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Mayor
Dwight C. Jones
Breastfeeding Commission
Presented to:
DWIGHT C. JONES, MAYOR
JULY 23, 2013
MAYOR’S BREASTFEEDING COMMISSION
REPORT TO DWIGHT C. JONES, MAYOR OF CITY OF
RICHMOND
July 23, 2013
CHAIR
STEPHANIE L. FERGUSON, Ph.D., RN, FAAN
Table of Contents
Page
I. Message from Chair 5
II. Executive Summary 6
III. Commission Structure 8
IV. Introduction 11
V. Breastfeeding Research
A. Federal and State Initiatives and Policies B. The Benefits of Breastfeeding C. Breastfeeding Among Minority Women D. Barriers to Breastfeeding
15
15
17
19
19
VI. Current Breastfeeding Activities in Richmond City Government 21
VII. Sub-Committee Preliminary Recommendations 23
VIII. Final Draft Recommendations 27
IX. Public Forums 30
X. Final Recommendations 34
XI. Conclusion 37
XII. Appendices
A. List of Meeting Dates and Topics Covered
B. Breastfeeding Research Listing
C. Breastfeeding Commission Notebook Contents
D. Media Coverage
E. PowerPoint Presentation
F. Breastfeeding Survey
38
38
40
41
42
49
82
THE MAYOR’S BREASTFEEDING COMMISSION JULY 2013
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I. Message from Chair
I express my gratitude and appreciation to Mayor Dwight C. Jones for his vision and commitment to promote
breastfeeding as a strategy to address public health issues and tackle school readiness, especially for Richmond’s
most vulnerable families. My sentiments also hold true for the enthusiastic members of the Mayor’s
Breastfeeding Commission and for the citizens of Richmond who provided valuable input. Without their
collective dedication, commitment, vision and flexibility, the bold recommendations provided in this report
would not have materialized.
More and more, Americans are realizing the exceptional benefits of breastfeeding. Scientific studies have shown
abundant benefits for babies, mothers and overall healthcare when newborns are breast-fed for a minimum of six
months. Despite what we know about the benefits of breastfeeding to children, mothers and the community,
many barriers to breastfeeding still exist. The Breastfeeding Commission’s recommendations seek to address
many of the barriers and create an environment where breastfeeding is supported and promoted, and health
inequalities are reduced.
All members of the Mayor’s Breastfeeding Commission contributed so much to this process. Regrettably, during
our service, we lost a true breastfeeding champion – Ms. Joyce Marie Branch also known lovingly as ―Sistah J‖.
Sistah J knew the important connection between breastfeeding and positive self development, both physical and
cognitive, in our most vulnerable children. She also was extremely optimistic that through partnerships and
educational awareness, social stigma as well as lack of know-how would be greatly reduced thereby creating
healthier communities. I share and embrace her optimism!
Thank you for affording me this phenomenal opportunity to champion this initiative on behalf of families in the
City of Richmond.
Yours in Service,
Stephanie L. Ferguson, Ph.D., RN, FAAN,
Chair: Director International Council of Nurses’
(ICN) Leadership for Change Programme
Director, Global Nursing Leadership Institute – Geneva Switzerland Consultant, World Health Organization Formerly, VCU School of Nursing, Director of the Community Nursing Organization and Associate Professor
THE MAYOR’S BREASTFEEDING COMMISSION JULY 2013
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II. Executive Summary
At least twice in the history of the United States, the medical community has been compelled to initiate
campaigns urging an increase in breastfeeding. Researchers in the early 20th century, found evidence to support
breastfeeding and its positive impact to decrease infant mortality. In 1897, the Chicago Department of Health
estimated that 15 hand-fed babies were dying for every breastfed baby. (Low Breastfeeding Rates and Public
Health in the United States. Wolfe, 2003) Today, there are many studies that find that numerous diseases and
health conditions are preventable or would be significantly reduced by prolonged breastfeeding. Once again,
breastfeeding is endorsed and embraced as a preventive health measure. Researchers have determined the link
between human milk and human health for both women and children. However, ―as important as breastfeeding
is to health, cultural norms override healthy activities. If breastfeeding initiation, exclusivity, and duration rates
are to increase…breastfeeding mothers need unambiguous medical, social and cultural support.‖ (Wolfe, 2003)
This context that ignites proactive leadership in Richmond to promote, support and protect breastfeeding.
