Informing Families During Pregnancy

As community advocates, we know that breastfeeding/chestfeeding/body feeding is critical for optimal early infant nutrition, providing essential nutrients and immune factors that support growth and development. Equitable access to unbiased support and resources during pregnancy is a vital first step to ensuring that families have the information they need to make informed decisions about infant feeding practices. However, for too many families, access to chestfeeding/breastfeeding information and resources is limited, commercially-driven, or unavailable/not equitably provided to all families in the community. Step 4 of the Ten Steps to a Breastfeeding Family Friendly Community recognizes these challenges, calling on the community to ensure that, during pregnancy, all families are receiving unbiased, non-commercial, culturally-appropriate information.

STEP 4.  During pregnancy, all families in the community are informed about the benefits of chest/breastfeeding, as well as about the risks of unnecessary formula use, and where to access support as needed. 

Ten Steps to a Breastfeeding Family Friendly Community

Measure: Non-commercial materials on this issue are distributed, in hard copy and/or online, through community and faith-based organizations, produced or approved by a breastfeeding authority (e.g., Black Mothers Breastfeeding Association, La Leche League International, Lactation Education Resources, Ready Set Baby Curriculum) or the Designating Group, reflective of the population, and culturally appropriate. Distribution may be via the health sector, local lactation support groups, or community  coalitions.

PASS if there is documentation that information has been widely distributed.

Explore how Breastfeed Durham and Breastfeed Orange NC have implemented a range of strategies to increase access to education and resources for families and healthcare providers, supporting the initiation and continuation of breastfeeding in the community. There is a little bit of history in these stories, too. We invite you to share your story…and maybe even the history…about the ways you are implementing Step 4 in your community. Email us at contact@breastfeedingcommunities.org.

Launch and Focus

In August 2015, the Towns of Chapel Hill and Carrboro launched a pilot Ten Steps initiative during National Breastfeeding Month to become the first Breastfeeding Family Friendly Communities. The aim was to support families to continue to breastfeed beyond the early days and weeks after leaving the hospital. Step 4 focused on ensuring the equitable distribution of non-commercial information on the benefits of breastfeeding/chestfeeding and the risks of unnecessary formula use in order to support families to make informed decisions regarding infant feeding practices. This information would be unbiased, culturally appropriate, and accessible to all members of the community, particularly those who are marginalized or more vulnerable.

Stakeholder Support

The implementation team in Carrboro and Chapel Hill looked to its stakeholders (e.g., the Orange County Health Department, the Carolina Global Breastfeeding Institute [CGBI]) for support in meeting the requirements of Step 4.

At that time, the Orange County Health Department was working towards the North Carolina Breastfeeding Coalition (NCBC) Mother Baby Clinic Award, that is based on the Baby-friendly USA Guidelines and Evaluation Criteria and includes an education component. In addition, CGBI was developing the Ready…Set…Baby! curriculum to provide culturally appropriate information for families on the importance of breastfeeding and risks of unnecessary formula use. CGBI also was offering Breastfeeding Friendly Child Care (BFCC) training and resources, in-person and online, to help childcare providers learn about the importance of chest/breastfeeding and explore ways to welcome and support lactating families in their programs.

When the Breastfeeding Family Friendly Community initiative in Carrboro and Chapel Hill expanded to include all of Orange County, the name changed to Breastfeed Orange NC and a new stakeholder, Piedmont Health Services (PHS), joined the project. PHS/WIC provides direct breastfeeding support and resources in the languages of the families in the local WIC program, as well as information about support and classes in our community.

Additional community advocates and stakeholders also were providing information to families. Breastfeed Orange NC was grateful to the work of its stakeholders. Both the importance of chestfeeding/breastfeeding and the work of local stakeholders are recognized in Town government proclamations and on the Breastfeed Orange NC social media/website.

What might this mean for your community?

1. Encourage your local health department and hospital to become stakeholders, if they are not already part of your initiative.
2. Bring together your stakeholders to review the educational resources already in your community (e.g.,  your local health department and hospital and other stakeholders in your community). Ask the team:
   • Do the resources for parents discuss the benefits of chestfeeding/breastfeeding and the risks of unnecessary formula use in a way that is right for the needs of your community**? 
   • Are the resources unbiased, culturally appropriate, and accessible to all members of the community, particularly those who may be more vulnerable? 
   • Do the resources reflect the diversity of the families in your community?
3. If the team can answer yes to those questions, you are well on your way to achieving this step! Support or promote the distribution of those resources as part of Step 4.
4. If the response to any of the questions in #3 above is no, consider working with your stakeholders and community advocates to build on their current resources to meet the Step 4 criteria.

**Your community organizations might not be ready to address the “risks of unnecessary formula use” at first. Perhaps the focus could initially be on the importance of chestfeeding/breastfeeding. Perhaps you can introduce the risks as ways they can impact successful breastfeeding (e.g., introducing formula can decrease your milk supply). The Ready…Set…Baby! curriculum offers some thoughtful phrases about the use of formula. 

