Authors: Meenu Immaneni, Meghan Etsey, Vashti Price, Brianna Clark, DO – on behalf of AMWA Gender Equity Task Force
“Our Voices, Our Future” is a podcast by the Gender Equity Task Force of the American Medical Women’s Association that explores the challenges, stories, and successes of those working to advance gender equity in medicine. Through candid conversations with changemakers, advocates, and leaders, each episode dives into issues like pay gaps, leadership disparities, and inclusive workplace culture. Tune in to be inspired, informed, and empowered to take action. Full episode listening links are available below the transcription.
Meenu: Welcome to Our Voices, Our Future, a podcast where we amplify the voices driving change in equity within medicine and beyond. Brought to you by the Gender Equity Task Force, a committee of the American Medical Women’s Association. We’re here to challenge norms, break barriers, and ignite conversations that matter.
Meenu: I’m Meenu Immaneni, and in each episode, we bring you candid conversations with leaders, change makers, and advocates, working to create a more inclusive and just world. No more silence, no more waiting. It’s time to get Our Voices, Our Future. Today, we are welcoming Dr. Brianna Clark. She’s a proud osteopathic physician who has completed fellowships in breastfeeding medicine at the University of Rochester and lessons in lactation, advanced curriculum, and climate health equity fellowship through the National Medical Association. She spends her spare time thinking about innovative ways to provide equitable healthcare to all and create sustainable advocacy. Welcome, Dr. Clark. We’re so happy to have you on the podcast.
Dr. Clark: Thank you for having me.
Meenu: So, one of our first questions for you is what made you pursue a fellowship in breastfeeding medicine?
Dr. Clark: I’ve always been interested in public health and understanding evidence-based practices, so not just what my friends were saying or what we think might be right, but digging into how we can improve people’s lives. The breastfeeding fellowship allowed me to better understand breastfeeding and its interaction with medicine. So, a lot of lactation courses are currently on the market. The IBCLC training isn’t directly pointed towards physicians, and that physician level of understanding is what we need for public health practice. Thinking about how medications can alter a plan, how social determinants of health impact health outcomes, and even how chronic disease states can impact life processes. That’s what we spend much of our time thinking about as physicians. The Lilac program gave me an evidence-based approach to systematically think about these things and ways that I could help people in communities more directly focused on breastfeeding.
Meenu: That’s cool to learn about. What are some of the biggest barriers to adequate lactation support that you see for physicians, patients, healthcare workers, and all people?
Dr.Clark: I’d say it’s policy in general. Policy can be built on intention; when you don’t have a policy for something, it often shows a lack of intention or desire. So when I was a kid, my parents would say, “If you put it in your schedule, it’s gonna happen”, “If you plan for it to happen, it’s more likely to happen”. When you have policies that protect parents and that support lactating parents, you’re more likely to see them in the communities and work environments that we are in. When there’s a lack of policy and intention, it tends not to happen. It’s not a priority, but creating a lactation policy, preferably with paid parental leave, does help support breastfeeding.
Meenu: I can see how intention plays a role in shaping policy. Can you share more examples of policies that improve lactation support in healthcare settings?
Dr. Clark: When we talk about actual policies, having parental leave is a big deal. So that means after the child is born or arrives in the case of an adoption, the parents can step away from their work duties and still receive pay. Often, it’s still a practice, specifically in the United States, where you’re allowed not to show up to work, but there are consequences to doing that. Sometimes it is using your paid time off. Sometimes, people are told that if nothing changes within the organization, they can have their job back when they come back. Sometimes it means you’ll take a reduction in pay or just not receive a paycheck while you’re away. Parental leave allows parents to recover from having a newborn because children are up in the middle of the night. It is not the same as watching a puppy. It’s a lot of work having a newborn child. It also allows for the frequent feeding that young children need, so that those parents can provide that. That policy alone would make a huge difference in improving breastfeeding rates and overall health within the family unit, the new parents, and the child.
