Issues and Action Items

Abstract

Topic and summary statement	Main issues	Urgent actions
Agency Efforts and Leadership Opportunity exists for agencies to provide leadership in addressing the “breastfeeding” community's needs. Improve cultural support for breastfeeding by focusing on the removal of barriers to breastfeeding through strong research unifying successful programs. Such efforts could fulfill commitments to integrate the “role” of breastfeeding for all women and its importance in our society.	Inter- and intra-agency walls prevent agency leaders from taking advantage of specific strengths to implement breastfeeding activism and program development.	Remove walls/barriers for high-level common goals. Promote leadership through research and solid program creation.
	Agencies lack proactive legislative roles because of legislative mandates.	Evolve a structured communication process so that agencies that don't allow leadership or activism around an issue can participate in integrated solutions with the entire breastfeeding community.
	Politics prevents effective research findings from being put into action.	Use research to develop solutions that are detailed and customized to support a national breastfeeding policy deployment—create a “Culture of Breastfeeding Support.”
High-Risk Populations Breastfeeding rates in racial and ethnic minority and poor populations are suboptimal and contribute to the heavy disease burden experienced by these groups. Interventions to improve breastfeeding need to be culturally appropriate to the population and address all aspects of the social- ecologic environment.	Large disparities exist in breastfeeding that are not fully understood, based on race, ethnicity, and geography.	Cultural competency across the spectrum of social service and healthcare providers must be achieved.
	Breastfeeding has the potential to dramatically improve the health of women and children who currently have the lowest rates of breastfeeding.	Health education and care provided to vulnerable populations of women and children must consistently support breastfeeding across all services.
	Because these women and children have few existing supports, they require many services to successfully breastfeed.	A social-ecologic approach is required to address the needs of vulnerable populations of moms and babies. The social-ecologic model encompasses individual, interpersonal, community, institutional, and policy factors.
Breastfeeding Community Initiatives Coalitions and collaborations across sectors are a primary mechanism at the community level to increase breastfeeding initiation and duration with a particular emphasis on racial/ethnic disparities and low-income families. A broad framework is needed to develop innovative strategies for addressing barriers and conducting research. A socio- ecologic model should underpin efforts focused on changing systems of care, reimbursement, and agency/organization policies. Positive and supportive attitudes and behaviors of individuals, families, communities, and society can have a multiplier, integrative effect.	Implementation of supportive agency and organizational policies and practices that are place-based is not adequate.	Incentives should be provided in the form of insurance coverage; third-party reimbursement; “perks” to promote collaboration [between] leadership and supportive services providers.
	Formula feeding is the U.S. cultural norm: Combating “breastmilk in a can” marketing and other commercial disincentives.	Social marketing tools and training to influence and be employed by the entire spectrum of stakeholders.
	Inadequate support services	Peer counselors, lactation consultants: Career ladders for individuals with specific skills in lactation support are needed.
Toxic Environment We must consider the impact of toxic exposures—chemical, physical, social, and emotional toxins—on women's ability to breastfeed successfully. Toxins can reduce both quantity and quality of breastmilk. Awareness of this issue should inspire us to reduce the levels of toxins in the environment so that breastfeeding can be done safely and successfully.	Toxins of many sorts—chemical, physical, social, and emotional—can affect breastfeeding.	Focus research on the impact of all types of toxins on breastfeeding.
	Insufficient milk supply is a major reason why women stop breastfeeding.	Take a mother's report of low milk supply seriously; it is not her fault—focus on the broad socio-ecologic context.
	Domestic violence is pervasive and has a major impact on breastfeeding success.	Address breastfeeding in domestic violence response settings, and vice versa.
In Companies, Large and Small To date, companies that have implemented breastfeeding support in the workplace have shown a lot of variability in program deployment and content. The use of return on investment models to fund these strategies does not answer the fundamental need to provide equitable cultural support for all.	There is inconsistent use of strategies to provide employer-based support of breastfeeding.	Evaluate and document the true impact of breastfeeding in the workplace and its effect on business investment.
	Small businesses are exempt from workplace breastfeeding support laws.	Support better dialogue between the current Healthcare Reform policy and possible application to the non-discrimination of the working woman and breastfeeding.