Rack Cards and Translations

In 2021, Breastfeed Orange NC began working on 3.5″ x 8″ rack cards to disseminate  information about the benefits of breastfeeding and where to find support. The size of the card was intended to fit neatly into rack card holders, whether an individual holder or a larger wall-mounted holder in a business. The Breastfeed Orange NC rack cards were a team effort, created and printed in English and Spanish with the time and funding support of our stakeholders. Stakeholders and community advocates distributed the rack cards across the community in the many locations that families meet and connect, e.g., community healthcare events and festivals; local faith-based organizations; healthcare clinics and pharmacies; and community organizations. Currently, the Breastfeed Orange NC team is securing local support to translate the rack cards into other languages to better meet the needs of more families in our community.

Before receiving funding, Breastfeed Durham developed one printed resource, a 3.5″ x 8″ rack card that included the benefits of breastfeeding and directed the community to the Breastfeed Durham website. In October 2022, Breastfeed Durham was able to secure funding and partnership with the Durham County Department of Public Health. The Health Department contracted with Breastfeed Durham to develop new, printed culturally-appropriate resources. Breastfeed Durham has put together a funding package for its Affinity Coalitions to produce resources that reflect the Durham community population and are culturally appropriate. Materials are distributed in hard copy and/or online through the Breastfeed Durham website, community advocates, health care providers, and community organizations. Please see the section “Affinity Coalitions” for more of the story about creating and distributing resources in the Durham community. 

Breastfeed Durham also is partnering with local advocates to distribute the printed materials even farther. PDFs of the materials will be available on the Breastfeed Durham website, and thanks to recent funding from the Health Department, anyone in the community will be able to order Breastfeed Durham print materials from the Mimeo website. Members of the Health Department will be able to order these materials without paying a direct cost. More on funding in the next sections.

In addition, Breastfeed Durham has been working with the Duke University Health System to set up a similar arrangement. Currently, Duke is interested in using the digital files and printing and distributing the rack cards on their own. That’s excellent! That’s the dream of this work!

What might this mean for your community?

1. Gather representatives from various organizations to work collaboratively to create non-commercial materials are distributed through community organizations so that families can be informed during pregnancy about the importance of chestfeeding/breastfeeding. 
2. Look to your stakeholders and other community organizations to produce and fund chestfeeding/breastfeeding-friendly resources that reflect the diversity of families in your community.
3. Explore opportunities to distribute materials online. This may take funding, and we will explore funding in the next sections.

Begin with the Benefits

Breastfeed Durham is a community-driven initiative that aims to promote and support breastfeeding practices in Durham, North Carolina. Launched in June 2018, Breastfeed Durham provides a range of resources and support services to families and healthcare providers, including newsletters, virtual trainings, educational outreach events, and culturally appropriate resources.

One of the key strategies used by Breastfeed Durham to implement Step 4 of the Ten Steps has been to remain focused on the benefits. Co-founder of Breastfeed Durham and former Executive Director Love Anderson says “Our community is still working on normalizing human milk feeding, and we like to keep the focus on the benefits rather than the risks [to encourage support for human milk feeding].”

Website, Newsletter, and Mailing List

The distribution of non-commercial materials on the importance of chestfeeding/breastfeeding has been the driving force behind Breastfeed Durham. In the summer of 2018, Breastfeed Durham started with a Google mailing list of 20 providers who wanted to collaborate to share information. We partnered with the Breastfeeding Family Friendly Communities global initiative, and they gave us a platform on their website. Our community partnerships and mailing list grew. By the summer of 2020 we had changed our name from Breastfeeding Family Friendly Communities of Durham to Breastfeed Durham, launched our own independent website, and had 200 community advocates, healthcare providers, and parents on our mailing list.  

Pre-Covid, Breastfeed Durham met in-person every other month in the morning and in-person on alternate months in the evening. The three members of the implementation team would have weekly phone calls at 2:30 PM, while we all waited in the childcare pick up line. We began to put a lot of energy into our newsletter at that time, sending one out every two weeks. Newsletters provided a way to widely-distribute resources to families and to the organizations that serve families. 

When the world shut down in the spring of 2020, the weekly phone calls transitioned to virtual video calls. So much in our world was changing so quickly, and so much was going on locally. There were too many emails going out to our mailing list. One of our board members was passionate about minimizing our communications via email and bundling them into a more polished format. In addition, Breastfeed Durham was just starting to partner with the Durham County Health Department and for the first time the co-founder, Love Anderson, was getting paid (six hours per week) to advocate for the promotion and protection of breastfeeding. With the support of a dedicated lactating parent who worked for the health department full time and the other three volunteer board members and with a lot of time and energy from the board members’ very tech savvy spouses, we were able to put in place on our website the technology for the newsletter. Today, our website is packed full of educational information that’s local and community based and receives 1500 visitors per month, and our mailing list has grown to 1100 subscribers.