Since we don’t typically allow for parental leave in the US, I’m hoping that this will change over the next few years and become more common. Provide spaces allowing parents to express human milk while they’re at work, properly store the milk, and possibly even create flex schedules, which means that not every workday has to start at 8:00 AM. Yes, some work tasks must be done at a specific time for a specific work function. Some of those can be relocated to a different time during the day, done from home, or in a lactation room if you have space for a phone and a computer to perform your overall work functions, but provide human milk for your child. Those policies help families out in the end. They’re not complicated policies. We’re not asking for someone to build a new wing to a building. We’re simply saying, could we provide somebody with some more breaks at work? Maybe if they’re a physician, could we put them on a work from home rotation, possibly even on telemedicine so that they could schedule their day out to be at home with their child more, and, provide that han milk or take more frequent breaks while they’re physically in a brick and mortar working space. Also, think about where those spaces will be within a hospital. Many of us, as physicians, have worked in very large hospitals. So, one lactation space for the entire hospital system is not practical. That would be the equivalent of having one women’s bathroom in all of the hospital system. We would be running back and forth and eventually say, “you know what, it’s just not worth it, I’m just going to try and hold it all day because I can’t commit 20 to 30 minutes just to get to that one spot”—creating spots and policies that allow for multiple lactation spaces within a reasonable distance from your main workstation. So if you’re working on the cardiac ICU, there’s a lactation space on that floor, and you don’t have to go three floors up in that hospital. So those types of policies do make a difference.
Meenu: Yeah, for sure, having the flexibility that makes sense in terms of scheduling and accessibility, but also just thinking about what the workday looks like for each career and trying to help that fully, definitely makes sense.
Dr. Clark: On another level, having physicians participate in healthy behavior is modeling what we’d like our patients to do. We no longer allow physicians to smoke in the hospital for multiple reasons. At some level, that is a good behavior model for our patients. We don’t want our patients smoking in the hospital bed either. It’s harder and harder to find fast food in hospitals. There was a time when you could find major fast food restaurants in just about every large hospital system, and those have slowly gone away because we’re modeling and setting up systems to promote healthy behavior. I 100% think that breastfeeding is good for all children. When we can do it, we should support it. Having those systems set up to make people successful is part of that process, setting them up for success and modeling that behavior for them. So it’s great for our patients to see this too.
Meenu: I love that it’s helping us show that it’s normal and part of life, and normalizing it. What other ways can we advocate, like physicians, for lactation support? How can we be part of the conversation regarding policy and change?
Dr. Clark: Analyzing our curriculum and how we’re trained is important, too. I love the education I received, but I got maybe a day and a half in medical school on breastfeeding. At that time, that was considered excessive; most people were getting none. Such a large biochemical process that occurs in just about every patient who becomes pregnant is something that we should be discussing and understanding more. There’s a campaign called “Trash the Pump & Dump” that was developed because so many physicians had a lack of knowledge about when it was okay to have a medication and still breastfeed your child versus when it was not safe. It would’ve been nice if we never needed a program like “Trash the Pump & Dump” because physicians already had that knowledge base that was baked into their curriculum. We were already thinking about drug-drug interactions, lipophilic drugs, and how they are processed through human milk, as well as half times of medications in the way they relate to human milk, so that we could answer those questions in an educated way. It would also be nice if we could include it in our curriculum. The resources to reach out to pharmacology groups and know what questions to ask. That’s a very physician-level understanding of breastfeeding. It’s not something that your doula or IBCLC typically thinks about. As physicians, we spend all of our time thinking about drug interactions and the impact that the drug will have on the human body. So that’s something that definitely should be in our curriculum.
Meenu: I’m sure many schools and education systems still lack that. I don’t think I’ve gotten a lot of details on what breastfeeding support looks like. What do we need to be thinking about as providers even now? I’m a third-year medical student. I hope to seek it out myself, but again, it shouldn’t be that we have to seek it out. It should be part of the curriculum..
Dr. Clark: Yes, absolutely.
Meenu: I was going to ask how the lack of lactation support affects certain groups. We talked a lot about physicians, but what about people of color and low-income patients? We talked about the social determinants of health, which you both mentioned. Can you talk more about how it disproportionately affects certain groups?
