by Amy Spangler
June 06, 2009

The Surgeon General’s Workshop on Breastfeeding and Human Lactation was held 25 years ago in Rochester, New York. To mark the anniversary of that important event, the Academy of Breastfeeding Medicine (ABM) with funding from the W.K. Kellogg Foundation (Kellogg is known for its support of breastfeeding, having aired a television commercial advertising its breakfast bars and featuring a breastfeeding mother and baby) is hosting the 1^st Annual Summit on Breastfeeding titled, “First Food: The Essential Role of Breastfeeding.”

The goal of the Summit is to develop recommendations for a national breastfeeding agenda that will guide policy makers. The meeting will take place June 11–12, 2009 in Washington, D.C. where Summit participants will explore strategies for improving breastfeeding rates, removing barriers to breastfeeding, and eliminating disparities.

Among the featured speakers will be former Surgeon General Koop, Acting Surgeon General Galson, Ruth Lawrence, MD, Chair of the Surgeon General’s Workshop on Breastfeeding and Human Lactation, and Senator Kirsten Gillibrand, member of the U.S. Senate Agricultural Committee that oversees the Supplemental Nutrition Program for Women, Infants, and Children (WIC).

By invitation only
I was excited to learn about the Summit. Certain that others would share my sentiment. But I quickly discovered that instead of accolades, ABM had been peppered with criticisms. Why the controversy?

ABM is bringing together a multi-disciplinary group of experts to explore how best to promote breastfeeding in the U.S. What is controversial about that?

It appears that the controversy has nothing to do with the Summit itself but everything to do with who gets to attend. The spark that ignited the fire? Eight words in an ABM press release publicizing the Summit, “Attendance at the Summit is by invitation only.”

Surely no one can argue the need to restrict attendance, given the limitations imposed by money and space. Nonetheless, when those eight words rippled through the breastfeeding community it prompted a cascade of inquiries, that many would describe as self-serving: When will the invitations go out? There must be a mistake, I didn’t get an invitation? Did you get an invitation? I can’t believe he got an invitation? Surely she got an invitation? Why were they invited? Why weren’t they invited? The verbal assault has likely been enough to cause ABM and Kellogg to rethink the wisdom of their decision. Once again it appears that no good deed goes unpunished.

Outside looking in
I have no knowledge of the behind the scenes activity related to the Summit. I consider myself a political outsider. I used to be on the inside (One of those people “In the know”). But now I’m on the outside. And to be perfectly honest, I like it on the outside. I don’t worry about invitations. I do what I like, when I like. And I answer to no one, except the mothers, fathers, and babies that I have the privilege of serving.

On the other hand, experience (acquired in my former inside life) has taught me the importance of broad-based coalitions for achieving public health goals. I served as Chair of the U.S. Breastfeeding Committee (USBC) during the time when the National Breastfeeding Awareness Campaign (NBAC) was launched by the U.S. Department of Health and Human Services Office on Women’s Health. Not unlike the upcoming Summit, the NBAC was fraught with controversy; controversy that in the end, diluted the effectiveness of the campaign, tarnished relationships with government officials, and reflected poorly on many in the breastfeeding community. Even today, when I am asked about the campaign, I refuse to take part in the finger pointing, because I know that everyone involved made mistakes, including breastfeeding advocates.

Passion stymies progress
If I had to use one word to describe breastfeeding advocates, it would be passionate. But as a member of that passionate cohort, even I must acknowledge that too often our passion undermines our progress. It keeps us from moderating our positions; from embracing a wider audience; from celebrating success even when it’s not our own; and from accepting a backseat in the interest of the families we claim to serve.

I applaud the efforts of ABM in coordinating the upcoming Summit. As to who was and wasn’t invited, I know only what is being circulated via listserves and blogs, so I contacted the U.S. Lactation Consultant Association (USLCA) and the USBC offices, two organizations that I would like to see represented at the Summit. After confirming that neither organization had been invited, I contacted the ABM office for clarification, and was told that 17 members of the USBC had been invited. While the USBC and the USLCA were not among the 17, numerous government agencies and professional associations were represented, including the Centers for Disease Control and Prevention (CDC), Maternal and Child Health Bureau (MCHB), American Academy of Pediatrics (AAP), and American Academy of Family Physicians (AAFP).

I can’t speak to the invitation process. But I can imagine the difficulty ABM faced in trying to identify those organizations/individuals essential to a successful Summit. The selection process might have been perceived as more fair-minded and transparent if invitations had been issued only to organizations and participation on the part of individuals had been limited to speakers. Each organization could then choose its own representative. Admittedly, there is always the risk that an organization will send a representative that is ineffective, thereby undermining the success of the Summit. But the fact remains that participation on the part of organizations is what is essential to building broad-based coalitions capable of achieving long-term success.

Ideal versus real
If the goal of the Summit is to bring together participants from government, academia, professional associations, etc. for the purpose of generating policy recommendations, then it is difficult to understand why the USBC (the nation’s breastfeeding committee) and the USLCA (the only health professional organization whose members focus their care exclusively on breastfeeding families) would not be included. I can only hope that ABM will rethink that decision.

In an ideal world, breastfeeding advocates everywhere (those invited and those not) would find the Summit cause for celebration. Unfortunately, in the real world, the importance of the Summit is being overshadowed by the controversy surrounding it, and breastfeeding advocates once again risk undermining a landmark event. Power and influence at its best and worst.

Editor’s Note—June 18, 2009
A recap on the Summit:

Day one featured plenary sessions aimed at elucidating the state of breastfeeding in the United States and laying a foundation for future promotion and support strategies. David Meyers, MD, Agency for Healthcare Research and Quality (AHRQ) spoke on the benefits of breastfeeding for moms and babies. Laurie Nommsen-Rivers, PhD, Cincinnati Children’s Hospital, discussed breastfeeding and parameters of normal growth. Larry Grummer-Strawn, PhD, Centers for Disease Control and Prevention addressed breastfeeding rates among underserved populations. Andy Burness, MA, Burness Communications discussed social marketing. Nancy Chin, PhD, University of Rochester School of Medicine and Elena Rios, MD, National Hispanic Medical Association addressed cultural differences. Last but not least, Alethia Carr, MBA, Michigan Department of Community Health discussed the WIC Program and its role in breastfeeding promotion and support.

Participants were then divided into Work Groups patterned after those identified during the Surgeon General’s Workshop on Breastfeeding and Human Lactation held 25 years earlier (to the day). Work groups included World of Work, Public Education, Professional Education, Health Care System, and Support Services.

Day two began with presentations by Carol Jenkins, The Women’s Media Center, Bruce Lanphear, MD, Child and Family Research Institute, and Cynthia Tuttle Reeves, PhD, National Business Group on Health. Their topics included breastfeeding and the media, breastfeeding and the environment, and the business case for breastfeeding.  Participants then returned to previously formed Work Groups for the remainder of the day.

Detailed summaries of the plenary sessions along with Work Group reports will be published in a special edition of Breastfeeding Medicine, the official journal of the Academy of Breastfeeding Medicine. To facilitate worldwide access, the information will be published online as well as in print. Publication is expected to take place in the last quarter of 2009. Individuals wishing to purchase a copy of the special edition can do so without subscribing to the journal.