Sixth Annual Summit on Breastfeeding: Summary and Action Items

Abstract

The focus sharpens on barriers to meeting the national goals of successful sustained breastfeeding at 6 months and 1 year of life; the challenge before us is to impact issues on many levels. We must achieve viable, effective, preventive services to advance the initiation and sustainability of breastfeeding among all mothers and infants. Leaders in our nation have been brought together for the sixth year, committed to these endeavors.

—Christopher L. Wade, MD, MPH

Summit Co-Chair

Session topics	Issues/messages	Actions/recommendations
A National View Continued Progress? Continued Priority? RADM Boris D. Lushniak, MD Carolyn Maloney Congresswoman (NY) U.S. House of Representatives Remarks presented by Christopher Gorud, Legislative Assistant to Rep. Maloney	Reaffirmation of our national goals, The Surgeon General's Call to Action, and priorities supporting breastfeeding at 6 months and 1 year of life. We need to address the challenges that will lead us to achieve viable, cost-effective plans to advance the initiation and sustainability of breastfeeding.	Improve the long-term effect of successful breastfeeding practices leading to a reduction in the prevalence of obesity in children and promote the positive effects for overall health of the mother and her infant during their life. Improve the response to disparities that make breastfeeding a lower priority. Improve culturally relevant support systems for women of color. Develop strategies for the changes needed in the workplace to address breastfeeding needs. Address the role that culture plays in the sustainability of breastfeeding in all aspects of childhood nutrition. Provide leadership that helps integrate the national goals to provide the optimal nutrition and health for infants at 6 months and 1 year of life.
Agency Implementation George L. Askew, MD Chief Medical Officer Administration for Children and Families, HHS Lekisha Daniel-Robinson Director Centers for Medicare & Medicaid, HHS	Interagency roles in the addressing specific disparities that affect successful long-term breastfeeding priorities for mother and infant	Recognize the role of agencies and their need for cross-agency evaluation of priorities leading to enhanced support for sustained breastfeeding. Improve the use of relevant data across agencies as they support a multitude of communities. Review how these agencies improve the knowledge base to all providers of health care and potentially integrate their common goals for breastfeeding sustainability in a leadership role nationally.
	Assisting state and local processes in addressing successful programmatic approaches to the identification and understanding of barriers to improving the cultural disparities to breastfeeding	Promote global processes that use a myriad of tools to address the social impact to change perceptions of breastfeeding and improve the social perception of our community response to sustained breastfeeding.Develop concepts that sustaining breastfeeding brings us closer to sustained health benefits for a lifetime.
Influential Role of Professional SocietiesThomas McInerny, MDImmediate Past-PresidentAmerican Academy of PediatricsMark S. DeFrancesco, MDPresident-ElectAmerican College of Obstetricians and GynecologistsReid Blackwelder, MDPresidentAmerican Academy of Family Physicians	Addressing and updating the position papers on breastfeeding by their respective societies and their effect on a congruent position across the platform of sustained breastfeeding success	Update policies and positions to reflect the consistency of our national response to sustaining breastfeeding across the nation, improving the united goals and message for women.Continue to expand the depth of partnering with cornerstones in the area of breastfeeding and initiatives that bring collaborations to fruition (Academy of Breastfeeding Medicine, United States Breastfeeding Committee, Academy of Pediatrics, American Academy of Family Practice, American College of Obstetricians and Gynecologists, The National Institute of Child Health and Human Development, and 1,000 Days; research; and subject matter experts)
Breastfeeding Research and Program DataCutberto Garza, MDAcademic Vice PresidentBoston College Jane Morton, MDProfessor, Department of PediatricsStanford University	Research continues to build significant understanding of the role that breastmilk plays in optimal growth and nutrition and promotes sustaining health through a lifetime.	Research continues the refinement of growth standards nationally and internationally of sustained breastfeeding and its effect on the health status of the infant through the first thousand days of life and prospective impact on an entire lifetime.The effect enables improved support and management of pregnancy and postnatal care, including sustained breastfeeding. It enhances the potential for improvement in maternal child policies and goals and opens research opportunities in the treatment of premature and low-birth-weight infants.
	Exploring viable strategies to envelop our mothers and infants in our hospitals to sustain breastfeeding	We need a critical mass of skilled, accountable bedside nurses to maintain a preventative, available, and sustainable program to allow the magic of Baby-Friendly care to flourish. The momentum for hospitals to adopt Baby-Friendly practices is the perfect time for bold changes. “A.B.C” can be used to remember the objectives: A=Attachment, B=Breastmilk production, C=Caloric/nutritional parameters—simple indicators of normal and adequate intake.