In July 2011, Mayor Dwight C. Jones officially created the Mayor’s Breastfeeding Commission and charged the
group with advising his administration on increasing the number of women breastfeeding, particularly among
underserved and fragile women in Richmond, where participation was well below the state average. On July 12,
2011, the Breastfeeding Commission led by co-chairs Doris D. Moseley, Director of the Richmond Department
of Social Services and Stephanie L. Ferguson, PhD, Associate Director at the School of Nursing at VCU, held a
historic press conference. Notable speakers at this event included: Dr. Karen Remley, Commissioner, Virginia
Department of Health; representatives of the three major Richmond Heath Systems: Mary Anne Graf, Vice
President of Women’s and Children’s Services at Bon Secours Virginia Health System; Ben Warner, Chief
Nursing Officer, HCA Virginia Health System; Jeniece Roane, Director of Nursing for Women’s and Children’s
Health, VCU Health System; John Easter, Senior Vice President for Government and Community Affairs of the
Greater Richmond Chamber; and Stormy Noland, a breastfeeding mother who works at Richmond Department
of Social Services. Approximately 100 citizens attended the press conference and well over half stayed to
participate in the inaugural meeting.
At the meeting, officials recognized Richmond City as the first locality to establish a breastfeeding commission
and the first to bring together businesses, government and healthcare advocates to encourage women - especially
low-income mothers - to breastfeed. During Mayor Jones’ address, he acknowledged the following:
Breastfeeding benefits infants, mothers, families and the entire community as it increases the likelihood
of healthy children, reduces childhood obesity, and enhances the health of mothers, thus contributing to
lower health care costs and lower rates of healthcare interventions.
Breastfeeding protects children from infection, illness, and allergies and enhances the development and
intelligence of infants who are exclusively breast-fed for six-months or longer.
Exclusive breast milk feeding for the first six months of life has long been the expressed goal of the
World Health Organization, The Joint Commission (formerly the Joint Commission on Accreditation of
Healthcare Organizations), the United States Department of Health and Human Services, the American
Academy of Pediatrics, and the American College of Obstetricians and Gynecologists.
THE MAYOR’S BREASTFEEDING COMMISSION JULY 2013
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Richmond City supports a comprehensive multi-faceted approach to increasing breastfeeding rates
among childbearing women in our community.
Further, Mayor Jones charged the Breastfeeding Commission to provide him with recommendations for
consideration, specifically:
strategies and priorities to pursue to increase the number of women exclusively breastfeeding for six
months or more;
strategies and priorities that can be sustained over time to attain and maintain the number of women
breastfeeding at a level of 25 percent or more;
strategies for the inclusion of other relevant groups in the ongoing efforts of increasing breastfeeding;
strategies that will eliminate ethnic and socio-economic disparities in the implementation of a
breastfeeding initiative;
the development of an ongoing social marketing campaign designed to increase citizens’ awareness and
knowledge of the benefits of breastfeeding, including relevant resources;
funding suggestions to sustain proposed breastfeeding initiatives.
From July 2011 through July 2012, the Breastfeeding Commission, a diverse group of individual leaders
representing sectors including public, private, non-profit, grass-roots, education, business, etc., came together to
target improved breastfeeding rates as a viable strategy to address public health, educational and social services
issues. The framework for their work was the Centers for Disease Control and Prevention’s Guide to
Breastfeeding Interventions and the Richmond Healthy Start Initiative – a program designed to improve birth
outcomes particularly in low-income communities. It is extremely important to note that diversity was paramount
in composing the Commission primarily because the members would serve as ―ambassadors‖ and lead the
promotion of breastfeeding efforts in their respective communities.
