People tell me all the time that you cannot build a breastfeeding family friendly community in a small town. They say you need a big budget. Then I tell them about Alleghany County.
Alleghany sits on the Blue Ridge Parkway with about 11,700 residents and roughly 100 births a year. There is no place to have a baby in the county. Families drive an hour or more to deliver. By most measures, this is a maternity care desert.
And yet, in just over a year, Alleghany has become one of the fastest-moving communities we work with.
Where they started
In the summer of 2025, a small team at AppHealthCare, the district health department serving Alleghant, Ashe and Watauga counties, raised their hands to join the Ten Steps to a Breastfeeding Family Friendly Community. Their first self-appraisal in fall 2025 showed real strengths. WIC, administered by AppHealthCare, already had over 40% of participants exclusively breastfeeding, and the district had earned national recognition for its WIC breastfeeding support. But most of the Ten Steps were still planning or just getting started. Eight local businesses had signed on as breastfeeding friendly. They needed 24.
Where they are now
At their annual self-appraisal on November 4, 2026, Alleghany passed four of the Ten Steps in full and more than half of the measures overall.
- Step 3: Health department leadership formally supports optimal infant feeding.
- Step 4: Families get breastfeeding information during pregnancy, free of formula marketing and in their own language.
- Step 7: 26 businesses now welcome breastfeeding families and display the cling, more than the 24 needed for a county their size. They include Bottomley Farm, one of the largest employers in the region, Parkdale Mills, and the Alleghany Visitor Center.
- Step 8: Health care settings, the local pharmacy and area stores keep formula marketing out, and chain stores have been asked to post lactation support information.
They also passed the yearly coordinating meeting (their team meets quarterly), books and images in schools, and breastfeeding support in child care.
They cleaned wide
I tell my kids, when you spill something, clean wide. Alleghany did exactly that. When they built a lactation resource rack card, they made one for the whole district, in English and Spanish, with a QR code for each county’s local resources. When they recognized businesses, they added five more in Watauga County. They are leading their first Spanish-language childbirth class this December.
This is how the work is supposed to be done. They did not build a new program. They sprinkled breastfeeding into the work they were already doing.
What comes next
The team has a clear plan for 2027:
- A county proclamation, timed for May or National Breastfeeding Month in August
- “Breastfeeding Welcome Here” signs on park benches, and a visitor center card listing their breastfeeding friendly businesses
- Bringing primary care practices on board, and growing local lactation expertise as a team member advances her credential
- A yearly Chamber of Commerce message on workplace lactation rights
- Breastfeeding woven into school health classes that reach whole grade levels, and library story times
The Ten Steps usually take about ten years. Alleghany started in 2025 and expects to be close to finishing by this time next year. They may pass before Durham does.
If you are in a rural county and wondering whether this is possible for you, it is. Alleghany is proof.
Want to start your own community’s journey or schedule an annual self-appraisal? Learn more about the Ten Steps. See Alleghany’s full self-appraisal.