The History

Breastfeeding Family Friendly Communities exists because feeding a baby is not only a clinical matter. A parent can leave the hospital fully supported and still stop within weeks, because the places where she actually spends her days, the job, the bus, the restaurant, the childcare centre, the clinic waiting room, were not built for it. The Ten Steps are a method for changing those places. What follows is where the method came from, and what has happened since.

The Breastfeeding Family Friendly Community Designation (BFFCD) initiative began in 2014 with a request from the World Alliance for Breastfeeding Action (WABA) to the Carolina Global Breastfeeding Institute (CGBI) to expand on Step 10 of the Baby-friendly Hospital Initiative Ten steps to successful breastfeeding. BFFCD initiative developed a community breastfeeding program that can be used to strengthen breastfeeding support and normalization.

2015

The designation was the work of Dr. Miriam Labbok, founder of the Carolina Global Breastfeeding Institute, who created it and piloted the Ten Steps in Carrboro and Chapel Hill. Dr. Labbok became ill and died before the model spread, and a group of advocates carried the work forward. Everything on this page rests on what she started.

The launch was held on 10 August 2015 at the Oasis Café in Carr Mill Mall, Carrboro. During National Breastfeeding Month, the Mayors of Chapel Hill and Carrboro announced their intent to become the first Breastfeeding Family Friendly Communities, and each town was presented with a plaque bearing its Certificate of Intent. The original program name was the Breastfeeding Family Friendly Communities of Chapel Hill and Carrboro.

The Breastfeeding Family Friendly Communities (BFFC) initiative was launched in 2015 in Chapel Hill and Carrboro, North Carolina (NC), with the support and coordinated efforts of a representative team from the Carolina Global Breastfeeding Institute (CGBI), the Chapel Hill Rotary Club, the Towns of Carrboro and Chapel Hill, La Leche League of Chapel Hill, and the Chapel Hill/Carrboro Chamber of Commerce, and later expanded to include the Orange County Health Department, Inter-Faith Council for Social Service, North Carolina Breastfeeding Coalition and others in and around the area. Read More

2018

In Durham, NC, the BFFC initiative began in 2018 with the combined efforts of representatives from the Durham Women’s Council, Family Connects Durham, and La Leche League of Durham. The initiative is growing. Currently, the BFFC team consists of representatives from Durham Women’s Council, Family Connects Durham, La Leche League of Durham, Mom’s Rising, and Duke University Health System (DUSH). Read More

2019

The Ten Steps initiative began to expand across North Carolina. In 2019, Buncombe County and Asheville proclaimed their commitment to building a welcoming community.

2020

In 2020, Breastfeeding Family Friendly Communities (BFFC) reached a major milestone: it formally incorporated as a nonprofit in May and was awarded 501(c)(3) status in October. Although the COVID-19 pandemic disrupted in-person services and public health systems across the country, BFFC expanded its virtual infrastructure, launched new policy education resources, and helped communities adapt the Ten Steps to a rapidly changing world.

Highlights from 2020 included:

• Durham County became the first county in the nation to issue a formal proclamation declaring itself a Breastfeeding Family Friendly Community, joined by renewed proclamations from Carrboro and Chapel Hill.
• BFFC supported partners in securing statements of support from local health departments and government officials, laying the groundwork for deeper policy integration.
• In response to COVID, BFFC shifted its model to emphasize community-driven policy, online advocacy tools, and remote technical assistance—strengthening its reach and sustainability.

2020 was a turning point. What began as a volunteer-led movement in Chapel Hill became a growing, structured nonprofit with the capacity to support communities navigating both public health crises and long-term systems change.

2021

In 2021, Breastfeeding Family Friendly Communities began to scale beyond North Carolina, supporting local coalitions in Indiana, Pennsylvania, and other emerging sites across the country. As interest in the Ten Steps framework grew, BFFC provided early-stage technical assistance to new communities while continuing to deepen relationships in North Carolina.

Key accomplishments in 2021 included:

• Supporting communities in four states with customized toolkits, policy support, and storytelling strategies.
• Launching early versions of self-assessment tools, outreach templates, and bundled resource guides to help coalitions replicate the Ten Steps in culturally relevant ways.
• Uplifting Black and Indigenous leaders, doulas, and lactation advocates through informal partnerships and community-led projects.
• Strengthening the role of Breastfeed Durham as a pilot site for racial equity-centered implementation, helping to test ideas later scaled to other communities.
• Planning for future infrastructure growth, including nonprofit incorporation efforts, digital tools, and the framework for what would become the SAFE Infant Feeding Team.

By the end of 2021, BFFC had grown from a grassroots regional initiative to a national network supporting systemic, policy, and environmental change across diverse communities.