This report provides information regarding the Commission’s structure and activities, relevant research related to
federal and state initiatives, benefits and barriers to breastfeeding and specifically look at breastfeeding among
minority women. It examines the current state of breastfeeding in Richmond. Finally, the report provides the
background and methodology for preliminary recommendations and presents final recommendations. The final
recommendations include:
Recommendation 1 - Encourage Health Systems to adopt the 10 Steps of the Baby Friendly Hospital
Initiative to achieve the 2020 Healthy People Goals.
Recommendation 2 - Support and encourage Richmond City businesses to develop and implement
comprehensive lactation support programs for their employees and patrons.
Recommendation 3 - Promote partnerships and education among care providers who come into
contact with mothers, fathers, partners, and families before, during, and after childbirth, and during the
infant’s first year of life.
Recommendation 4 - Develop an Education/Marketing Strategy.
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Once the recommendations are approved, the Breastfeeding Commission will develop a work plan that will serve
as the framework for implementing the recommendations.
III. Commission Structure
Mayor Jones appointed 47 members in five key areas: Health Care; Business Community; Government;
Community; and At Large. Positions refer to those held by members at time of Commission’s appointment.
Co-Chairs:
Stephanie Ferguson, Ph.D., RN, FAAN - Associate Professor, School of Nursing, Community Nursing Organization, Virginia Commonwealth University
Doris D. Moseley, MM/HRM – Director, Department of Social Services, City of Richmond
The members of the Health Care Sub-Committee were:
Sulola Adekoya, MD, OB/GYN - Director of Clinical Services, Richmond City Health District
Lisa H. Akers, MS, RD, IBCLC, RLC –State Breastfeeding Coordinator, Virginia Department of Health
Joyce Branch, Birth Doula
Tracey Causey, CEO – Capital Area Health Network
Valerie Coleman, RN, MSN, IBCLC, FACCE – Lactation Specialist, Virginia Commonwealth University
Health Systems
Angela D. Davis - Division Director, March of Dimes
Susie Dunton, RN – Lactation Specialist, Chippenham Hospital
Laurinda Finn - Davis, RN, BSN – Nursing Supervisor, Richmond City Health District
Gauri Gulati, MD – Pediatrician/Lactation Consultant, Director of Pediatric Residency, Virginia
Commonwealth University Health System
Brian Gullins - Program Coordinator, Richmond Family and Fatherhood Initiative, Richmond City
Health District
Vernessa Holmes - WIC Breastfeeding Coordinator and Nutritionist, Richmond City Health District
Karen Jefferson - MD, OB/GYN
Basmah Karriem – Birth Doula
Vicki Lovings, MD – Pediatrician, private practice
Carolina Lugo – La Leche League
Leslie Lytle – MS, CMA, LCCE, OmMama, LLC
Saba Masho, MD, MPH, DrPH – Department of Epidemiology and Community Health, School of
Medicine, Virginia Commonwealth University
Norma Ryan – Outreach Worker, CHIP of Greater Richmond
Martina Jones-Smith - Postpartum Doula
Amy Turner - Community Education and Outreach Director, Bon Secours Health System
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Adrienne Uphoff, AAPL, IBCLC, RLC – La Leche League
Carol Williams, MD - Pediatrician
Business Community subcommittee members were:
Chris Bennett - Members Services and Accounting Manager, Greater Richmond Chamber
Guenet M. Beshah - Executive Coach, Capitol One
LaJune D. Fowlkes - Health Educator/Community Relations Liaison, VA Premier Health Plan, Inc.
