing the care in a study. This study aims to change that by obtaining the breastfeeding experiences and perspectives of patients and medical providers in a low-risk prenatal clinic in urban North Philadelphia. The secondary aim is to disseminate patient feedback to providers to develop a realistic call to action specific to that community. Work obligations and perceived necessary lifestyle changes were the patients' most significant barriers to breastfeeding. Patients desire more education from the medical community, but at the same time, providers lack the knowledge, comfort, and time to counsel. What is clear is that the medical system contributes to these poor outcomes; institutionalized barriers add to existing disparities and ultimately worsen the crisis for everyone, with long-term effects on the economy and productivity of the surrounding community and the population. Providers cannot create change by themselves, as breastfeeding disparities have roots in much larger policies and systems, but providers must examine what is in their scope of influence. Future research is needed to explore the effects of empowering Black communities with education regarding workplace laws and addressing myths that reinforce breastfeeding barriers. Medical education must incorporate breastfeeding into its curriculum as the consequences are dire and intersect with many areas of medicine. This research offers hope for change and has led to providers developing proposals for timely and realistic interventions based on community feedback and narratives. / Urban Bioethics