Once you have established a diverse group of stakeholders and local government has proclaimed the community Breastfeeding Family Friendly.
The community’s elected or appointed leadership has a written statement supporting breastfeeding that is routinely communicated to all.STEP 1 of 10
BREASTFEEDING FAMILY FRIENDLY COMMUNITY (BFFC) DESIGNATION
Download the Global Criteria.
The written and signed policy must includes actions to support the Ten Steps. A copy of the Ten Steps designation and the local policy must be widely distributed at least annually, possibly during World Breastfeeding Week (In US, National Breastfeeding Month)
We have research policies from all world (resources at bottom of the page). Email us directly if you want to collaborate.
The City and County of [Our Town] respect a family’s desire to breastfeed and appreciate the benefits of breastfeeding for the health of the child, the mother, the family, and the community because breastfeeding provides the healthiest start for babies, providing ideal nutrition and a multitude of health benefits for both infants and families. In 2011, the Surgeon General’s Call to Action to Support Breastfeeding highlighted a need for a community level, multifaceted approach to breastfeeding support. In Action 4, Use community-based organizations to promote and support breastfeeding, the Call to Action recognized that organizations “based in communities and do their work there are aware of the specific barriers that (families) in their communities face,” as well as understand “their needs and opportunities.” Through a breastfeeding family friendly community, the City and County of [Our Town] support a [Our Town] family’s decision to breastfeed. Most [Our Town] families initiate breastfeeding in the hospital; however, many stop breastfeeding within a few days or weeks. There are many barriers to increasing breastfeeding duration, in particular the need to return to work and be separated from their young babies and also a lack of welcome in the community to breastfeed when and where the family needs. We, the [Our Town] leadership, must improve the overall tone and community atmosphere to promote [Our Town] public health interventions and breastfeeding support interventions aimed specifically at closing the gaps in the community support for breastfeeding families. A guiding priority and core value of the City and County [Our Town] are supporting the creation of health equity. Our goal is that all [Our Town] people, regardless of skin color or social status, will have equal opportunity to engage in optimal breastfeeding and live longer, happier, and healthier lives. (1)
Intention statement: The purpose of this Policy is to ensure that all breastfeeding families have the support they need to continue breastfeeding and to engage in optimal breastfeeding whenever possible. The [Our Town] Government, with the help of the [Our Town] Communities, strives to make sure that all families are well-informed about the risks and benefits of infant feeding choices and are welcomed to breastfeed in the community.
Background: Improving rates of optimal breastfeeding is one of the most important ways [Our Town] can improve the health of our children and our families. The international definition of optimal breastfeeding is early and exclusive breastfeeding for up to 6 months, followed by appropriately-timed introduction of complementary foods starting at 6 months with continued breastfeeding for at least 1-2 years and for as long as mutually desired. Breastfeeding decreases the risk of maternal diabetes and cancers as well as a myriad of preventable pediatric conditions, including obesity, Type II diabetes, pneumonia, and Sudden Infant Death Syndrome (2). [Our Town] is committed to the support of optimal breastfeeding for all including all minoritized [Our Town] families, marginalized [Our Town] families, lower socio-economic families, younger mother/families, and African-American families. Achieving health equity, eliminating disparities, and improving the health of all [Our Town] populations is one of the goals of the Breastfeeding Support Policy. By health equity, we mean everyone has the opportunity to attain their highest level of health including optimal breastfeeding. (3)
Procedures/practices: It’s important for all of [Our Town] including staff, volunteers, and families to understand how to support families choosing to breastfeed. Different families need different things – some need more privacy, and some need more affirmation. It also is important to understand how to support breastfeeding staff and volunteers by providing them with adequate break time and space to express breast milk or breastfeed their babies while working their shifts. The common agreement should be that all breastfeeding families (including [Our Town] government staff and volunteers) will NOT be discriminated against, treated disrespectfully, or asked to leave because they are breastfeeding.
- The [Our Town] community’s elected or appointed leadership has a written statement supporting breastfeeding that is routinely communicated to all.
