Third Annual Summit on Breastfeeding: Issues and Action Items

Abstract

Topic and summary statement	Opportunities/issues	Potential actions
Federal Government: Washington Leadership and Progress Significant progress has been made in the past year in Federal efforts to promote and support breastfeeding, and there is upcoming opportunity to incorporate breastfeeding promotion into many federal support health promotion efforts. Led by the CDC, an interagency workgroup has been formed to coordinate efforts to promote breastfeeding and increase U.S. breastfeeding rates. This has been a long-standing recommendation that is at last a reality.	Breastfeeding is a biological process that encompasses much more than just the composition of breastmilk and has a profound impact on all aspects of child development.	It is appropriate to incorporate breastfeeding into health prevention strategies for a variety of chronic diseases. Opportunity exists to emphasize the importance of breastfeeding to health outcomes across the life span and involve non–maternal-child health medical practitioners in breastfeeding promotion.
	Federal funding is available for home visitation programs. Additionally, community transformation grants provide an opportunity to incorporate recommendations about evidence-based prevention strategies such as breastfeeding.	Because of the strong evidence base around the health benefits of breastfeeding and the risks of formula feeding, there are opportunities to incorporate breastfeeding promotion/education into evidence-based home visiting interventions and into community transformation grants. Advocates are encouraged to provide recommendations to each of the 17 Federal agencies on the National Prevention Council as to what each agency could do to promote breastfeeding.
	Strengths, needs, and resources of individual communities are unique and need to be assessed and understood before breastfeeding support at the local level can be optimized.	CDC has many data sets that can help to characterize local populations. Many of the analyses are available; the CDC is interested in assisting communities in assessing local strengths and needs.
	Safety net programs that we value are at great risk in the current political climate.	(a) Ask health prevention advocates such as Senator Harkin to convene a hearing about functional food additives. (b) Encourage work on code implementation—specifically the elimination of formula sample distribution from hospitals. (c) With regard to WIC, urge representatives to get on record in support of WIC; strike reporting language in current appropriation bill; urge an increase in funding.
Best Practice: Front Line Reports Local community, county, and state initiatives provide real life examples of how to assess needs and address deficiencies to promote breastfeeding using the socioecological model of support across the continuum of women's lives.	A variety of examples of successful programs addressing issues including increasing hospital support for breastfeeding, peer support programs, and WIC agency support have been implemented across the US to great success. There is immense potential to use these programs to mentor efforts in other localities.	Public health officials, advocates, and healthcare providers may find successful models on which to base local interventions by looking to other cities, counties, and states. Communication and sharing between programs may foster successful adaptation to local needs and preserve scarce resources.
Payers as Players Explore various approaches current Payers have used to accomplish breastfeeding and nutrition solutions to the President/Surgeons General's “Call to Action” in support of increasing the benefits of breastfeeding. As Players the session brought together nine participants from the public and private sectors: WIC, United Healthcare Community Plan, OptumHealth, Well-Point, Inc., TRICARE, Texas Children's Hospital, Baylor College of Medicine, Kaiser Permanente, and the National Quality Forum.	Address cultural solutions that improve breastfeeding support and reimbursement for interventions that affect communities of color, transition to culturally determined breastfeeding solutions sets, relationships to the work environment, and social support improving breastfeeding outcomes directly.	Leverage the impact of WIC and solutions increasing the penetration of effective breastfeeding solutions while reducing the impact of formula feeding. There is a social commitment that needs continued support for no reductions in current funding for WIC and other safety net programs.
	Develop a series of strategies defining effective reimbursement for breastfeeding support. These should pay attention to the implementation of multifactorial activities in deploying effective transitional processes to take the current progress and augment these; include changes to reimbursement processes improving the breastfeeding length of duration over the next 10–20 years. The defining process must encompass the mother, baby, and the environment for breastfeeding. The environment should include cultural integration of communities of color.	Integrate and expand the role of breastfeeding success from 6 months to 1 year, with the positive effects of the Family and Medical Leave Act outcomes and Health Care Reform initiatives, to address the following issue: “How do we allow all women who choose to breastfeed the opportunity to return to work at 6 months without loss of their jobs and its intrinsic negative impact to family income loss, breastfeeding success, impact to childhood obesity, and improved infant health?”