Dr. Clark: After graduating from college, I did an AmeriCorps Community HealthCorps Year, a service year where I was allowed to be paid a stipend to work at a fairly qualified health center. I started reading more about breastfeeding and lactation because I was interested in women’s health. I often read articles about why people fail at breastfeeding, and was taken aback by some of the reasons listed that didn’t make sense to me. Often, race was listed as a reason for failure. As my public health career has advanced, my academic training has also advanced. I’ve gained a deeper understanding that it’s not race that causes us to fail; it’s exposure to racism. So, within that, physicians need to understand the historical context of breastfeeding in America. It was not always the posh or healthy thing to do, and that was especially true for African Americans and those descendants of enslaved persons in the United States. Their history involved the forcible breastfeeding of white children. Those people who experienced that they are not alive today, but that history and racism and the impact of that racism live on today. I think understanding that is important when we try to understand why some people are successful with breastfeeding and why some aren’t. If you have a negative connotation with something, you’re less likely to be successful with it. For example, I don’t like snakes. People know that about me. I just don’t like snakes. When I had to take a reptile herpetology class, I didn’t do very well in college. I did not enjoy it. I already had a negative connotation. It wasn’t my ability to read, and it wasn’t my ability to think critically. I already had a negative connotation with that because I had negative experiences. So when we apply that to certain demographics, we have to go in with that lens.
Additionally, issues such as redlining in the United States. We made it difficult for communities to survive in certain parts of the city. That limited transportation put them closer to unhealthy pollution, exposed them to more air pollution, and raised barriers for them to have these flexible work schedules. That all plays into success with breastfeeding. When you have generational wealth and can stay at home and not worry about whether your lights will get turned off next week, it is easier to breastfeed. When you have plenty of access to food and are trying to decide if you want oat milk, soy milk, 2%, or whole milk on your cereal, it is easier to breastfeed. That’s something that, as physicians, we have to keep in mind. It’s not just about a will and desire. When you have a medical condition that’s very well understood by physicians, that has been documented and well studied, it’s easier to be successful. Women who have conditions such as Fibromyalgia, for which we don’t have a strong understanding as physicians. Some of us are still taught that it’s not a disease. Those patients are in a harder position to be successful with anything, and that carries over to breastfeeding. That’s really important to understand, and for me individually. So I was breastfed as a child, but I’ve never breastfed myself, but that shouldn’t stop me from having empathy and putting in extra effort to try and understand these processes and what our patients are going through, and thinking about ways to reduce barriers to make them successful. So, I’ve never had fibromyalgia, but I can do my best to understand what barriers somebody with fibromyalgia might face in breastfeeding, and how, as a physician, I might work to reduce those barriers whether it’s recommending different work schedules, recommending different ergonomics, recommending different logs, or referring them to specialists early. Those things all play a role as a physician that I have the power to change, that your doula or IBCLC, who is a lactation consultant, might not have the ability to do.
Meenu: listening and trying to help the person in front of us. Oftentimes, issues that affect our barriers or things that might not be what’s happening right now, they might not have control over. So if we can make that a little bit better, it would make perfect sense to try to help make things easier so they can breastfeed. Make things easier so they’re not feeling as much pain from fibromyalgia or from whatever chronic disease that we might not know fully about.
Dr. Clark: Yes, I think understanding the historical context of things is important. There are probably some medical students and young physicians who may think that smoking was always been considered a bad idea. That’s actually not the case. That was a public health movement and alot of public health education. Even reeducating physicians to teach people that tobacco smoke is a bad idea. There was an era not too long ago in the United States where breast milk was seen as a bad idea; why not give your baby formula? In some cases, goat’s milk was even used.
Meenu: We have a campaign, I forgot what era, but we were pushing formula to new mothers.
Dr. Clark: There are still active campaigns to do that; part of it involves money. It is important to dig down to the evidence-based science and understand what’s best for the parents and the infant, given their specific situation. That not only requires us to understand biochemistry, but we also need to understand how an infant’s kidneys work and the impact free water has on a newborn. Infants don’t tolerate free water or drinking water very well, but we also have to understand the historical context and the social determinants of health that are at play.
Meenu: If you could give the listeners one piece of advice to be able to advocate for someone who’s not themselves, or particularly like themselves, what would it be?
