Breastfeeding & Maternity Leave; Larry Grummer-Strawn of World Health Organization

your positive, positive, positive imprint, imprint, imprint,

imprint stories are everywhere.

People and their positive actions inspire positive achievements.

Your PI could mean the world to you.

Get ready for your positive imprint.

Hello there.

I'm Catherine, your host of this Variety show podcast.

Your positive imprint is transforming how we live today

for a more sustainable tomorrow through education and information.

Your own positive actions inspire, change.

Follow me on Instagram and my YouTube channel, your Positive Imprint, and

you can also follow me on Facebook and connect with me on LinkedIn.

Check out my website, yourpositiveimprint.com, where you

can learn more about the podcast and sign up for email updates.

Thank you so much for listening.

Music by the legendary and talented, Chris Nole.

ChrisNole.com C-H-R-I-S-N-O-L-E.

Thank you again for listening and for your support of this

podcast, your positive imprint.

What's your pi?

Today's guest is Larry Grummer-Strawn from the World Health Organization.

WHO workforce reflects the principles of human rights, ethical standards,

and equity, which are inspired by the WHO vision of a world

in which all peoples attain the highest possible level of health.

The World Health Organization's mission is to promote health, keep the

world safe, and serve the vulnerable.

Larry, hello.

Hello.

And welcome back to your home.

Always good to be in the Southwest.

It is.

Fun to be here.

You're part of the World Health Organization- That's

right ... which is so incredible.

Let's first tell the listeners a little bit of background about

World Health Organization and why you chose to go that route.

So the World Health Organization is

part of the United Nations.

There are a lot of specialized agencies within the UN to address

problems of the world, and obviously, World Health Organization is trying

to improve the health of the world.

problems around the world and said, "How can we conquer these problems of health in

a better way by working together on them?"

And created the organization headquartered in Geneva, Switzerland.

It is still in the original buildings that it was in at the time.

I joined them prior to that, I was with the US Centers for Disease

Control, which is based in Atlanta.

When I retired from CDC, I then started my second career with

the World Health Organization.

They're actually very similar in many ways.

They're both science-based organizations that are trying to

use the best scientific evidence to change the way we deal with health.

While some of it is about healthcare and making sure that people have healthcare

and that healthcare is high quality a lot of it is more of a public health approach.

So we're trying to make sure that people are healthy by creating

a world that is more healthy.

So policies that make it easier for people to do things that are good for their own

health rather than waiting until they get sick, and we treat them when they're sick.

So like vaccinations maybe?

Or what?

Vaccinations

would certainly be a part of it.

But that's part of g- the healthcare system.

We tend to do to do that as a preventive measure within healthcare.

But a lot of what we work on too is just trying to change the

nature of the world we live in.

So water and water safety and hygiene.

So making sure that populations have access to latrines or flush toilets so

that they're not passing diseases around.

One of the things that I'm working on is on maternity leave so that women

after they have their babies are able to have some time to bond with their

babies, to take care of their babies.

It's good for child development.

It's good for their own health.

Helps them to breastfeed, that we know is good for the health of their children.

And so it's something completely outside of the health arena.

It's much more an economic strategy for maternity leave.

But we know it has huge health implications, so how do we actually

build those kinds of policies?

So how do you do that when you build a policy?

How does this affect directly the people around the world?

Do you have any staff that goes down and watches these policies being implemented?

So we do a lot of different kinds of studies.

Some studies are about the efficacy, so you do an- do a study somewhere

of, okay, we put in place a policy.

What happens to the behaviors of people?

Do they actually breastfeed for longer?

Do they actually take care of o- other children better?

A- and study what happens in, in the real world.

We also will look just kind of on a monitoring basis not - just to look

at the outcomes, but say they put in place a policy, but are we actually

seeing that people use that policy?

It's one thing to write the law, but then if no one actually enforces that

law and no one pays any attention to it.

So you put in measures over time to see, well, are women

actually taking that leave?