Affinity Coalitions 

Breastfeed Durham also created local breastfeeding coalitions to develop culturally appropriate resources on breastfeeding and available resources, targeting populations of need, such as the Asian and Pacific Islander Breastfeeding Coalition, Black Breastfeeding Coalition, LGBTQ+ Human Milk Feeding Coalition, Native American/Alaska Native Breastfeeding Coalition, and Pro-Lactancia Hispana Coalition. Materials have been developed by our Affinity Coalitions and are distributed in hard copy and/or online through the Breastfeed Durham website, community advocates, health care providers, and community organizations.

To support this important work, Affinity Coalition facilitators were paid small amounts of money, using the funding from the Durham County Department of Public Health, and Breastfeed Durham was able to offer gift cards for their coalition meetings. Through the Breastfeed Durham social media, newsletters, and website, the Department of Public Health Department and the County Commissioners saw that Breastfeed Durham was active and functioning in the community with modest financial support, and Breastfeed Durham was able to secure a contract with the Department of Public Health.

Developing these culturally appropriate resources have been one of the transformative accomplishments of the Durham pilot project. The Affinity Coalitions dive deep into exploring and developing culturally appropriate information for our Black Breastfeeding Coalition, LGBTQ+ Human Milk Feeding Coalition, Pro-Lactancia Hispana Coalition, and our Tea and Milk Coalition (Serving Asian American, Middle Eastern American, and refugee families). 

Using our mailing list, the Breastfeed Durham newsletter, and the diligence of our implementation team, Breastfeed Durham works closely with local chestfeeding/breastfeeding support groups, the health sector, and coalitions to ensure that information reaches those who need it most.

What might this mean for your community?

1. Start where your community is and grow from there.
   • Does the community already embrace breastfeeding, chestfeeding, and human milk feeding?
   • Who are your advocates?
   • Where will you need to expand information and support?
   • Use your mailing lists, newsletters, and website to lift up the lactation resources already available in your community.
2. Use social media!
   • Seek out advocates through social media. 
   • Keep them engaged through regular contact (e.g., newsletter, emails).
   • Publicize your initiative.
3. Encourage coalitions that reflect your community.
   • Support those who already are doing the work of building support for breastfeeding, chestfeeding, and human milk feeding.
   • Seek additional advocates.
4. Funding can be a challenge! Check out local and statewide funding sources.
   • If possible, seek funding with your local Health Departments.
   • Look to individual supporters or stakeholders.
   • If you do have funding, support affinity coalitions to develop print/online materials to meet the needs of families in your community.

Community Outreach

In June 2020, i n addition to distributing educational materials, Breastfeed Durham invested in community outreach and engagement by funding a community health worker known in the community as the “resource lady” of Durham. Bernadette, a mother of five breastfed children, has been active throughout the community from working as a teacher’s aide with Headstart to volunteering with the Health Department. Bernadette also has lived experience of receiving all of her services through the Durham County Health Department and the WIC office. In November 2021, Breastfeed Durham named Bernadette as the new Executive Director of Breastfeed Durham. When Breastfeed Durham lost funding from the Health Department, the initiative was able to secure private funding for Bernadette’s salary. The private donor stated that they wanted to donate money to fund Bernadette “to be Bernadette.”  In summer of 2022 Bernadette started hosting weekly events, reaching out to businesses and families with information and support (e.g., rack cards, copies of the North Carolina Business Case for Breastfeeding, business cards, T-shirts for volunteers).  Now when you walk into businesses in Durham, families often will find information cards about the benefits of breastfeeding and where to find support.

Outreach Events

Educational outreach events are another key strategy used by Breastfeed Durham to promote culturally and linguistically appropriate education on breastfeeding. In May 2022, the initiative hosted the Family Festival, which attracted over 300 attendees and inspired several community partners to continue the work in the years to come.

Work with Health Care

To further support healthcare providers in providing culturally appropriate education on breastfeeding, Breastfeed Durham has developed a series of virtual trainings on relevant breastfeeding topics. The First Food Equity Series, with topics such as A Discussion of Birth and Community Wellness, Exploring Gaps in Care, Fully Integrate Appropriate Lactation Support, Impact of Birth Experience on Breastfeeding Initiation and Duration. These trainings aim to increase healthcare providers’ knowledge and skills in order to provide information for pregnant families and those already on their breastfeeding journey.

What might this mean for your community?

1. Seek connections with the Health Department and local healthcare leadership.
   • Participate in Health Department outreach events.
   • View your Health Department as a possible funding source.
2. If your team is able, focus some time on funding 
   • Share funding opportunities with those on your mailing list. Having a specific need, such as an outreach position, provides a focus and often a more successful response
3. If you do have funding, consider focusing some of those funds towards a community outreach position.
   • Welcome all who show an interest in the initiative.
   • Be open to the energy and spirit of community workers. It may take some time to find a “resource lady”, such as Bernadette. It is worth the effort!

Step 4 of the Ten Steps to a Breastfeeding Family Friendly Community emphasizes the importance of providing families with unbiased, culturally appropriate education on chestfeeding/breastfeeding. Breastfeed Durham and Breastfeed Orange NC have implemented a number of strategies to ensure the equitable distribution of information to help families make informed decisions regarding infant feeding practices.

We encourage you to share ways that you are implementing Step 4 in your community. Email us at contact@breastfeedingcommunities.org.