Dr. Clark: I think for right, this is a challenging political environment. I definitely think knowing your history matters. I’ve always said that part of understanding public health and prevention is understanding America’s history, especially if you’re going to practice in the United States. We can understand how policy and decision-making should play out by understanding history. So, as simple as when I’m in the clinic and I hear that a patient is being labeled as bossy and demanding, understanding the historical context that might have for some minority patients. That already informs me of how I will handle the information provided because I understand the history there. So, it’s challenging as a pre-medical student, medical student, and resident because you don’t hold much power. Still, you do have the ability to know history and find those points of influence. We have AI generation at the tips of our fingers, where we can quickly pull historical documents that tell us the history, and that can empower you to understand when and how to speak up whether that’s showing up with a sign in a formal protest, or redirecting an attending or other staff member who’s not very aware of depth to the situation. That your generation is smart. We just have to teach you all the history so that you can apply it appropriately, and that all starts with going back and researching it.
Meenu: Are there any resources that you have that our listeners could go to? Any websites or books that come to mind that people should read regarding?
Dr. Clark: I keep “Hale’s Medications & Mothers’ Milk” on me as a physician. It’s a pharmacological reference book. Although I’m a proud graduate of Texas A&M University, I give a shout out to Texas Tech for their pharmacological background in breastfeeding medicine. When we think about medicine, it’s very important to understand the pharmacology at play. There are tons of books on racism in America and specifically, racism within the lactation and women’s health that you can read. If your medical library doesn’t have those books, I would contact a group like the National Medical Association. Ask for a list of what they recommend so you can submit a request list to your librarian.
Meenu: Lovely. That’s a great idea. Thank you for that. Thank you so much for speaking to us today. This wraps up our episode for “Our Voices, Our Future”. We hope today’s conversation inspired you, challenged you, and reminded you of the power of raising your voice. The fight for equity doesn’t stop here. Join us in this movement. Subscribe wherever you get your podcasts. If you love this episode, share it with someone who needs to hear it. Until next time, stay bold, stay local, and keep the conversation going. This is Our Voices, Our Future.
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About the Authors
Lakshmi Meenakshi Immaneni, MS3
Meenu Immaneni is a third-year medical student at the Burrell College of Osteopathic Medicine. She has a Bachelor of Science in Public Health with a focus in Nutrition from the University of North Carolina at Chapel Hill. Passionate about patient advocacy and advancing equity in healthcare, Meenu is a dedicated member of the American Medical Women’s Association, where she serves on the Gender Equity Task Force. She is particularly interested in promoting mentorship, and championing women’s leadership in medicine. When she is not studying, Meenu enjoys spending time with her husband and their cat, playing board games, reading, and traveling to explore new places.
Meghan Etsey, MS4
Meghan Etsey is a fourth year medical student from St. George’s University. She has a Bachelors of Arts in Biology and a Bachelors of Arts in Nutrition and Dietetics from Bluffton University in Bluffton, Ohio. She served as the President of the St. George’s University’s Women in Medicine chapter in St. George, Grenada where she expanded relationships with the community and worked towards educating women and helping the youth. She is also a member of the Gender Equity Task Force and Sex and Gender Health Collaborative Committees within the American Medical Women’s Association. When she is not pursuing medicine, you can find her with her friends and family on different road trips and adventures exploring the world.
Vashti Price is a third-year medical student at St. George’s University. She holds a Bachelor of Science in Biology from the University of Louisiana at Lafayette, a Master’s in Biological Sciences from Alcorn State University, and a Master’s in Health Sciences from Meharry Medical College. With a strong passion for public health and health equity, Vashti has dedicated much of her time over the years to volunteering with underserved populations, including individuals experiencing homelessness and children in need. Her commitment to service continues through her involvement with the American Medical Women’s Association, where she serves on the Gender Equity Task Force and the Sex & Gender Health Collaborative Committees. Vashti is particularly interested in the intersection of medicine, public health, and community outreach. Outside of her academic and clinical pursuits, she enjoys spending time with friends and family, attending festivals, exploring new cities, and winding down with a good Netflix series.
Dr. Brianna Clark is a proud osteopathic physician. She has completed fellowships in Breastfeeding Medicine at the University of Rochester Lessons in Lactation Advanced Curriculum ( LILAC) and Climate Health Equity Fellowship ( CHEF) through the National Medical Association ( NMA). She spends her spare time thinking about innovative ways to provide equitable health care to all and create sustainable advocacy.