Are pe- are they staying home- Oh, okay ... with their babies longer?

So we have surveillance systems, but we also do in more in-depth

research studies to find out what the impacts are.

That's exciting because I love research and reading different papers and

knowing that policies are being, rendered in ways that are based upon research.

You are doing this in Switzerland,

that's the headquarters for the WHO a- and a

number of United Nations agencies.

In fact people think of the United Nations headquarters being in New York, and

they consider that to be the political headquarters, whereas Geneva, Switzerland

is really the operational headquarters.

So we have a lot of staff there that are involved in carrying out the

work of the United Nations, and the WHO is one of those agencies there.

It was created there.

You know, Switzerland was known as a neutral country- Right, right ... Not

taking sides in World War II.

The United Nations was created just after World War II.

And so it was kind of a natural location in that sense.

And the Swiss government kind of volunteered, we will host you.

To h- yeah.

We'll provide you with a lot of the land to take care of that, to put

in p- place you know, tax systems to take care of the people who'd be

working th- with the United Nations to make it a good home for that, and

so it's continued to be the home.

And you travel extensively actually around the world, not

just in Europe, so what does this entail when you do travel?

You know, how are you carrying this positive imprint with you?

Yeah, so pretty much all of the work is for,

r- all the travel is for work.

Sometimes I can add on a couple of days to have some fun too.

But it, it is to travel to countries- Really to help them figure out how

do they put in place these policies,

So I'm usually

working with the government.

Sometimes we'll have meetings with other organizations in that same

country along with the government.

So there might be non-governmental organizations that implement or

that advise them, that do some of that research, and so we'll do

it jointly, but really our main contact is with the government.

And so it's advising them what are the recommendations that we're

putting out from WHO, why are those recommendations w- what we th-

what we think they should be doing.

And it's to work with them, how do you actually make that work in their country?

You know, you can't just have, "This is the global policy. Everybody should do

it exactly the same way." So how do you adapt it in the circumstances that they're

in and how do you actually get there?

Sometimes it's not just, "Oh, we want to have this policy," but

there are barriers in the way.

There might be corporations that don't want that to be the policy

because it might influence... Interfere with their corporate gains.

There might be other groups that are fighting against it for other reasons.

And so you have to figure out, well, how do we work toward a solution

here that's going to be in the best interest of the population?

Sometimes you can find things that are in the mutual interest of everyone.

Sometimes you have to say, "Well, no, th- this isn't always going to

be best for corporations but it's better for the health of people,"

and how do we work through that?

This is interesting.

I'm enjoying this, and I know the listeners have questions, and

I'm trying to read their minds.

One of them is not all nations are part of United Nations.

So when it comes to world health, Do you only provide your visits

or your communications, your connections with countries that

are part of the United Nations?

Actually, just about the entire world is a

member of the United Nations.

The only states that really are not are states that are in a

little bit of flux in some way.

Right.

They might be a territory of another country.

And there might be some disputes about d- are they actually their own

country or are they still under the auspices of another, and so they may

not get United Nations status because it's still being thought about.

But those are more the exceptions, and they're tend- tend to be small countries.

So really most countries are in the United Nations.

And

then they just have a different participation level than-

It's... Yeah, it's a different

participation level, and sometimes it does get complicated-

Right ... for us to work in those because we might have to have the

permission of- another entity that says they're in charge of that land.

And so there are situations we have to sometimes be very careful.

Sometimes we can invite them to come to our meetings and learn about what they

need to be doing, but we can't recognize them as a full-fledged member there.

So we might go into a, and have a meeting and say, "All right.

We have 20 entities in the room, 18 countries in the room." We can't

call the other two countries because they're, you know, not... They

don't have a legal status that's recognized by everyone in the room.

But really we

don't limit our help that we-

so you don't limit your help.

What about the funding?

Is that up to every government

so as standard for the United Nations the World

Health Organization gets an allotment from all countries.

So all members are expected to chip in.

Mm-hmm.