This written and signed Policy will be shared via all local media outlets, including the [Our Town] Government websites, government print materials, Government podcasts/radio and streaming/television as well as social media, as available, and the majority have done so in the last year. A copy of the Breastfeeding Policy will be widely distributed at least annually, possibly during World Breastfeeding Week (In US, National Breastfeeding Month) .
- The [Our Town] community as a whole will provide a welcoming atmosphere for breastfeeding families.
Building upon US Federal and State laws that dictate that breastfeeding may be carried out wherever a woman is lawfully allowed to be. The maintenance of milk supply is only possible when infants are fed on cue and frequently day and night. Parents know that the infant needs to breastfeed when the infant indicates, and breastfeeding must not be relegated to places where adults would not consume food, such as toilet areas.
[Our Town] government will display stickers, window clings, or signage in a visible location – and even on the [Our Town] website – indicating that breastfeeding families are welcome in all establishments in which they have the lawful right to be. We work to set up a network of semi-private or private space for all of [Our Town] staff, volunteers, clients, and families to express milk or breastfeed.
“Breastfeeding welcome here” signage shall be posted next to the welcome signs to the city or in similar prominent positions (e.g., city operated parks, swimming pools, senior centers, etc.). In addition, a “Breastfeeding welcome here” seal/logo shall be posted on city and county websites and/or social media or similar, and/or flyers are available at the visitor’s bureau.
North Carolina Law is enforced. Welcoming breastfeeding shall be supported by local law enforcement.
- Breastfeeding shall be viewed as a safe and effective way to feed a child even in an emergency.
Human milk is always clean; requires no fuel, water, or electricity; and is readily available when baby and nursing parents are kept close. Human milk contains antibodies that fight infection, including diarrhea and respiratory infections that are common among infants in emergency situations such as hurricanes and tropical storms. Breastfeeding releases hormones that lower stress and anxiety in both the child and the nursing parent. Especially when stressed, it is important to continue offering the breast or expressing milk at regular intervals.
During an emergency, emergency response teams (ERTs) will assist families to continue breastfeeding and/or to express milk at the same rate or more frequently during the emergency. ERTs will be knowledgeable about the implications of reducing the frequency of expressing milk (e.g., expressing milk fewer times will lead to a low supply). Families shall be encouraged by all to keep their babies close to them and not to delay evacuating because of your frozen milk.
- Optimal breastfeeding is supported by health leadership. This Policy shall be disseminated at appropriate times, such as World Breastfeeding Week or National Breastfeeding Month, to all health entities. The definition of optimal breastfeeding, or that proposed by the World Health Organization, American Academy of Family Practitioners or American Academy of Pediatricians, shall be disseminated and confirmed with healthcare and community leadership, with discussion and corrections as needed. [Our Town] wants local health authorities to accept this definition and include optimal breastfeeding support in their work.
- During pregnancy, all families shall be informed about the benefits of breastfeeding, as well as about the risks of unnecessary formula use, and where to access support as needed. Breastfeeding education and support allows families to make informed decisions regarding infant feeding practices. The [Our Town] government is supportive of the International Code of Marketing of Breast-milk Substitutes, that calls for unbiased information in the hands of the public, especially concerning the risks of formula use for maternal and child health outcomes. Distribution shall include attention to equity – ensuring that those populations who are more vulnerable receive special inputs. [Our Town] encourages faith-based organizations and other organizations that are reflective of the [Our Town] population and [Our Town] culture to inform families about the benefits of breastfeeding through community wide distribution. Groups can get materials, such as those produced by La Leche League (LLL), Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) or other local groups, Breastfeed [Our Town], other parts of the health sector, local breastfeeding support groups, or breastfeeding coalitions.
