Our Work

Breastfeeding Family Friendly Communities works on policy, systems and environmental change. We do not run parenting classes or hand out pamphlets and call it a day. We work with communities to change the places where families live, work, learn, shop, worship and receive care, so that feeding a baby is possible everywhere, and so the change outlasts any single grant.

This page is what that has produced.

What we run

Some of the communities on this site are our own projects. Others are communities we advise. The difference matters, so we state it plainly.

  • Breastfeed Durham is our pilot project. It is the community we operate directly, and where the Ten Steps have been built out furthest: from a $200 budget and two volunteers in 2018 to a strategic plan adopted into county public health policy in 2025.
  • Breastfeed Orange NC is our project. Carrboro, within it, is the first community anywhere to complete all ten steps, proclaimed in June 2025.
  • Breastfeed Franklin is a funded partnership with the Franklin County Health Department, now in its fourth year. We build and own the website, write the newsletter, do the business and organization outreach, and meet with the county team every two weeks. It is our clearest example of the Ten Steps in a rural county.
  • Breastfeed Guilford is ours now. It began as a contract with the county health department and has become a project we run. We employ the community health workers who do the work on the ground, and we keep them employed steadily, braiding several funders behind one plan so that a gap in any single grant cycle does not become a gap in someone’s paycheck or in a family’s support. That is what lets implementation of the Ten Steps in Guilford move at the pace the community sets rather than the pace the funding happens to allow.
  • SAFE Infant Feeding is our investigation of the national policy gap around infant and young child feeding in emergencies. It was founded jointly with the North Carolina Breastfeeding Coalition and the Asheville Breastfeeding Coalition after Hurricane Helene, and it is now a project of BFFC because we are the organization prepared to sustain it and to do the policy work that closing the gap requires.

Everywhere else, our role is technical assistance and capacity building: the framework, the templates, peer learning, assessment and evaluation. Those communities run themselves, and we say so on each community page. Here is what working with us looks like.

Policy adopted into government

  • Durham County, February 2025. The Human Milk Feeding Strategic Plan, co-authored with the county, was formally adopted by the Durham County Department of Public Health. The Ten Steps model is now county policy rather than a program dependent on a funding cycle.
  • Durham City and County, August 2024. Proclaimed a Breastfeeding Family Friendly Community by the Board of County Commissioners on 12 August and by the City of Durham on 19 August.
  • Carrboro, June 2025. Proclaimed a Breastfeeding Family Friendly Community by Mayor Barbara Foushee, having completed all ten steps.
  • Earlier proclamations in Chapel Hill, Carrboro and Durham date back to 2016. See the full record.

Systems and environments changed

  • All 189 Durham childcare providers serving infants and toddlers received the breastfeeding normalization curriculum.
  • Durham Public Schools, Duke University, North Carolina Central University and Durham Technical Community College have all completed Step 10.
  • Permanent welcome signage in public parks, remodeled lactation spaces, and 85 employers with lactation space in Durham alone.
  • Durham has passed eight of the Ten Steps outright. The remaining two are conditional and named as such in its published self appraisal: Step 5 passes when Duke Health is designated Baby Friendly, and Step 7 when Durham reaches one participating business for every 500 residents. Several hundred Durham organizations already hold a current designation, and the public directory at breastfeeddurham.org is always the live count.
  • In Franklin County, a rural county of 82,000, the number of designated breastfeeding friendly spaces went from one in August 2023 to twenty-seven, including all four library branches.

A national policy gap, found and documented

When Hurricane Helene hit western North Carolina in 2024, the infrastructure that Ten Steps communities had built became the emergency response. It also revealed that infant and young child feeding is missing from almost every emergency plan in the country. A 2026 study scored 46 state Emergency Operations Plans against global standards and found a mean score of zero.

The SAFE Infant Feeding Team was founded jointly by the North Carolina Breastfeeding Coalition, Breastfeeding Family Friendly Communities and the Asheville Breastfeeding Coalition. SAFE is now a project of BFFC, because we are the organization prepared to sustain it financially over the long term and to do the systems, policy and environmental change work that closing this gap requires. More than 100 professionals have been trained to date. Read about SAFE.

Recognized nationally

In June 2026 the National Association of County and City Health Officials, the voice of more than 3,300 local health departments, selected BFFC as one of three Blueprint Peer Ambassadors in the United States, to provide technical assistance and peer learning to health departments implementing NACCHO’s Continuity of Care in Breastfeeding Support Blueprint.

What the numbers show

Between 2019 and 2024 Durham County’s infant mortality rate fell from 7.7 deaths per 1,000 live births to 2.9, a 62.3% reduction. We report that carefully. 2019 was a crisis year, and it is part of why this community organized. 2024 was an exceptional year. As more data comes in we expect the rate to rise again, and we do not expect to hold 62.3%. When this work began we hoped for a 20% reduction, and what the county has seen is far beyond that. Infant mortality is shaped by many interacting forces and hundreds of programs launched in Durham over these years, so we offer this trend as context for what a mature, community wide support system can accompany, not as a claim of sole causation.

We ask communities to publish where they actually stand, so we do the same. Guilford County’s published self appraisal states that it needs 1,118 participating businesses and currently has 26. See every community’s self appraisal.

Ten years, in a town that was already welcoming

Carrboro is the first community in the nation to complete all Ten Steps, proclaimed on 17 June 2025. It is worth knowing how long that took, and where it started from. Carrboro is a town of about twenty one thousand people with a Baby Friendly hospital nearby, a strong lactation support community, an engaged chamber of commerce, and families who were already nursing in public without anyone thinking twice. It still took ten years from the Certificates of Intent in 2015 to completing the last step.

That is the argument for the Ten Steps in a place that already feels supportive. Being welcoming is not the same as being documented, covered and durable. The work in Carrboro was not persuasion. It was signage that stays up, first responders who are trained, health leadership on the record, businesses that have signed something, and a proclamation with a clause for every step. None of that happens on its own, however welcoming the town already is.

The gap we are working on

The benefits of human milk are available to every infant. Access to the support that makes it possible is not. In Durham, our pilot county, more than nine in ten parents start out breastfeeding, but among families served by home visiting only about one in five Black mothers were exclusively breastfeeding between two and twelve weeks postpartum, against a statewide average closer to two in five. Nationally, Black infants are markedly less likely to be breastfed at birth and at three months than white infants, and Black mothers die of pregnancy related causes at three to four times the rate of white mothers, with around three in five of those deaths considered preventable.

We do not treat this as a problem of information or motivation. We treat it as a problem of conditions, and conditions are what a community can change. That is why we describe ourselves as a movement building organization rather than a service provider: our work is to help communities reclaim infant feeding support as part of reproductive justice, birth equity and public health.

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