The Healthiest State in the Nation: Vermont Embraces Breastfeeding

Overview

I was honored to be at the Second Annual Summit on Breastfeeding to discuss removing barriers to breastfeeding and progress in breastfeeding policy and practice. This is an area of public health on which we have had to stay focused in Vermont. And our goal—like the Beatles song—is to be “Getting better all the time.”

Vermont is routinely rated the healthiest state in the nation, including the past 2 years in a row, by the United Health Foundation, and one reason for this—I believe—is we've stayed focused on maternal and child health.

We've worked hard to improve the health of the youngest and most vulnerable Vermonters. In Vermont, 90% of pregnant women get in to see the doctor in the first trimester of pregnancy. The earlier a woman sees a doctor during her pregnancy, the more chances she has to adopt healthier behaviors, and the better the outcome of that pregnancy.

Vermont women breastfeed babies at a rate well above the national average. The percentage of Vermont mothers who have breastfed their infant (80%) far exceeds the national rate (74%) and exceeds the national goal established by the Centers for Disease Control and Prevention (CDC) to increase breastfeeding to 75% by 2010. Fifty-nine percent are still nursing at 6 months, compared to 43% nationally.

We have never been content to adhere to national standards of excellence when it comes to breastfeeding. We have made an effort to show what the standard can—and should be.

Although society has come a long way in its acceptance of breastfeeding, there continue to be exceptions. Unfortunately, in October 2006, we had an incident involving a young woman who was removed from a flight that had landed in Burlington because she was breastfeeding her baby. This incident was a good reminder for all Vermonters that we must protect any nursing mother who may be targeted for discrimination.

Breastfeeding Legislation

Vermont is proud to be one of 44 states that specifically allow women to breastfeed in any public or private location. Every nursing mother should feel good about nurturing her baby whenever it is convenient, and we have made an effort to facilitate that. The University of Vermont, for example, recently set up lactation rooms across campus.

Since 2003, Vermont law (Act 117) has provided protection for mothers who wanted to nurse in public. This was an excellent piece of legislation, and I was proud to sign it into law. In 2008, Act 144 took effect, protecting the rights of breastfeeding women when returning to work—protections that have now been extended nationwide through healthcare reform. I was proud to be joined at the Act 144 bill signing ceremony by one current and one former employee of mine, and their babies. Both are very talented professionals who serve Vermont well and both chose to breastfeed their babies. It was important to me that they enjoyed a workplace that supported them in this—and other—important family decisions.

To help employers implement breastfeeding-friendly policies, Vermont also has a Breastfeeding Friendly Employer Project that provides sample policies and simple accommodations that will meet the requirements of the law.

From getting the kids up, fed, dressed, and off to child care or school, there are many demands on working parents. (I certainly recall the challenges that Dorothy and I faced as young parents, just getting started in our careers and working hard to provide for our baby boys.)

The bottom line is this: Employers can succeed in retaining their employees and encourage enhanced productivity by providing a family-friendly workplace.

The project was also designed to recognize employers who support and respect a woman's right to breastfeed. Nearly 200 businesses in Vermont have been recognized for their efforts to date, including—I'm proud to report—my office.

WIC and Peer Counseling

We have also looked for areas of the state where the breastfeeding rates are lower than expected—and then we took action. For example, in Rutland County, in 2008, the breastfeeding initiation rate was a state-low 54%. As a result, we started a WIC [Special Supplemental Nutrition Program for Women, Infants and Children] Breastfeeding Peer Counselors project—training a group of WIC moms to be peer counselors. They lead outreach and support efforts that influence approximately half of the births each year in Rutland County. We now have a total of 30 counselors working in four different counties and they are doing a remarkable job.

More than half of newborn children here in Vermont receive a nutritional boost and a healthy start to their lives because of WIC. And, mothers enrolled in our WIC program are educated about the limitless benefits of breastfeeding their children.

Obesity Prevention

Breastfeeding has also played a major role in our efforts to reduce the rates of childhood obesity. Childhood obesity—as you know—has become a national epidemic.

Studies clearly show that breastfed infants are less likely than bottle-fed infants to become overweight as children, and the risk is lowest among babies who are exclusively breastfed and breastfed for a longer period. In Vermont, 26% of children in grades 8–12 are overweight for their age and height, and 60% of Vermont adults are overweight or obese.

Breastfeeding is a key piece of the Fit & Healthy Vermonters initiative and our state's Obesity Prevention Plan.

We have four key breastfeeding strategies in our Obesity Prevention Plan:

Use evidence-based practices and policies that support breastfeeding. For example, integrate breastfeeding as a curriculum component of health education in schools. Our medical school at the University of Vermont is one of the few that offers training for new physicians about the importance of breastfeeding.

Vermont will work to expand coalitions at the community level that have the knowledge and skills to work with mothers and babies and advise them of their legal protections (public and workplace).

For low-income Vemonters with additional barriers to breastfeeding, we've grown our peer counseling through a WIC–CDC Preventive Services Block grant, maximized new WIC food packages, and have been funded by the U.S. Department of Agriculture to measure the effect of social marketing on breastfeeding rates.

What's Next

My hope, as I near the end of my fourth—and final—term as Governor, is that Vermont will continue to take a leadership role in this area. For example, the Health Department is developing a new campaign to empower lower-income mothers to take action and overcome ordinary breastfeeding challenges after they leave the hospital.

I believe social networking sites and viral video channels could be exciting ways to help young women understand that early success leads to long-term success when it comes to breastfeeding. Public health is just beginning to use these tools to reach families and change health outcomes.

As is true of every public health issue we face, our challenges are ongoing. There will never come a time when we have enough women breastfeeding in Vermont and our job will be done. While we have made excellent progress in breastfeeding initiation, our exclusive breastfeeding rates are not as good as our rates right out of the hospital, and that needs to continue to be addressed.

Even states with high breastfeeding rates need to do more to support women, especially underserved women, to initiate and continue exclusive breastfeeding for the first year of life.

The overriding message we will continue to send to all new mothers in Vermont is that we will work hard to remove any possible barriers to providing babies with a healthy start to their young lives.

Thank you again for inviting me to talk about breastfeeding—and giving me an opportunity to talk about the work we have done in Vermont.