Vision, Mission and Values

Our Vision

We recognise that racial bias is entrenched in our society, including in our healthcare system and in the lactation support world. To achieve our aim requires significant energy, commitment and an active anti-racist approach to play our part in dismantling institutionalised bias and discrimination in society.

We will help enable families to access timely, accurate diagnosis and clinical management of conditions of the breast/chest which relate to lactation, regardless of skin colour.

Overall, we will contribute to reducing health inequalities, enabling more families who wish to breast/chestfeed to achieve this, contributing to a healthier and more equal society.

Our Mission

Spectrum’s goal is to develop and maintain an open access image bank of normality, pathology and anatomical variations in the lactating breast/chest across a range of skin colours. We are particularly focusing on people with black and brown skin as they are under-represented in Western medical and lactation educational resources.

Images will be high quality and will have been assessed by doctors and/or lactation professionals to confirm the condition or normality that they are likely to represent. Given that many health and lactation professionals may not be able to accurately diagnose conditions in black and brown skin we will use external experts and maintain discussion of grey cases to try to minimise incorrect diagnosis.

The intention is to add to the currently existing educational resources available for health/lactation workers/volunteers to improve their awareness and ability to visually recognise conditions related to lactation in the full spectrum of skin tones.

A specific aim is to increase the ability to identify lactating breast/chest conditions in black and brown skin, which are currently under-represented in the medical literature. This resource will increase representation and aid in improving health outcomes for people with black and brown skin, who may otherwise be misdiagnosed or receive delayed diagnosis.

Background

The literature shows that:

  • Women from ethnic minority groups, particularly Black and South Asian women, have poorer pregnancy outcomes and their babies also have poorer health outcomes including higher mortality for both mothers and infants (Puthussery, 2016; MBRRACE 2019).
  • Women born outside the UK are less likely to receive adequate breastfeeding support (Puthussery 2016) and women from ethnic minority groups were more likely to report stopping breastfeeding during the period of the Covid-19 pandemic (Brown & Shenker 2021).
  • Health professionals have historically received no training related to the needs of women from Black and other ethnic minority groups (Chitongo 2019).
  • There is an “implicit racial bias in published images from medical literature with an underrepresentation of minorities compared to the general population, which could… contribute to inequities in health care” (Massie et al 2021).
  • Dark skin tones account for only 5% of images in leading medical textbooks (Louie & Wilkes 2018). This has also been specifically noted for surgical breast literature, with only 6% of images in high profile journals demonstrating non-White skin (Cho et al 2020).

About the Team

Members of this project come from a range of backgrounds and work in a range of professional and voluntary roles in infant feeding support and healthcare. We strive to co-operate and work together:

  • In the public interest
  • Minimising and declaring any conflict of interest
  • Wherever possible using an evidence base and/or expert oversight
  • Being accountable for the quality of the resource, and to our individual professional organisational and professional codes
  • Demonstrating transparency in all interactions with image contributors and colleagues
  • Honestly representing our work to our contributors, team members and collaborators
  • Promoting equitable healthcare and modelling good practice for other organisations and healthcare resources.

Our Mission

Spectrum’s goal is to develop and maintain an open access image bank of normality, pathology and anatomical variations in the lactating breast/chest across a range of skin colours. We are particularly focusing on people with black and brown skin as they are under-represented in Western medical and lactation educational resources.

Images will be high quality and will have been assessed by doctors and/or lactation professionals to confirm the condition or normality that they are likely to represent. Given that many health and lactation professionals may not be able to accurately diagnose conditions in black and brown skin we will use external experts and maintain discussion of grey cases to try to minimise incorrect diagnosis.

The intention is to add to the currently existing educational resources available for health/lactation workers/volunteers to improve their awareness and ability to visually recognise conditions related to lactation in the full spectrum of skin tones.

A specific aim is to increase the ability to identify lactating breast/chest conditions in Black and Brown skin, which are currently under-represented in the medical literature. This resource will increase representation and aid in improving health outcomes for people with Black and Brown skin, who may otherwise be misdiagnosed or receive delayed diagnosis.

Background

The literature shows that:

  • Women from ethnic minority groups, particularly Black and South Asian women, have poorer pregnancy outcomes and their babies also have poorer health outcomes including higher mortality for both mothers and infants (Puthussery, 2016; MBRRACE 2019).
  • Women born outside the UK are less likely to receive adequate breastfeeding support (Puthussery, 2016) and women from ethnic minority groups were more likely to report stopping breastfeeding during the period of the Covid-19 pandemic (Brown & Shenker 2021).
  • Health professionals have historically received no training related to the needs of women from Black and other ethnic minority groups (Chitongo 2019).
  • There is an “implicit racial bias in published images from medical literature with an underrepresentation of minorities compared to the general population, which could… contribute to inequities in health care” (Massie et al., 2021).
  • Dark skin tones account for only 5% of images in leading medical textbooks (Louie & Wilkes 2018). This has also been specifically noted for surgical breast literature, with only 6% of images in high profile journals demonstrating non-White skin (Cho et al., 2020).