- [Our Town] encourages all health care in the community to be breastfeeding friendly. Health care within the community must be breastfeeding friendly, if a community is to support breastfeeding. Research confirms that comprehensive breastfeeding support in prenatal, maternity and postnatal care results in improved breastfeeding success. We encourage all maternity care centers to be designated Baby-friendly (or designated as fully qualified by their state maternity care breastfeeding designation) or a state-level designation. This designation must include at least the following: Healthcare personnel involved in the care of mothers and babies are trained in the skills necessary to support optimal breastfeeding. All [Our Town] Health Care Providers and clinics are encouraged to apply for a breastfeeding friendly and/or baby friendly designation, OR, offices provide documentation concerning the prenatal breastfeeding support, such as educational tools, or practice behaviours, that they employ with all patients, regardless of race or ethnicity. A Designating Group should receive documentation from local healthcare organizations. (In North Carolina in 2020, the Designating Group for the Office designation http://ncbfc.org/mother-baby-friendly-clinic-award/ is NCBC.)
- [Our Town] encourages all non-health system breastfeeding support groups and services to be fully available in the community, including International Board Certified Lactation Consultants (IBCLCs), La Leche League (LLL), and other skilled breastfeeding support. Breastfeeding support must extend beyond the clinic. Therefore, there must be active community support for referral and independent action by breastfeeding mothers 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 breastfeeding support entities is needed to support [Our Town] families and achieve equality. The [Our Town] Government encourages the Health Department to:
- Host at least one in-person yearly meeting with all breastfeeding support providers to confirm that breastfeeding support services are actively being created with attention to meeting the needs of various racial/ethnic groups
- Document annually a list of all non-health system breastfeeding support groups and services including IBCLCs, LLL, and other skilled breastfeeding support
- Provide at least one communication to the public on the mutual effort of breastfeeding support providers.
- The [Our Town] Government supports all [Our Town] businesses and [Our Town] social organizations in the community to become welcoming to breastfeeding families. For a community to support breastfeeding, there is a need to provide locations where families are comfortable breastfeeding. We call on the Chamber of Commerce: At least 50% of the Chamber of Commerce (CoC) member organizations, economic development organizations, and non-member organizations have signed a form (see Business Application) that they welcome breastfeeding in their place of business, and display welcome signs or “Breastfeeding Welcome Here” logo (e.g. window clings). Local organizations (e.g., breastfeeding coalitions, La Leche League or other breastfeeding support groups, Rotary) are encouraged to help distribution of window clings/magnets and hanging unit for breastfeeding materials.
- [Our Town] Public Libraries shall be welcoming. One of the easiest places to visit when you have a brand-new baby are the [Our Town] Public Libraries. All [Our Town] libraries should have a written breastfeeding policy (including employee policy if separate) culturally appropriate breastfeeding-friendly educational materials used and/or citations for publications. All libraries shall have a list of community breastfeeding resources. All libraries shall provide staff training on: Optimal breastfeeding practices and benefits for child, mother, and family; Appropriate introduction of solid foods with continued breastfeeding for one year or longer, as desired by families; and Communication with families to support breastfeeding and lactation goals. All libraries shall provide interactive and developmentally appropriate learning opportunities that normalize breastfeeding for children in the program. Breastfeeding information and books are available at the public library
- [Our Town] Public Swimming Pools and Public Parks and Recreation shall provide families with positive and encouraging messages about breastfeeding. Semi-public swimming and recreation areas shall be encouraged to provide families with positive and encouraging messages about breastfeeding. In compliance with North Carolina law, a person may breastfeed a child at a recreation area, swimming pool, or pool deck area at their discretion. Support for breastfeeding includes: Provide “Breastfeeding Welcome Here” signs; Explain the law to staff, including how to support breastfeeding at the facility; Let staff know that they must not ask someone who is breastfeeding to move, cover up, be more discreet, or stop breastfeeding for any reason; Prepare staff for how to respond to complaints; consider role playing to improve knowledge and comfort with the topic. If a person complains, staff should consider it an opportunity to share information about the law. If staff is uncomfortable or a complaint worsens, ensure that staff knows to engage the manager responsible for responding to complaints so information is quickly given to guests.