	U.S. laws currently do not adequately address workplace strategies that support breastfeeding.	“In order to prevent discrimination against women on the grounds of marriage or maternity and to ensure their effective right to work, the [United States] shall take appropriate measures … . To introduce maternity leave with pay or with comparable social benefits without loss of former employment, seniority or social allowances”—United Nations Convention on the Elimination of All Forms of Discrimination against Women, December 18, 1979.
Regulation and Support: Public and Private Variations in healthcare delivery systems promote a vast array of solutions to breastfeeding issues. Included are processes that are innovative and offer best practices from the interchange of quality goals in breastfeeding and greater potentials for success. Core value systems supporting breastfeeding practice can create federations of various agencies, medical care systems, and cultural opportunity to bridge gaps in breastfeeding care and create strategies to bring superior results in breastfeeding rates and support diversity in the breastfeeding culture in America.	Public and private sector healthcare best practices are not integrated for the benefit of all.	Facilitate the sharing of business practices within unique environments to promote a more efficient method of “reinventing the wheel” in program strategies for breastfeeding success.
	Domestic policy needs to be integrated to support a wider range of projects that incorporate best practices.	Encourage private and public support of common goals by taking advantage of the organizational strength of large companies and healthcare systems to do the heavy lifting.
	How can the Office on Women's Health best highlight current policy and clinical data to support changes that emphasize return on investment and result in recommendations for preventive practices, including breastfeeding?	Use large federal and state agencies with the ability to analyze data to develop potential solutions that address how return on investment priorities can match the Healthcare Reform legislation.
Roles and Responsibilities of the Health Professions Each member of the healthcare team, especially the physician, the team leader, must assume responsibility for ensuring a successful breastfeeding outcome, by means of appropriate education and training, employment of outcome- and evidence-based performance measures, and meticulous coordination of care across disciplines.	As leaders of the healthcare team, physicians must have the knowledge base and the skill set required to ensure optimal management of the breastfeeding dyad.	Greater education of physicians, nurses, and other members of the healthcare team will be required at all levels of training.
	Nurses have close and extended contact with the mother and her infant, and as with the physicians, they must be equipped with the necessary skills to support and promote breastfeeding.	Performance metrics must be put in place to assess quality of care in breastfeeding management. Such metrics should be evidence-based and linked to breastfeeding outcomes.
	In the end, effective breastfeeding management is a systems issue and requires ongoing and conscientious collaboration involving all healthcare services within the hospital and the community that it serves.	Methods must be developed to coordinate care across all disciplines in the maternity care setting.
Hospitals Play a Critical Role All healthcare workers in the maternity care setting must embrace breastfeeding support as an urgent public health issue. Assurance of high-quality care can be realized to a great degree by utilizing metrics by which to make maternity care units more accountable for their performance. Hospitals and birthing centers must be required to comply with the Joint Commission's core measure on exclusive breastfeeding, as well as with other standards of care that are based on the Ten Steps and the World Health Organization Code. A strong commitment to adequate maternity care will require seamless coordination of hospital and community services, and the leadership of policy makers at the highest levels of government.	The cost of not breastfeeding in terms of loss of life and incurred health-related expenses can no longer be ignored or tolerated.	Policy makers must prioritize and fund breastfeeding support in the maternity care setting.
	Lack of awareness within the medical community about the Ten Steps and the World Health Organization Code.	Joint Commission standards must hold maternity care units accountable for breastfeeding support, exclusive breastfeeding rates, and implementation of the Ten Steps and the World Health Organization Code.
	Lack of standardization of hospital practices, priorities, educational requirements, and staffing with respect to breastfeeding.	Healthcare systems, payers, and policy makers must adopt a consistent set of standards for educational requirements, practice priorities, and staffing for maternity care around breastfeeding.
Sell It! • How to sell ○ Why should I think about this? Care? ○ How will this help me win? • Decrease jargon, simplify language: ○ Careful with exclusive breastfeeding ○ Value of benefits, tailored, not prescriptive solutions, malnutrition • Provisions of Healthcare Reform Law	Social marketing campaign for policymakers on women and infant nutrition.	Funding is required for social marketing.
	Learn and utilize the Healthcare Reform Law to promote breastfeeding.	It is necessary to be careful about how we frame the message.
	Influence the National Prevention, Health Promotion, and Public Health Council.	Learn, utilize, and influence the Healthcare Reform Law and the National Prevention, Health Promotion, and Public Health Council.