And there's an algorithm on appropriate amount should be for them to make

their member state contributions.

For some very poor countries, it's very small.

But for large rich countries they have a much larger contribution to put

in, and that does provide a base of funding for WHO and other entities.

But in addition to that, we raise funds on the basis of the projects that we're

working on some from countries themselves, not necessarily as a, an assessed...

They call those assessed contributions when it's just part

of their kind of tax to the system.

But we'll also go to countries and say, "We want to work on this project.

Would you support our work on this particular activity?" So we'll also

get country support specific to the projects that we're working on.

In addition, we'll go out to foundations and do funding funding requests.

Actually a g- a large part of WHO's budget is now paid for by the

Bill & Melinda Gates Foundation.

That's wonderful,

so that's only one part.

So, at the CDC I was doing nutrition across the board.

So I was the chief of the nutrition branch at the US Centers for Disease

Control, and so dealt with a lot of different nutrition issues.

So it might be breastfeeding one day, it might be trans fatty acids, it might

be consumption of fruits and vegetables.

Yeah.

It might be iodine deficiency.

So we were just kind of all over either US problems or sometimes

international problems just all kinds of nutrition issues.

When I went to WHO, I kind of focused in on the topics i- in nutrition.

And so I'm only doing infant and young child feeding.

I have a broader geographic scope that I'm dealing with the entire world, but

it's only on that young feeding really in the first few years in addition

to some general stuff that I do.

But my main focus is on infant and young child feeding.

So a lot about a- breastfeeding and how we can support breastfeeding, and

that's where the maternity leave work-

fits in, is to support women so that they can continue breastfeeding

after their babies are born.

But lots of other things that we'll do with that, medical education,

trying to change systems in, in hospitals that get in the way of

the beginning of breastfeeding counseling around breastfeeding.

What do you mean hospitals

that get in the way?

So there are a lot of procedures that they'll do

when babies are born that actually make it hard to breastfeed.

So having nurseries- Oh ... where we keep the baby off in a nursery, and so

Mom isn't there to see when the baby got hungry, so she doesn't breastfeed, and

her milk supply doesn't come in- Okay

because she's not getting that hormonal r- reinforcement.

The baby's not suckling at the breast often enough.

When the baby's off in the nursery, there might be a standing order for ba- feeding

the baby with infant formula, and so the baby gets fed with infant formula, and the

baby- Okay ... isn't hungry when the baby does come to Mom, and so doesn't suckle

at the breast very vigorously, so her milk never comes in, and a couple weeks

later they say, "Oh, I couldn't breastfeed because my milk supply dried up."

Right.

But- And it's because of those procedures that the hospital had put in

place that that made it hard for her.

So we're trying to get hospitals to change the way they do their procedures.

How do you think WHO has provided or allowed our world to

sustain ourselves in a healthy manner?

I, I think that the World Health Organization has made

huge impact on the health of the world.

And you really just have to point to examples.

I can't say that there's one big thing that they've done for everyone.

But take polio for example.

The World Health Organization was the leader in mobilizing

the world to eradicate polio.

It's a disease that doesn't exist.

See, these are... That's a

great example

right.

And it, it wouldn't happen if you didn't have that coordination

across lots of countries.

You could say, "Oh, well, you know, a country could have gone and done the

vaccinations themselves." Well, first of all, many countries didn't have

the resources to do it for themselves.

Mm-hmm.

And diseases like that cross borders, so you can't say, "Oh, because these

countries took care of it themselves, we've taken care of the problem." Well,

the fact that other countries didn't take care of it means it's going to come

back into that country again and again.

So you had to have a coordinated effort to stamp that out.

We got to where people knew what the solution was a lot earlier than that.

But if you don't have an international body who can make de- decisions,

"We're going to solve this problem, and here's how we're going to do it,"

provide the resources to the places that couldn't do it on their own,

and make it happen, it won't happen.

Just because people know it's the right thing doesn't mean that

it will automatically happen.