- All [Our Town] food pantries shall be encouraged to create a welcoming environment that feels friendly, accepting, and supportive of breastfeeding families. Food pantries play a critical role in supporting breastfeeding families. It’s important for food pantry staff and volunteers to understand how to support families choosing to breastfeed. If the pantrie accepts formula, we encourage food pantries to store it in a location that’s out of view of the clients. This can help to ensure that it is distributed thoughtfully, and that information is included about safe preparation. We encourage the site to write breastfeeding friendly guidelines or policies. Provide information, education, and resources to breastfeeding families, including staff and volunteers. Decide where to place/store formula, how to let clients know about formula, how to support clients with formula needs, and providing accurate information on safe preparation and storage of formula and formula feeding practices. Offer informative breastfeeding information and resources, including information about breastfeeding basics; nutritional information for breastfeeding families; and connecting families with local community breastfeeding resources, such as WIC, hospital support groups, etc. Offer to provide breastfeeding education and peer support. Consider language, imagery, nutritional restrictions, literacy levels, and family structure. Different volunteers and staff have different roles. Make sure that training and education is offered accordingly.
- Local businesses and healthcare clinics/offices are called on by [Our Town] to affirm principles of the International Code of Marketing of Breast-Milk Substitutes. The International Code of Marketing of Breast-milk Substitutes (“Code of Marketing/WHO Code”) affirms that “the encouragement and protection of breastfeeding is an important part of the health, nutrition and other social measures required to promote healthy growth and development of infants and young children.” It strives to protect, promote, and support breastfeeding for the health and well-being of infants, especially during the vulnerable early months of life. Breastfeeding education and support allows families to make informed decisions regarding infant feeding practices. While realizing that manufacturers and distributors of breast-milk substitutes have a role to play in relation to infant feeding, the Code of Marketing recognizes that inappropriate and unnecessary marketing and distribution of breastmilk substitutes by healthcare facilities and businesses can impact the infant feeding practices of families. [Our Town] asks that no locally controlled businesses have advertised infant formula or related toddler formulas by verification with such businesses
- The World Alliance for Breastfeeding Action (WABA) Maternity Care or, in the U.S., The US Business Case for Breastfeeding is promulgated by the [Our Town] Government and we ask the same of the [Our Town] Chamber of Commerce. Workplace accommodation for breastfeeding workers is included in the Affordable Care Act (ACA) for hourly workers and is needed for breastfeeding to be successful following return to work. The current state of the laws concerning mandated business support for breastfeeding, and the materials available to support the law, shall be made available to all Chamber of Commerce members, similar business groups, and other businesses at least annually (provided by local breastfeeding organizations or health department; ACA materials from Dept. of Labor: http://www.dol.gov/whd/nursingmothers/ ). The US Business Case for Breastfeeding or WABA Maternity Care related materials are promulgated by the Chamber of Commerce and other similar organizations (available at: http://www.womenshealth.gov/breastfeeding/employer-solutions/index.php).
- The [Our Town] education systems, including childcare, K-12, colleges and universities, are encouraged to include breastfeeding-friendly curricula at all levels. To become the normative behavior, people of all ages should be exposed to breastfeeding as part of all health and family education. The [Our Town] School District, and the Department of Education, shall cooperate in review of all textbooks to ensure breastfeeding nor Breastfeeding-friendly curricula are introduced at all levels of education. Education systems are encouraged to have a written policy for promoting and supporting breastfeeding, and it is regularly communicated to our staff and families. Education systems are encouraged to support breastfeeding employees with appropriate breaks so that they may express milk and/or nurse. The schools are encouraged to provide a clean, comfortable, private place for employees to pump/express milk and/or nurse their babies as needed. Contact and coordinate with community breastfeeding support resources; actively refer mothers and families.