It's Not for Hospitals AloneCindy PelligriniSenior Vice-President, Public Policy and Government AffairsMarch of DimesErin BonzonAssociate Director, Women's & Infant HealthAssociation of Maternal and Child Health Programs	Maternal and child health programs have a 75-year history of building comprehensive, integrated systems to ensure the health and well-being of women, children (including children with special healthcare needs), and their families.	Partner with colleagues in chronic disease and Medicaid to develop and implement model benchmark policies for public and private insurance coverage of lactation counseling, support, and supplies.Partner with state labor departments and provide resources to employers to help guide implementation of worksite accommodations and reasonable break time for nursing mothers.Partner with state breastfeeding coalitions to implement a breastfeeding-friendly workplace accommodation recognition program.Create and use breastfeeding benchmark indicators, data, and information regarding breastfeeding women participating in the MIECHV program.Ensure MIECHV and other home visitors receive training about breastfeeding resources and information available to participants.
The State of a State: CaliforniaRaymond J. Baxter, PhDSenior Vice President of Community Benefits, Research and Health PolicyKaiser PermanenteEric Walsh, MDFormer Director, Pasadena Public Health DepartmentTera K. HillardProgram Manager, Black Infant Health ProgramGreat Beginnings for Black BabiesKelly HardySenior Director, Health PolicyChildren Now	Breastfeeding is a crucial aspect of the concept of “total health.” It impacts the mother and infant, the community, and the society and has a worldwide effect upon all countries. By not sustaining breastfeeding, we are placing the total health of our country at risk in many ways. Envisioning the broader impact of sustained breastfeeding, we can achieve impact in many areas of health of all people.	Improve the commitment to families, the workforce, and communities by requiring an investment in a comprehensive approach to support sustainability of breastfeeding and all of the health benefits for the mother and child during their lifetime.Optimize the operations of medical centers and hospitals and education and training of all professionals to support sustained breastfeeding and require also the establishment of system-wide performance improvement programs, evidence-based hospital breastfeeding practices, and ongoing levels of support and sustained focus throughout the first year of life.Leadership requires a conscious decision to facilitate the changes needed to achieve the highest level of quality for the "total health" for the mother and infant, families, and all communities.
	Understanding the effect of a cultural gap on breastfeeding sustainability for African Americans creates the need for a more directed and sensitive effort at raising the depth of our consciousness and the need for improving social and interpersonal processes for each mother and infant.	The implications of our role in serving population-based health approaches to issues surrounding breastfeeding success are deeper than previously understood.Develop strategies to not only help individuals push their health burden through good individual interventions, but also decrease the gradient that they push against social, cultural, and individual disparities. Decreasing this gradient will reduce pressures.Prepare the task of coordinating an effort to strategize actions to address the collective impact and effort to close the gap in the disparities that women of color experience at a community/local city level.Create a momentum for those communities to act as an additional level of “family” support needed for sustained breastfeeding.
	Opportunities on the horizon	Promote the use of various evaluation processes and initiatives to create a broader understanding of the impact on sustained breastfeeding.The California County Score Card improves the tracking by county in California of breastfeeding rates. Home visiting programs increase the sustained breastfeeding rates.
		Paid Family Leave Initiatives see women in California breastfeed twice as long as the national median. Young adults, Latinos, and low-income households are the least likely to use this benefit. Improve access for these processes to unite with their targets.
Focus on DisparitiesSusan Karol, MDChief Medical OfficerIndian Health ServicesJennifer A. WhiteProgram Specialist, HealthNAACPCelia BesoreExecutive Director and CEONational Association of Hispanic NursesMalia VillegasDirector, Policy Research CenterNational Congress on American Indians	Infusing equity, social justice, cultural insight, communities of faith, cultural empowerment, and cultural-specific language to support successful sustained breastfeeding among the communities of color	Reengage our communities, creating a healthy and supportive environment for the Indian Nations across America. Work within the tribal processes to secure traditional life values supporting women and their infants. Bring knowledge supporting sustaining breastfeeding forward into the consciousness of all people. Keep moving us toward an equitable distribution of social, economic, and community strength.