2022

In 2022, Breastfeeding Family Friendly Communities focused on infrastructure building, internal systems development, and equity-centered leadership. After operating for years as a mostly volunteer-driven initiative, BFFC began laying the groundwork for sustainable growth by:

• Formalizing leadership roles, including hiring part-time coordinators to support grant writing, communications, and policy.
• Expanding community partnerships with a special emphasis on racial and linguistic equity, including deepened support for Black and Spanish-speaking families.
• Standardizing technical assistance to streamline how new communities received support in implementing the Ten Steps.
• Developing shared tools such as self-assessment forms, policy templates, outreach materials, and funding guides that would help local coalitions grow with more independence.

BFFC also deepened its relationships with university public health programs, preparing to host MPH and MPP practicum students who would bring data, evaluation, and policy capacity to the organization. The seeds planted in 2022 set the stage for the national and state-level growth that followed in 2023 and 2024.

2023

2023 was a breakthrough year for Breastfeeding Family Friendly Communities, marked by national growth, deeper equity work, and the launch of powerful new tools for coalition storytelling and sustainability.

Key milestones included:

• Growth to 24 communities across five states, with each adapting the Ten Steps framework to meet the unique needs of their local context. BFFC’s reach expanded significantly through partnerships with public health departments, doulas, peer counselors, schools, and grassroots leaders.
• New tools and templates were created to support local coalitions, including self-assessment forms, business engagement scripts, signage, and policy guides.
• Equity-centered initiatives deepened across the network, with a focus on Black, Indigenous, Spanish-speaking, and immigrant families. Breastfeed Durham, in particular, led racial equity work in public parks, preschools, and peer lactation education.
• BFFC also worked behind the scenes to build internal infrastructure, preparing to host graduate students, track program data, and manage cross-state communications.
• Piloting new models of care through Breastfeed Durham—like community education events, lactation-friendly signage in public parks, and more direct collaboration with city and county government.

By the end of 2023, BFFC was more than a growing movement—it had become a recognized hub for technical assistance, storytelling, and policy alignment, creating ripple effects across maternal and infant health systems.

2024

Hurricane Helene and the founding of the SAFE Infant Feeding Team. Helene made landfall on 26 September 2024. More than thirty inches of rain fell on western North Carolina in three days, and clean water was not restored to Asheville for 53 days. Two local lactation consultants, Brandi Harrison and Jayne Carpenter, founded the SAFE Infant Feeding Team in response. On 6 October the first deployment sent 23 infant feeding specialists into Asheville, and over the following five months hundreds of volunteers from Breastfeeding Family Friendly Communities and the North Carolina Breastfeeding Coalition provided sanitation kits, lactation support, formula feeding education and staff training. SAFE has since consulted on emergencies in Virginia, Texas, California and Wisconsin.

• Trauma-Informed Response & Emergency Infrastructure: The launch of the SAFE Infant Feeding Teamfollowing Hurricane Helene highlighted BFFC’s ability to rapidly respond in crisis while centering trauma-informed care. Daily check-ins, sanitation kit distribution, human milk sharing coordination, and rapid needs assessments were documented and shared nationally.
• Lactation Support in Higher Ed: Breastfeed Durham, in partnership with Duke and Durham Tech, developed a model for a Breastfeeding Friendly University—adapting the Ten Steps to meet Title IX requirements and institutional norms.
• Black Breastfeeding Coalition Capacity Building: Through an ARPA-funded grant from Durham County, Breastfeed Durham expanded culturally relevant signage, lactation space access, and policy work to uplift the leadership of Black lactation professionals.

2025

• Systems Change through Direct Services: BFFC and Breastfeed Durham launched their first direct-service pilot through the Lactation Collaborative, providing free lactation clinics and home visits for uninsured and underinsured families. This marked a strategic expansion from technical assistance into direct care, driven by local IBCLCs experiencing burnout within hospital systems.
• Grant Recognition: BFFC applied for—and began receiving—major foundation support to continue emergency response work, fund doula and IBCLC services, and support sustainability efforts in rural communities.

The first community to finish. On 17 June 2025, Mayor Barbara M. Foushee read a proclamation at a Carrboro Town Council meeting naming the Town of Carrboro a Breastfeeding Family Friendly Community. Carrboro is the first community in the nation to complete all Ten Steps, ten years after the Certificates of Intent were presented a few streets away. The proclamation carries a clause for every one of the Ten Steps, and it is the template we now offer other communities.

Durable policy change. On 28 February 2025 the Durham County Department of Public Health formally adopted the 2025 to 2035 Human Milk Feeding Strategic Plan, co-authored with Breastfeed Durham and signed by Public Health Director Rod Jenkins. This was the first time the Ten Steps model was written into a county’s own public health policy rather than delivered alongside it as a program, which means it no longer depends on any single funding cycle.

Education systems at every level. Durham Public Schools completed Step 10 in spring 2025, following a Proclamation of Support for Infant Feeding Practices from its Board of Education on 24 April. Duke University completed Step 10 in February, and Durham Technical Community College and North Carolina Central University have also passed it. By May, all 189 Durham childcare providers serving children from birth to three had received the breastfeeding normalization curriculum.