About the Team

Members of this project come from a range of backgrounds and work in a variety of professional and voluntary roles in infant feeding support and healthcare. We strive to co-operate and work together:

  • In the public interest
  • Minimising and declaring any conflict of interest
  • Wherever possible using an evidence base and/or expert oversight
  • Being accountable for the quality of the resource, and to our individual professional organisational and professional codes
  • Demonstrating transparency in all interactions with image contributors and colleagues
  • Honestly representing our work to our contributors, team members and collaborators
  • Promoting equitable healthcare and modelling good practice for other organisations and healthcare resources.

Our Values

  • Maintain a free, open access resource for users, developed for UK use but available globally.

  • Contribute towards reducing health inequalities experienced by under-represented patient groups, especially for those with black and brown skin.
  • Ensure that as an organisation are made up of people from different ethnic backgrounds and that people with black and brown skin are particularly well represented.

  • Treat all image contributors and their communities with equal dignity.
  • Ensure informed consent and anonymity.
  • Consider and strive for cultural safety (creating an atmosphere where everyone involved feels safe to examine their own cultural identities and attitudes and be open-minded towards others).
  • Abide by legal and professional standards in the country of origin for any person contributing images and in the UK.

  • Contribute to normalising the inclusion of images of people with black and brown skin in medical/healthcare education.
  • Widen the perspective of health and lactation professionals/volunteers to improve their ability to care for families from different backgrounds.

  • Provide high quality images and descriptors, combining the contributor’s story with professional opinions.

  • Communicate and practice honestly and transparently with image contributors and project partners.

  • Handle images and communications according to Data protection responsibilities such as UK GDPR.

  • Commit to this resource being not-for profit for its lifetime.

  • Engage with stakeholder communities to shape and feedback on the project.

  • Display the images we collect for anything other than the intended educational purpose or to communicate about the work of the image bank and our above stated aims.
  • Accept money from or work with companies covered by the World Health Organisation International Code of Marketing of Breastmilk Substitutes and associated resolutions – for example manufacturers of infant formula, bottles, teats or food marketed for young children.
  • Unfairly impact the healthcare provided to individual contributors or contributors to the project as a result of their level of involvement or non-involvement.
  • Discriminate negatively based on any protected characteristics in making decisions on image inclusion.

References

  1. Brown A, Shenker N. Experiences of breastfeeding during COVID-19: Lessons for future practical and emotional support. Matern Child Nutr. 2021 Jan;17(1):e13088. doi: 10.1111/mcn.13088. Epub 2020 Sep 23. PMID: 32969184; PMCID: PMC7537017.
  2. Chitongo S. Midwives experiences of caring for high risk women from Black Asian Ethnic Minority Groups. Mary Seacole Development Award report 2018/2019.
  3. Cho DY, Kneib CJ, Shakir A, Burns JR, Lane M, Massie JP, Crowe CS, Sobol DL, Morrison SD, Sousa JD, Sabin J. Underrepresentation of Racial Minorities in Breast Surgery Literature: A Call for Increased Diversity and Inclusion. Ann Surg. 2020 Sep 15
  4. Louie P, Wilkes R. Representations of race and skin tone in medical textbook imagery. Soc Sci Med. 2018 Apr;202:38-42.
  5. Massie JP, Cho DY, Kneib CJ, Sousa JD, Morrison SD, Friedrich JB. A Picture of Modern Medicine: Race and Visual Representation in Medical Literature. J Natl Med Assoc. 2021 Feb;113(1):88-94. doi: 10.1016/j.jnma.2020.07.013.
  6. Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK. Saving lives, improving mothers’ care: Lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2014–16. Oxford: National Perinatal Epidemiology Unit, University of Oxford, 2018. www.npeu.ox.ac.uk/mbrrace-uk/reports/confidential-enquiry-into-maternal-deaths
  7. Puthussery S. Perinatal outcomes among migrant mothers in the United Kingdom: Is it a matter of biology, behaviour, policy, social determinants or access to health care? Best Pract Res Clin Obstet Gynaecol. 2016 Apr;32:39-49. doi: 10.1016/j.bpobgyn.2015.09.003. Epub 2015 Oct 14. PMID: 26527304.

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