The Ten Steps to a Breastfeeding Family Friendly Community is a measured framework, not a slogan. Communities assess themselves against published criteria, document what they find, and publish the result including the steps they have not passed. This page collects the research the model has produced and the evidence behind it.
Peer reviewed and published research
- Supporting Safe Infant Feeding in Western North Carolina After Hurricane Helene. Natural Hazards Center Quick Response Research Report Series, QR 374, 2026. Conducted with researchers at the University of North Carolina and Duke, using ripple effects mapping with 42 participants. It found that the SAFE Infant Feeding Team substantially helped families while working without any formal protocols to rely on, because none existed.
- Infant feeding in state emergency operations plans. Pewitt et al., International Journal of Disaster Risk Reduction, 2026. Forty six state Emergency Operations Plans scored against global standards for infant and young child feeding in emergencies. The mean score was zero. Twelve of the forty six mention infant feeding at all.
The framework itself
The Ten Steps with Approaches and Measures is the authoritative statement of the model: each step with its rationale, its measures, the approaches a designating group uses to verify them, and the rule by which each step passes. It originated in a 2014 request from the World Alliance for Breastfeeding Action to the Carolina Global Breastfeeding Institute at the UNC Gillings School of Global Public Health, and launched in Chapel Hill and Carrboro in 2015.
Community self appraisals
Communities publish their own assessments, including what they have not achieved. Tuskegee, Alleghany County, Durham, Guilford County, Orange County and the Hampton Roads Region have published theirs. Guilford’s states plainly that it needs 1,118 participating businesses and has 26. That candor is the point: a designation that only ever reported good news would not be worth having. Read the self appraisals.
Measuring the model at scale
With a researcher at the University of North Carolina we have developed a common instrument that scores a community against every measure in the Ten Steps, so that communities can be compared consistently and change can be tracked over time rather than asserted. That work is underway now, with findings expected in 2027.
We are also asking a question nobody has answered: what do the Ten Steps 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. If the framework holds one level up, a state can do in one action what a hundred communities would each have to do separately.
Working with us on research
We collaborate with universities, health departments and coalitions on evaluation, practicum and capstone placements, and shared instruments. If you are working on something adjacent, please contact us.