Economics of BreastfeedingA. Building a Better CaseEncourage firms to support breastfeeding, relying on:• building good employee relationships• eliminating job turnover• benefits from such activitiesNeed paid maternity leave (no federal rules exist).	• Does a business case exist that this is in the self-interest of the company employing those who become mothers?• Maternal labor force issues• Net cost to employers• What is the proper role for the healthcare financing system?	New research to show improved health of mothers themselves (i.e., breast cancer, ovarian cancer, diabetes).Need very strong research to support best business case.
B. Barrier RemovalProvide timely coaching and information to new mothers.Social issues:• Paid maternity leave• Health insurance coverage• Public breastfeeding in the law• Cost to mothers when they work	Hospitals, practitioner's offices, and WIC can provide peer support.Development of milk banks within hospitals so that all infants receive human milk; costs remain unknown.Consider direct payment to mothers to breastfeed.	Institutional changes: Develop Baby-Friendly hospitals.The Joint Commission should mandate the Ten Steps.Eliminate free formula.Congress fully funds WIC so the formula rebates are not required to fund the Program.Income tax breaks or payments for breastfeeding.
C. Increasing the Knowledge Base Need better understanding of economic costs of breastfeeding (lost wages, etc). Understanding of economic savings of breastfeeding.	Need to know:• The real value of exclusivity• Incremental value of duration• Impact of herd immunity from disease for children• Medical cost saving of maternal protection from cancers and diabetes• What activities or programs will increase duration by education, income, and other socioeconomic groups?	Highly focused requests for proposals from the National Institutes of Health, Agency for Healthcare Research and Quality, CDC, and foundations.The social science of breastfeeding.Enormous research agenda required but well worth the effort given the potential benefits of increasing breastfeeding in the United States and around the world.
Affordable Care Act: Opportunities and Challenges To some degree, mothers may not succeed in meeting their breastfeeding goals because of potentially preventable problems. These problems can be made worse by the injudicious provision of infant formula in the maternity care setting. The degree to which healthcare providers, hospitals, and birthing centers assume responsibility for poor breastfeeding outcomes is difficult to determine. Employment constitutes a significant barrier to breastfeeding duration. The Affordable Care Act requires provision of adequate break time and a designated area for breastmilk expression in the workplace. The U.S. Department of Labor will assume the responsibility for guidance in interpreting and implementing of Affordable Care Act requirements.	Quality indicators specifically related to breastfeeding must be established by which to assess medical care performance. Accountability for said performance can be established by means of linking indicator compliance to compensation.	A potential high-impact example might include providing differential reimbursement to maternity care centers who are practicing the Ten Steps.
	The Affordable Care Act provides opportunities for improvement in the quality of medical care of the breastfeeding dyad, by means of (1) mandatory insurance coverage of breastfeeding counseling services and (2) Medicaid-provided support of free-standing birth center services, home visitation programs, enhanced access to preventive health services, and Section 4108 demonstration grants.	Advocates should encourage The Joint Commission to adopt the Ten Steps as required quality indicator standards of maternity care.
		Healthcare organizations and breastfeeding advocates must remain vigilant in monitoring the degree to which the U.S. Department of Labor oversees the enforcement of the Affordable Care Act provisions for protection and support of breastfeeding in the workplace.
Sell It Again, Sam! How do we use strategic communications to advance the breastfeeding agenda?	Articulate the benefits of breastfeeding without maligning mothers who choose not to breastfeed or overstating the dangers of not breastfeeding.	Have a balanced perspective. Be proactive about acknowledging the challenges faced by all mothers, especially women of color and women in underserved communities; then, explain in detail the plethora of interventions/services/programs made available by advocates to support these mothers. Advance solutions that work and are working with affected communities.
	Consider devoting resources to developing an advocacy strategy and plan to counter marketing and advocacy of well-resourced opponents. Breastfeeding effort could include messaging research for audiences including policy leaders and community leaders, who can and should be more involved in advocacy.	Expand our communications reach strategically to create public will for policy and program changes.
	Expand our communications reach beyond select health professionals and employers to potential partners/messengers/users of our services including communities of faith, media, and community leaders.	Be more intentional about sharing best practices via user friendly, non-technical language.

CDC, Centers for Disease Control and Prevention; WIC, Women, Infants, and Children.