So taking it back to my example of breastfeeding, pretty much everybody

knows that breastfeeding is the healthiest thing for their babies.

Mm-hmm.

It's not a matter of telling them what is the best thing to do.

It's a matter of how do you actually change the systems

that are getting in their way.

So that early return to work, the practices that are wrong in the hospitals,

you have to change those things.

One of the big things that, that we're working on is the corporate

influence of infant formula.

So companies, multinational corporations are out there making money selling infant

formula, and we need those companies.

So it's, we're not negative on those companies, , because there

are women who can't breastfeed.

And we want them to have the healthiest product possible.

And infant formula is clearly better than taking milk off the shelves and

doing your own special concoctions-

infant formula is definitely healthier.

But it's not as healthy as breastfeeding.

And so when those companies come in and start pushing their products and

advertising them, and convince women that, "Well, maybe this would be just as

good as my breast milk," or, "Eh, it'll be a lot easier for me to do that instead

of breastfeed," it shifts decisions away from what's best for health.

And so if we don't have controls on how marketing can be done, then that will just

continue to push away from breastfeeding.

And so what we work on at WHO is to put those controls in place, and

then help countries put in place laws so that they're controlling

that marketing in a way that doesn't interfere with breastfeeding.

Do you do lobbying?

So in a way, yes.

We certainly advise national governments and national organizations

to say, "Well, if you're going to get to a better policy, you need

to be talking to your congressman.

You need to be talking to your parliamentarians." And so we give them

the tools, basically for that lobbying.

We do advocacy, if you wanna call that lobbying, but it's not on a specific bill.

You know, the technical definition of lobbying is this bill, are you

going to help this one pass forward?

We're not at that level of minutia, but we certainly are doing advocacy.

Advocacy definitely is education.

But we also wanna do it in a way that doesn't put the responsibility

on individual women, individual families, that somehow you're

making the wrong decision for your health or for your baby's health.

That's not the issue.

We know that most families are making the right decision for them under the

circumstances that they're faced with.

If mom needs to go back to work early, if she's been given these messages

then she's going to be making the decision that she thinks are right.

Right.

And we don't wanna say that you're making the wrong decision.

What we wanna do is we wanna change the systems that are making it hard

for her to make the healthiest choice.

So we wanna give her the maternity leave that makes it easy.

We wanna give her educated healthcare professionals

that know how to support her.

We wanna give her access to counseling so that she can figure out issues

of, "Well, how am I going to go back to work and breastfeed at the same

time? I've never had to do this for, before. I'm a first-time mom." Yeah.

So give her the resources so that healthy choice is actually

the easiest choice for her.

Where would a mother go for these resources that you're talking about?

Well, she should be able to go to her healthcare

providers in her community.

She should be able to go to community organizations in the village that she

lives in or the city that she lives in.

In some places they do exist.

In some places they don't.

Here in the United States, you've got access to lactation consultants.

In the low income WIC program in the United States there are peer

counselors available to women who are women who have breastfed themselves

and are there to help other women, and they're hired i- in- into that.

They're trained how to help other women.

So there are resources available to them.

Not enough.

It needs to be grown much more in this country.

But in the rest of the world as well, we need to build more of those

mother-to-mother support groups, outpatient clinics for help ways to

get that community support for women.

Choose one of the countries that you've been to where you've sat

down with the government and just kind of walk us through a typical conversation

I don't know

how to walk through a single conversation.

Usually these things spread out over, you know, years really.

Yeah.

I guess, one example I'll take is with Oman in the Middle East,

and we were very interested in how to control the marketing

of breast milk substitutes there.

And they actually already have a law there that, that says, "The,

these are the parameters Here's how you can market your products.

Here's how you can't," to try to make sure that they're not convincing women

who could easily be breastfeeding that, "Oh, I don't really wanna breastfeed.

I'm gonna use infant formula." And the laws have been there

for a number of years, but they don't actually enforce them.

They don't have systems in place for even catching when

someone has violated the law.