	Dedicated vision and strategies help to focus the attention on community building and education of the impact of history upon decisions made today surrounding infant care and breastfeeding. We can learn from history, and we can change history.	Collaborations including community organizers need to come together and create programs with a holistic approach that examines the historical impact that slavery, wet nursing, and formula marketing have had on a woman's desire to breastfeed. Examine the disparities existing in the distribution of social, economic, and political resources.
	Models of care that provide continuity and family of support for breastfeeding are lacking sophistication in language, cultural impact assessment, and interpretation when cultural differences are significant to the success needed.	Improve relationships and coordination among Indian Health Services, agencies, hospitals, and medical professionals.Promote collaborative efforts among healthcare providers, institutions, public and private organizations (e.g., NAACP, Indian Health Services, and WIC programs), and others to infuse and distribute knowledge for cultural support for diverse communities that encourage and need breastfeeding success.
	Preparing America's children—Growing Up Healthy	Ongoing research provides 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.
So Many Problems, So Little TimeKate Dupont PhillipsSenior Program AnalystNemours Health and Prevention ServicesJennifer KleinSenior Advisor to Hillary ClintonToo Small to Fail	The message needed to help a nation and community move forward in the consciousness of all needs to be simple and direct and communicates the advocacy and imperative of our goals.	Promote new research on the science of early childhood brain development, improving the lives and health of children.Support ongoing research aimed at understanding the value that total health and longevity of breastfeeding give our children.
It's All in the CommunicationBob McKinnonFounder and PresidentGalewill, Inc.Irum TaqiAdvocacy SpecialistUNICEF	Can we create a Brand for Breastfeeding? The message is simple—Breastfeeding, Healthy for Life	Improve the culturally significant message to our diverse populations and use the methods to promote advocacy that are consistent with the culture they are intended to support.
	The message needed to help a nation and community move forward in the consciousness of all needs to be simple, direct, and communicates the advocacy and imperative of our goals.	New approaches to promote sustained breastfeeding and the use of brand identification that personalizes breastfeedingUtilize methods that create a brand-identified consciousness for breastfeeding.Create effective/strong messages for the public.Target messages that are culturally significant for the mothers, infant, and breastfeeding.
	Moving to global advocacy highlights challenges contributing to the low profile that breastfeeding has received, including insufficient leadership for breastfeeding, low prioritization and financial commitment by national policy makers, and lack of a unified voice among breastfeeding experts and advocates to compel a unified narrative to recast and reposition breastfeeding for the 21st century.	To this end the global advocacy initiative between UNICEF and WHO actions will follow these areas of actions:• Raise the visibility of breastfeeding as a cornerstone of child survival• Secure resources for national breastfeeding and support policies• Strengthen political commitment to these issues• Galvanize interest and excitement among internal and external stakeholders• Inspire a social movement that repositions breastfeeding as the norm
Advocacy: Recommendations from Summit Participants	Centralize approaches to address health inequities and address disparities in breastfeeding success.	There are better tools/methods on communicating the effect of natural breastfeeding in the context of the micro-view of infant growth and development. Looking at other hallmarks of benefits from breastfeeding might include the aspect of infant growth and maturity of breastfeeding experience reflected in how babies socialize and become integrated into family and communities.
	Collaborate broadly.	Create the ability of various cultures to coalesce around a central theme that the lifelong effect of sustained breastfeeding is a value for the mother, the infant, and society's total health.Improve understanding of the value of cultural support systems from impact and gap analyses to move closer with mother/infant social support integration at the family/community level. Multiple organizations with diverse goals can lead to support the growth of health-based communities sharing common knowledge and success.
	Simplify the message.	Bring together organizations to meet in the middle to develop strong strategies that can effectively address the “formula” silent wars that are directed at mothers during the mid-day time frame.Explore the message that breastfeeding is natural.
		Simplify the message—envelop the breastfeeding mother and infant as the most precious resource: Healthy for Life

HHS, U.S. Department of Health and Human Services; MIECHV, Maternal, Infant and Early Childhood Home Visiting; WHO, World Health Organization; WIC, Special Supplemental Nutrition Program for Women, Infants, and Children.