Application: This policy applies to all [Our Town] employees and residents, including but not limited to: outpatient setting, the hospital setting, home care agencies, the pediatric setting, child care centers, family day care homes, baby-sitters, public settings malls, restaurants, parks, banks, stores, theaters, libraries, swimming pool, food pantries, the workplace place , Chamber of Commerce, schools, etc. Agencies are expected to write protocols for their setting that are consistent with these policies. If you would like assistance in writing breastfeeding policies for your agency, please contact Breastfeed[Our Town] <[Our Town]@breastfeedingcommunities.org>
Communication: [Our Town] County will correctly communicate the policy to all.
- Ip S; Chung M; Raman G; Chew P; Magula N; DeVine D; Trikalinos T; Lau J. Breastfeeding and Maternal and Infant Health Outcomes in Developed Countries Evidence Report/Technology Assessment No. 153 (Prepared by Tufts-New England Medical Center Evidence-based Practice Center, under Contract No. 290-02-0022). AHRQ Publication No. 07-E007. Rockville, MD: Agency for Healthcare Research and Quality; April 2007.
ECONOMICS OF BREASTFEEDING
- Eradicating Reliance on Free Artificial Milk-Srinivas, G. L., Swiler, K. B., Marsi, V. A., & Taylor, S. N. (2014). Eradicating Reliance on Free Artificial Milk. Journal of Human Lactation, 0890334414553246.
- A Transition Strategy for Becoming a Baby-Friendly Hospital: Exploring the Costs, Benefits, and Challenges
- DelliFraine, J., Langabeer, J., Delgado, R., Williams, J. F., & Gong, A. (2013). A transition strategy for becoming a Baby-Friendly hospital: Exploring the costs, benefits, and challenges. Breastfeeding Medicine, 8(2), 170-175.
- Delayed Breastfeeding Initiation Increases Risk of Neonatal Mortality-Edmond, K. M., Zandoh, C., Quigley, M. A., Amenga-Etego, S., Owusu-Agyei, S., & Kirkwood, B. R. (2006). Delayed breastfeeding initiation increases risk of neonatal mortality. Pediatrics, 117(3), e380-e386.
BREASTFEEDING & DIABETES
- Evidence on the long-term effects of breastfeeding: World Health Organization. Horta BL, Bahl R, Martines JC, Victora CG. Evidence on the long-term effects of breastfeeding. Systematic reviews and meta-analyses. WHO Press, World Health Organization, Geneva, Switzerland, ISBN 978 92 4 159523 O, 2007. 52 pages.
- Insulin requirements of diabetic women who breast feed: Davies, H. A., Clark, J. D., Dalton, K. J., & Edwards, O. M. (1989). Insulin requirements of diabetic women who breast feed. BMJ: British Medical Journal,298(6684), 1357.
- Duration of Lactation and Incidence of Type 2 Diabetes: Stuebe, A. M., Rich-Edwards, J. W., Willett, W. C., Manson, J. E., & Michels, K. B. (2005). Duration of lactation and incidence of type 2 diabetes. Jama,294(20), 2601-2610.
BREASTFEEDING & HYPOGLYCEMIA
- Postnatal Glucose Homeostasis in Late-Preterm and Term Infants
- Adamkin, D. H. (2011). Postnatal glucose homeostasis in late-preterm and term infants. Pediatrics, 127(3), 575-579.
BREASTFEEDING & CHOLESTEROL
- Evidence on the long-term effects of breastfeeding-World Health Organization. Horta BL, Bahl R, Martines JC, Victora CG. Evidence on the long-term effects of breastfeeding. Systematic reviews and meta-analyses. WHO Press, World Health Organization, Geneva, Switzerland, ISBN 978 92 4 159523 O, 2007. 52 pages.
BREASTFEEDING & OBESITY
- Effect of Infant Feeding on the Risk of Obesity Across the Life Course: A Quantitative Review of Published Evidence.
- Owen, C. G., Martin, R. M., Whincup, P. H., Smith, G. D., & Cook, D. G. (2005). Effect of infant feeding on the risk of obesity across the life course: a quantitative review of published evidence. Pediatrics, 115(5), 1367-1377.