And so, , you'll still see, you know, billboards up a- advertising

infant formula when it's not allowed, and you'll see them giving

gifts to healthcare providers which is not allowed under their law.

So we were working with them on, well, how can you actually build systems to

catch these things in a fast enough way that you can say, "That's against the

law, and we're going to penalize you for it so that you stop the behavior." What

you would find before was, well, people would say, "Oh, this happened." And okay,

we found out that it happened, but by the time it actually makes it to the people

in the government who could do something about it, well, it was a year earlier,

and can we prove that actually happened?

How do we really know?

And no one would really do anything about it.

And we came up with the solution that they actually have in their healthcare system

an adverse events reporting- Normally it's been for when something goes wrong

in a hospital it's an adverse event that, , someone died that, , because a

procedure was accidentally done wrong.

And they said, "But we have the electronic system here that we can easily just

put in the form for people who are at recognizing something is being done

that's not supposed to be done, and that, that information is automatically stored

in the computer and can be diverted to the appropriate office. So we can

divert that information to the office who is in charge of enforcing this law."

And so they just had to change some of the forms and educate people

within the healthcare system, "Here's how to fill out this form

when you see these kinds of things happening." And so it's up and running.

So it was a relatively easy thing, but no one had thought of, how

do we put these pieces together?

And so it was a matter of sitting down with the people who cared in

the Department of Nutrition, with the people who had the system in the

electronics management- ... system, and the people in the enforcement office,

and get them all to talk about, how do we actually link all of this together?

It's up and running.

And they're catching- That's it ... violations.

Nothing is ever perfect.

There's still, you know, issues that they're sorting through.

But it really has been a success story that we're using in a number

of places, particularly across the Middle East- Oh, well good for you

as an example of how you can build a system-

Yeah ... to

catch this.

So according to the constitution of the o- of the World Health

Organization, there are multiple tiers of how decisions can be made.

So you can have conventions that are essentially treaties

that governments sign on to.

They still have to take the national action.

We have sovereign states.

But it basically is an agreement, this is a convention that we're all saying,

"We need to do this, so we need to sign on to this treaty." there is a

framework convention on tobacco control.

So all countries as part of the United Nations have said,

"We have to control tobacco and here's how we're going to do it."

There are regulations, international health regulations that are also part

of the constitution that manage how how diseases are managed across borders.

Oh.

They don't have the same level of a treaty.

Okay.

Right.

But they're a, they are a regulation, so there's an expectation that- You

essentially have to abide by this.

We can't enforce that, but there's an understanding.

And then there are recommendations, and this code of marketing of breast milk

substitutes is in the recommendation tier.

So basically, all member states have signed on and said, "This is

what we recommend everyone should do," but it doesn't mean that

they all have done it themselves.

It doesn't have that s- that higher level of regulatory power that

it, that we would like it to have.

It was a conscious decision at the time to kinda make it a little

bit softer actually because of the pressure from the United States.

It was under the Reagan administration at the time who argued for let's

have this a little bit weaker so that we can give more room to industry.

And the i- the idea being that if it was weakened, then the United

States would support it, and then in the end when it came down to a vote,

the United States voted against it.

So it actually didn't get the power that it would have liked.

And some people have said in hindsight, maybe we should have tried to

make it- Mm-hmm into a regulation.

But it was put forward as a recommendation.

We're currently at the point that 135 countries have put in place

at least some of the provisions of that code of marketing.

But we at last count have... That there were only about, I think it

was 37 countries that have fully implemented, probably 39 countries

have fully implemented the code in its entirety into their laws.

But we are making progress.

It is slow.

I think that the vision of where it where we would like it to

go is definitely a good thing.

I'm sure I would still stay in the area of nutrition but will my job

become a broader set of nutrition?

We'll just have to see how that shakes out-

Yeah.

No, it, that, that fulfills pretty much my, my, my time.

I do sing at the church, and I sing in the UN choir.

We practice once a week in the same building that I'm in, which makes

it very convenient- ... that I don't have to go to another building.