• Student Practica & University Partnerships: BFFC formalized partnerships with Temple University, Duke University, and UNC to support graduate student practica in public policy, public health, and maternal health systems transformation.

Present

As with everything BFFC does, this work follows a universal access model: it expands the reach of services that are open to every family. No service described here is denied to anyone on the basis of race, color, ethnicity, national origin, immigration status, religion or creed, age, sex, pregnancy or lactation status, sexual orientation, gender identity, family structure, primary language, ability or disability, veteran or military status, or socio-economic status.

Today, Breastfeeding Family Friendly Communities (BFFC) supports more than two dozen communities across the U.S. through a flexible model of free technical assistance, contracted services, and community-led coalition building. While funding varies widely from site to site, each project is guided by BFFC’s commitment to racial equity, local leadership, and systemic change.

We currently provide funded technical assistance or receive active contracts from:

• Durham County, NC – Supporting Breastfeed Durham and five active affinity groups (including groups centered on Black families, Spanish-speaking families, healthcare providers, and immigrant communities), with funding from the Durham County Department of Public Health.
• Franklin County, NC – Providing coalition support and Ten Steps technical assistance, funded by the Franklin County Department of Public Health.
• Guilford County, NC – Offering event and coalition support through short-term project-based funding.
• North Carolina Breastfeeding Coalition (statewide) – Partnering on special projects, including the SAFE Infant Feeding Team, with intermittent funding and shared financial leadership.
• SAFE Infant Feeding Team (Western NC) – A fully sustained, but underfunded branch of BFFC focused on infant and young child feeding in emergencies. BFFC serves as the team’s fiduciary and coordinates funding, staffing, and technical assistance for this critical work.

We also provide free technical assistance (3–5 hours per year per site) to the following communities:

• Asheville/Buncombe County, NC – Funded locally by the Early Childhood Partnership; BFFC provides informal support.
• Chatham County, NC – Home to the EMBRACe project, which has local funding. BFFC continues to offer support as they build coalition infrastructure.
• Orange County, NC – Working closely with Piedmont Health and Orange County Health Department, though BFFC receives no direct funding.
• Northeast NC (Bertie, Camden, Chowan, Currituck, Gates, Hertford, Pasquotank, Perquimans) – A new collaborative just getting started with resource mapping and early coalition building.
• Sandhills Collaborative (Cumberland, Hoke, Montgomery, Scotland, Richmond Counties, NC) – Though funded through the Improving Community Outcomes for Maternal and Child Health program (DHHS NC), BFFC provides free TA support without financial compensation.
• Hampton Roads Region, VA – Coalition continues to grow. BFFC provides our standard free TA offering.
• Wood County, WI – Temporarily paused after declining a fall 2024 needs assessment, but planning to re-engage in late 2025.

We remain in contact or loose affiliation with communities including:

• South Bend, IN
• Cincinnati and surrounding counties, OH
• Wilkinsburg, Chester, Williamsport, Lycoming-Clinton, PA
• Pennsylvania Chapter of the AAP – Formerly connected through joint training and support.

Several of these communities still attend BFFC trainings or utilize our free resources, even when funding is not available.

BFFC continues to evolve with community needs. Whether through a county contract or a 30-minute check-in with a grassroots organizer, we remain committed to supporting any community working to build a breastfeeding-supportive environment—because systems change begins with people who care.

Several former projects, including those in Pennsylvania, were previously funded and continue to receive strategic guidance as capacity allows. BFFC adapts to the needs and readiness of each local coalition, offering both free technical support and contracted services for funded projects.

Whether fueled by small grassroots energy or county-level contracts, each initiative contributes to a broader movement to normalize lactation, reduce disparities, and protect infant and maternal health. Currently, we provide 3-5 hours of free technical assistance to emerging communities and will contract with you for additional technical support. See the growing list of communities.

2026

Recognised 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.

SAFE Infant Feeding became a project of BFFC. Founded jointly with the North Carolina Breastfeeding Coalition and the Asheville Breastfeeding Coalition after Hurricane Helene, SAFE now sits with BFFC, because we are the organization prepared to sustain it over the long term and to do the policy work that closing this gap requires.

The gap entered the literature. The Natural Hazards Center published Quick Response Report QR 374 on infant feeding in western North Carolina after Helene, conducted with researchers at UNC and Duke. A separate 2026 study scored 46 state Emergency Operations Plans against global standards for infant and young child feeding in emergencies and found a mean score of zero.

What the numbers showed in Durham. 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 part of why the community organised; 2024 was exceptional, and as more data arrives we expect the rate to rise again. When this work began we hoped for a 20% reduction. Infant mortality is shaped by many interacting forces and hundreds of programs launched in Durham over these years, so we offer this as context for what a mature, community wide support system can accompany, not as a claim of sole causation.

A question at state scale. The Ten Steps were written for a town. North Carolina is now asking what they mean when the community is a state: a proclamation from a governor rather than a mayor, signage in state parks rather than town parks, state procurement, the state labor department, the university and community college systems.