Fifth Annual Summit on Breastfeeding: Summary and Action Items

Abstract

Session topics	Issues	Actions
Equity/Health Disparities	Language/messaging to reach minority and immigrant communities	• Develop and incorporate culturally appropriate unique messages for specific populations
		• The use of messages with more emotional, less informational, content is effective, especially for low-income and minority families.
		• Promote maternal self-efficacy
		• Use culturally appropriate messaging at the community level and during prenatal care to increase maternal commitment to early and sustained exclusive breastfeeding
	Culturally appropriate care	• Recognize the role of support persons, neighborhoods, community ecology, poverty, and the workplace in a woman's choice to breastfeed
		• Raise the profile of fathers as key partners in supporting breastfeeding women in their families
		• Encourage existing mother-to-mother support groups such as ROSE (Reaching Our Sisters Everywhere), MOCHA Moms, and Black Mothers' Breastfeeding Association
	Need for social marketing of breastfeeding	Use social marketing as a powerful tool to change perceptions of breastfeeding
	Access to adequate support	Encourage Baby-Friendly hospitals in minority communities; support WIC peer counseling programs
	Lean Six Sigma	Using Lean Six Sigma methodology, explore and identify the root problems impacting low initiation, duration, and exclusivity rates in poor and impoverished communities
Formula Marketing	FDA lacks authority to determine efficacy of additives in infant formula.	Urge the FDA to conduct scientific reviews of formula additives
	Marketing of breastfeeding	• Use modern advertising techniques to promote breastfeeding.
		• Utilize lessons learned from groups like Alive and Thrive in other areas of the world
		• Create effective/strong messages for mothers/the public
		• Target prenatal and preconception time periods
	WHO code compliance	• Encourage professional organizations to be code-compliant
		• More directly confront efforts to promote formula
Milk Banking	Inadequate supply of donor milk	• Increase the public awareness of uses of donor milk and opportunities for mothers to donate milk
		• Work to establish metrics to document total volume of donor milk required
	FDA has not assumed responsibility for setting standards for human donor milk banking.	Encourage the FDA to assume a regulatory role in overseeing milk bank operation
	Evidence base for donor milk and fortifiers is minimal.	• More research is needed around use of donor milk and human milk fortifiers in populations of sick and well infants.
		• Investigate the therapeutic use of donor milk in other disease processes
	National standards are needed for milk bank operation and for the production of donor human milk products.	• Develop national standards, policies, and procedures for milk banking
		• Develop donor milk national standards with regard to products (milk, fortifiers)
		• Develop a national donor milk registry
Federal and State	Implementation of ACA-covered lactation services and breast pumps	• Define standards for covered breast pumps and services (who can provide these)
		• Document implementation of breastfeeding support coverage by insurers
		• Lobby for Medicaid reimbursement for peer counselor/community health worker services
	Legislative advocacy	Continue to lobby for services to support breastfeeding at local, state, and national levels
	Workplace advocacy	• Develop tools for breastfeeding mothers to use in seeking workplace protection (time and facilities to express milk)
		• Develop resources for small employers/challenging worksites to support breastfeeding in workplace and highlight successful examples
	Breastfeeding is a public health issue, not a lifestyle choice.	Frame language to emphasize breastfeeding as a health issue/child right and highlight the importance of exclusive human milk feeding and feeding at the breast (e.g., avoiding mother–baby separation)
	“War on Women” in Congress	Lobby for support/funding for maternal and child health programs and breastfeeding across agencies at the federal, state, and local levels
	FDA lacks authority to determine efficacy of additives to infant formula.	Urge FDA scientific review of formula additives
	WIC and formula distribution	• Lobby to remove formula distribution from WIC services
		• Lobby for WIC breastfeeding initiatives including peer counseling programs
	Implementation of Surgeon General's “Call to Action”	Use action steps to guide implementation of breastfeeding support at the local, state, and national levels
Community Support	Community-level support for breastfeeding is lacking.	Create breastfeeding-friendly environment in key institutions (defined at the local level)
	Collaboration among community organizations	• Improve relationships and coordination among local WIC agencies, hospitals, and medical professionals
		• Promote collaborative efforts between healthcare providers/institutions and public health departments
		• Develop tools and infrastructure to increase the impact of mother-to-mother support groups
	Models of care that provide continuity of support for breastfeeding are lacking, as is the research base.	• Research/provide examples of successful programs to engage mothers' support networks and healthcare provider support
		• Develop and document models of care that provide continuity of support across time (prenatal to postpartum) for mothers at risk for not initiating or not sustaining breastfeeding
Providers	Availability of lactation consultants in hospitals	Work to establish a nationally accepted standard number of lactation consultants per number of births for well and NICU populations
	Some physicians do not recognize the importance of breastfeeding and human milk feeding.	Physician education around breastfeeding targeted to all physician specialties, especially Obstetrics/Gynecolody, Family Practice, Internal Medicine, and Pediatrics
	Many physicians do not know how to bill for lactation services.	Develop coding/billing resources and educate physicians, residents, advanced practice nurses, and office billers
	Marketing of formula in physician offices and by medical organizations	Encourage WHO code compliance in outpatient and inpatient settings and by medical organizations
	Electronic health records lack important documentation with regard to breastfeeding.	Encourage vendors of electronic health records to include adequate and standardized documentation of breastfeeding (e.g., infant feeding assessments in hospital record, skin to skin in delivery room)
Research	The United States is focusing on breastmilk feeding rather than breastfeeding.	• Research the health consequences of breastmilk feeding versus exclusive breastfeeding
		• What are the consequences of focusing policy solutions on milk (milk expression at work, payment for pumps, donor milk) as opposed to the process of breastfeeding?
		• Review the research needs in the field (e.g., composition of breastmilk direct from breast versus breastmilk pumped and frozen)
		• Conduct research to ascertain the mental health aspects of breastfeeding as opposed to breastmilk feeding
	Lessons from abroad should be used to help guide U.S. efforts.	Use country-level lessons from projects in other areas of world (e.g., Alive and Thrive; USAID) to inform U.S. efforts
Advocacy	Collaborate broadly	• Utilize private/public/nonprofit partnerships
		• Tie breastfeeding practices in hospitals (Ten Steps) more clearly to Joint Commission (incentivize hospitals by standards)

ACA, Affordable Care Act; FDA, Food and Drug Administration; NICU, neonatal intensive care unit; WHO, World Health Organization; WIC, Special Supplemental Nutrition Program for Women, Infants and Children.