So being the United Nations Choir, do you have a bunch of

people from all different countries?

So

the people are from all over the world.

Oh, that's so cool.

Definitely.

You know, it is- That's awesome ... totally- Did you have

to learn different languages?

So the singing that we do is in all different languages.

That I would not even be able to pronounce had they not just provided-

the pronunciation of the words as we sing through

them.

But yes, languages from Africa, Asia, Europe just all over.

So you can carry a tune in a different

language.

And we,

We will sing everything.

It we tend to focus on songs that are just loved by that country.

That become the folklore-

It's

really fun when we give a concert that there are often

people in the audience that, you know, kind of be humming along and

try to sing with you a little bit.

You know, they don't want to interfere with the music, but it's like, "This is my

song. I love this. It bring, reminds me of home." Um, and so we make that connection.

It's great.

Oh, that's

awesome.

I love that.

And- Really we just stay in Geneva

sometimes they're concerts for the community.

And sometimes they are p- for United Nations events.

So, you know, you'll be celebrating some anniversary of some you know, human

rights convention or some other program that's bringing everyone together, and

you have heads of state that are coming, and they want to do a show for them.

We'll put those on.

And we'll sometimes do them just for the community.

Oh, I think that i- that is, that's dynamic.

Wow.

It's

it's fun.

Learn, learning those languages and the, the- different styles- ... and the

culture ... of music around the world.

It's fun.

Now that's a, that's another fun positive imprint about you, Larry.

I think that's cool.

Mm-hmm.

Well, Geneva is a very multicultural, multinational place.

Just as you're walking down the streets, you will hear tons of different languages.

We're very active in our church there.

It's an English-speaking Catholic church i, in Geneva.

And in our congregation, we have 109 different nationalities.

So you're, you're- ... that's fun ... rubbing up against people from all

around the world on a regular basis.

Larry, congratulations on all of that work that you've been doing with

CDC and now World Health Organization.

Absolute wonderful changes that you're making globally.

Well, thank you.

We're trying to change the world.

Well, you are.

I don't know if we're doing it, but we're trying to change the world.

No, you are.

You

are changing the world and it's phenomenal to be able

to hear your story and some of the work that you're working on.

Thank you.

Well, Larry, thank you so much for the inspiration that you're

providing within your job.

And, in closing, can you provide, your inspirational words

WHO ha- has really made it- its mandate a- and its

reason for existence to improve the health of people around the

world, and I think the successes that we've seen are just tremendous.

If you look at the improvements that we've had in child

mortality, they're astronomical.

I don't remember exactly the numbers, but I'd say probably over the last 20 years,

we've cut child mortality down by half.

We We've brought down infectious disease tremendously in so many places.

Diseases that used to just be rampant throughout the world are often

limited to only a few countries and only to certain areas of countries.

So much of the world is a healthier place to live in.

There are still- - new challenges for us to face.

It's not like we've solved it all.

But we are in such a better place than we were 70 years ago when WHO was started.

And it's because of that coordination, bringing countries together, prioritizing,

that we need to take care of our people, and we know how to do it.

We're applying the science.

We're applying the policies.

We're putting in place the programs.

We're really making a huge difference.

Larry, thank you so much, and I congratulate you again on everything

that you're doing, and I look forward to hearing more of your successes in World

Health Organization and their inspiration.

Thank you again.

Well, thank you for the chance to talk.

Enjoyed talking with you.

Learn more about the World Health Organization by going to their

website, WHO.int and learn more about breastfeeding and what the World

Health Organization is doing worldwide.

Join me next time for another episode as I recognize motherhood around

the world during the month of May

If you'd like to buy me a coffee to help fund the production

of this podcast, here's how.

Go to buymeacoffee.com/Yourpositiveimprint and any support you offer

will be greatly valued.

Thank you so much for your support and for listening to your positive imprint.

And until next time, enjoy listening to over 200 episodes of your positive

imprint, your positive imprint.

What's your P.I.?