STEP 6: Community chest/breastfeeding support groups and lactation services are fully available, including peer-to-peer lactation support providers, International Board Certified Lactation Consultants (IBCLCs), and other skilled chest/breastfeeding support.
Ten Steps to a Breastfeeding Family Friendly Community
Breastfeeding, chestfeeding, and human milk feeding support must extend beyond the clinic. Therefore, there must be active community support for referral and independent action by lactating families to find the support they need. Once these are established, all clinics and hospitals should be called upon to provide active referral. Active collaboration between health care providers and community lactation support entities is needed to support this Step.
Measure:
- Confirmation that such services are active or being created that would serve the community, with attention to meeting the needs of various racial/ethnic groups.
- At least one in-person or virtual meeting has been held and at least one communication to the public on this mutual effort are documented annually.
Suggested Approaches:
- Designating Group may facilitate first meeting.
- Designating Group reviews action for adherence.
Durham: piloting Step 6 for a global initiative
The Ten Steps to a Breastfeeding Family Friendly Community were developed to be a global initiative. Breastfeed Durham is the pilot — the community where the work of implementing each Step is tested, refined, and documented so that others can follow. What appears below is the pilot implementation of Step 6: the patient, year-after-year work of training people, building relationships, making space, connecting the dots, and filling the gaps until a community that once had almost no coordinated support became a place where families can find skilled help on nearly any day of the week.
When Durham began piloting the Ten Steps in 2018, lactation support existed — but it was scattered, hard to find, and unevenly available across neighborhoods and racial and ethnic groups. Families often didn’t know where to turn, and the people who provided support frequently didn’t know one another. The story below is the work of closing that gap, offered as a template any designating group or coalition can adapt.
The pilot implementation, year by year
A timeline of building Step 6 in Durham
Durham begins piloting the Ten Steps. Support is real but fragmented — a few groups, no shared map, and little connection among the people doing the work. This is the “almost nothing” starting line most communities will recognize.
Starting pointCommunity organizers — including Love Anderson, Gina Rose, Rachel Lewis, and Aubrey Delaney — launch advocacy efforts, and a pivotal meeting with Durham County Commissioner Heidi Carter introduces the model and opens ongoing county engagement. The first relationships are formed.
Build relationshipsWhen COVID-19 hit, Breastfeed Durham pivoted to a web-based resource hub — the origin of a single, independent place that gathers all the community’s lactation support in one spot. That summer, Breastfeeding-Friendly Awards launched and a partnership formed with ICO4MCH and the Durham County Department of Public Health.
Build spaceBreastfeed Durham hosted inclusive events for Black and LGBTQ+ families, expanded its web presence, and certified 30+ local businesses. A community baby shower co-hosted with MAAME, Equity Before Birth, and SisterSong knit grassroots partners into the network — making sure support reached the families most often left out.
Fill gaps · equityStrategic-plan development began alongside the Durham County Department of Public Health, led by community health workers Bernadette Greene and Love Anderson. A collaboration with the WIC office aligned breastfeeding policy with equity goals — connecting public health, peer support, and clinical care.
Build connectionsA Health Equity Impact Assessment convened 20 stakeholders, and the First Food Equity webinar series carried the conversation to the public — covering gaps in care, integrating lactation support into patient visits, and the impact of birth experience on breastfeeding. By year’s end the strategic plan was signed by DCoDPH Director Rod Jenkins.
Annual meeting · public communicationOn August 6, the annual convening brought healthcare providers and community advocates to one room to name the barriers, share collaborative care models, and commit to action. This is the heart of Step 6: once a year, everyone who supports lactation gets to know one another and closes the gaps together.
The annual conveningIn February, Durham County formally adopted the Human Milk Feeding Strategic Plan, embedding lactation equity into public health policy. In September, community generosity launched the Lactation Collaborative — free and low-cost, in-home and clinic-based care for uninsured and underinsured families, delivered by volunteer IBCLCs and CLCs, including Black and Spanish-speaking consultants. The last and hardest gap — care for families who can’t access traditional services — now has an answer.
Fill gaps · sustainWhat actually made it work
Five mechanisms any community can borrow
None of this required a single heroic act. It required repeatable mechanisms, returned to year after year — the moving parts that turned a scattered set of services into a connected web of care.
One independent place to find help
The Breastfeed Durham website lists every peer-to-peer group, class, and clinic — organized by the day it meets — so a family doesn’t have to already know who to call. It belongs to the whole community, not to any one provider, which is exactly why families and clinics trust it for referral.
An annual convening that builds relationships
Once a year, providers and community advocates gather — “Bridging Gaps from Birth to Breast,” the First Food Equity series, the stakeholder assessments. People who refer to one another finally meet one another. Relationships, not directories, are what make referral real.
Growing the number of groups
From roughly three peer-to-peer groups a year to more than sixteen recurring offerings — Baby Bistro, La Leche League, Four Sisters Hands for Black families, Spanish-language community circles, perinatal mood support, hospital and home-visit programs — so support exists on nearly any day of the week.
Designing for racial & ethnic equity
Support was deliberately built where families were being left out — Black-led groups, Spanish-language peer circles, LGBTQ+ resources, and bilingual lactation care — directly answering the Step’s call to meet the needs of various racial and ethnic groups.
Filling the last gap with a community safety net
Even a rich directory leaves out families who can’t afford care or can’t reach it. The Lactation Collaborative closes that gap with free and low-cost, in-home and clinic-based support from volunteer IBCLCs and CLCs — building a sustainable volunteer network and strong referral pathways so no family is left behind, regardless of income, insurance, or identity.
Mapping the pilot back to the Step
How the pilot meets the Measure
1 · Services are active & equity-attentive
A continuously updated, independent directory of 16+ recurring groups, classes, and clinics — intentionally including Black-led, Spanish-language, LGBTQ+, and bilingual support — plus the Lactation Collaborative serving uninsured and underinsured families.
Evidence: public support-group directory, the Lactation Collaborative, and partner programs across the county.
2 · An annual meeting & public communication
At least one convening of providers and community advocates each year — “Bridging Gaps from Birth to Breast,” the First Food Equity series, stakeholder assessments — paired with ongoing public communication through the website, the Durham Digest newsletter, and published recaps.
Evidence: documented convenings and published communications, year over year.
Lessons from the pilot
The repeatable path
If your community is near the starting line Durham was at in 2018, the order of operations matters less than the rhythm. Begin where you can, return to it every year, and let the web of care thicken over time.
- Train and gather the people already doing the work. Find your peer counselors, IBCLCs, WIC staff, hospital teams, and community organizations — and get them in one room.
- Build one independent, neutral place where every group and service is listed by the day it meets, so families and referring clinics can find help without already knowing the landscape.
- Make space and build relationships through an annual convening. One meeting a year, every year, where providers and advocates connect, name the gaps, and plan together.
- Connect the system to public health and clinical care — WIC, the health department, hospitals — so referral becomes routine and the work outlasts any one person.
- Fill the gaps deliberately, especially for the racial and ethnic groups and low-income families most often left out — and build a safety net, like a volunteer collaborative, for those who can’t access traditional services.
You don’t need everything at once. You need a place to gather, a reason to return, and the patience to fill one gap a year.