- Intergenerational impact of maternal obesity and postnatal feeding practices on pediatric obesity
ADOPTING A POLICY
- Announce your plans for a breastfeeding family friendly policy to your community.
- Identify members in your organization who are currently breastfeeding or breastfed in the past to assist.
- Inform public of the policy/guidelines and make educational materials on breastfeeding available.
- Plan a celebration to announce the new breastfeeding friendly policy and make information on breastfeeding available to all.
- Present copies of the policy/guidelines to public.
- Create a private place for staff to express their milk and to accommodate staff and other parents who may wish to nurse their infants in private while in the facilities, while welcoming breastfeeding in the public spaces.
- Continue to provide education to public and resources to support breastfeeding.
Your Health Department might want to review the Breastfeeding Friendly Health Department Toolkit developed by Dr. Bonnie Brueshoff of the Dakota County Public Health Department.
Recommended Laws for Review
The federal Fair Labor Standards Act (FLSA) offers protections for many breastfeeding parents, and a number of states have even better levels of support for lactation. The cities listed here also offer lactation policies..
San Francisco, California
In 2018, San Francisco was the first U.S. city to implement a city-wide lactation law requiring all San Francisco employers to provide break time and a lactation space (other than a bathroom) to all breastfeeding employees. (FLSA only covers hourly employees). The law also sets minimum standards for lactation spaces, requiring that they space be clean, include a chair and a surface for a breast pump, and be located near a sink and a refrigerator where moms can store their milk. In addition, all San Francisco businesses must have a written lactation accommodation policy that outlines the process for requesting workplace support. (As a state, California is top-notch for breastfeeding mothers. Read more about California’s breastfeeding laws.)
The Windy City passed a law in 2015 requiring all large airports in Chicago to have a lactation space (other than a restroom) beyond security in every terminal. Not only was Chicago a year ahead of their own state—Illinois passed a version of the same law in 2016— they were five years ahead of the FAA law that will require more than 60 national airports to have lactation spaces in every terminal. Read more about Illinois’s breastfeeding laws.
San Antonio, Texas
The city of San Antonio is the second largest city in Texas and home of the Alamo. It’s also a great city to work for if you’re a breastfeeding mom. Their workplace lactation policy mandates a private space (not a bathroom) to pump for all public employees —from interns to full-time employees. The city employees almost 12,000 people! The best part? The city also provides hospital grade pumps to borrow in city lactations rooms and office spaces.
Dane County, home to Madison, is the second largest county in Wisconsin. In 2014 they passed a resolution requiring every county-owned building to provide a lactation space (other than a bathroom) that could be used by both the public employees who worked there and visitors to the spaces. While resolutions are not laws, per se, they matter because they express the clear will of the legislative body. And while every state has legislation to protect a mother’s right to breastfeed in public, Mad City takes it a step further with a breastfeeding ordinance that slaps a fine on anyone who tries to stop or interfere with a breastfeeding mama.
New York, New York
New York City law requires lactation spaces in departments that provide public services for families such as the Department of Health and Mental Hygiene, the Administration for Children’s Services, and the Department of Social Services. In 2018, The Big Apple’s City Council also passed ten new bills—called The Mother’s Day bills—to improve services and support for moms and families. One of these new laws (Int. 879-A) requires employers with 15 or more employees to provide a dedicated lactation space (not a bathroom) for all employees (not just hourly). The other law (Int. 905-A) requires employers to provide breastfeeding employees with a written lactation accommodation policy to ensure moms know about their workplace rights. Both laws go into effect March 18, 2019. NYC’s local laws are in line with the rest of the state’s progressive legislation that ensures support for all nursing moms, including those in prison. Read more about New York’s breastfeeding laws.
It’s fitting that our nation’s capital is a beacon of support for working breastfeeding women. Employers in D.C. are required to support breastfeeding employees by providing break time and a space (other than a bathroom) to pump at work. Plus, the Department of Health is charged with monitoring and reporting on D.C. breastfeeding rates.