George Peyton - Retail Merchants Association of Greater Richmond
Freda Thornton- President, FWL and Sons, McDonalds Corporation
Lynn Vogel-Program Manager Field Operations, Anthem HealthKeepers Plus
Government members were:
Ashley Barton, LCSW – Division of Maternal and Child Health, Virginia Department of Medical
Assistance Services
Gurdeep Bhatia – IT Manager, City of Richmond
Valena A. Dixon - Vice President, Community Relations and Marketing, Richmond Redevelopment and
Housing Authority
Carolyn N. Graham, M.Ed, MPA, M.DIV, DMIN - Deputy Chief Administrative Officer for Human
Services
Stormy Noland - Department of Social Services (Breastfeeding Mother)
Theresa Sirles - Systems Operations Analyst I
Carol Stanley, MS, CPHQ - Quality Improvement Analyst, Virginia Department of Medical Assistance
Services
Community members were:
Laneka Austin - WIC Breastfeeding Peer Counselor
Cecilia Barbos - Principal, cBe Consulting
Melanie Headley- Certfied Lactation Counselor, Child Birth Educator
Shawna Manning
Anoa M. Marshall
Cherry Peters- Interim Executive Director, Friends Association for Children
Rev. Deborah Simmons – Director of Women Ministry, Baptist General Convention
Monica Tinsley - WIC Breastfeeding Peer Counselor
Rachael Watson - Community Breastfeeding Mother
THE MAYOR’S BREASTFEEDING COMMISSION JULY 2013
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At-Large Members were:
Teri Brown – RN, BSN, BA, PHN, Richmond City Health District
Lydia English – Outreach Worker, Bon Secours Richmond Health System
Kathryn Suyes – RN, BSN, MSN – Public Health Nurse, Richmond City Health District
In addition to the above, there were several interested persons who attended and contributed greatly to the
Commission’s work. Those members are:
April Frasier
Sarah Boyd
Denise DiCicco, RN
Patricia Mills
Melinda King
Susan Lindner
Kelly Harris-Braxton
Kendal Brooks
Sonyia Elder, RN
Christine Flavin
Chinary Hall
Kathy Stewart
Carolyn Hawley
Nubia Reid
Richmond City Staff:
Rose Stith Singleton
Betty J. Northington-Winston
Carla P. Childs Sadie Johnson Myra Barnes
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IV. Introduction
The City of Richmond is committed to improving health outcomes for its citizens. Mayor Dwight C. Jones has
been unyielding in his support to tackle critical health issues. Under his leadership, Richmond has placed a major
emphasis on health initiatives ranging from encouraging breastfeeding to developing bike trails for residents.
This initiative began with the establishment of the Blue Ribbon Commission on Health Policy (Commission) in
January 2010, which was created and convened by Mayor Jones to address disparities in health outcomes across
the Richmond community.
The Commission -- which was made up of health experts including physicians, hospital executives, mental health
and clinical providers, and members of the community -- worked together to identify critical health issues facing
the City of Richmond. The Commission identified numerous factors that contributed to disparity and poor
health, and prioritized and agreed on five recommendations they believed would make the greatest impact on
improving the health and well-being of Richmond residents. The recommendations to Mayor Jones were:
Healthy Richmond Campaign - promoting healthy lifestyle behaviors and participating in various
initiatives to improve the health of Richmond’s residents.
Health and Social Equity - impacting policy by creating an infrastructure that promotes healthy living.
Behavioral Health - addressing prevention and intervention for at-risk youth and families.
Medical Homes for the Uninsured - eliminating barriers that impact access to health care.
Support for Healthcare Providers - encouraging health care providers to practice in underserved areas of
the community.
After the initial recommendations of the Commission, the following initiatives/commissions were integrated into
the overall Healthy Richmond Campaign: Breastfeeding Commission, Pedestrian Bikes and Trails Commission,
Food Policy Task Force, Blue Ribbon Health Commission; and the city’s commitment to the Let’s Move!
initiative, all of which represent initiatives that promote a healthy, physically active community.
The Beginning of Richmond’s Breastfeeding Initiative
Prior to the establishment of the Breastfeeding Commission, Dr. Carolyn N. Graham, then Deputy Chief
Administrative Officer for Human Services, established a solid foundation for refocusing the human services
delivery process in Richmond on 10 key strategic human services goals. They were:
1. All children enter school ready to learn
2. Children and youth succeed in school
3. Children live in healthy, safe and supportive families
4. Youth make a successful transition to adulthood
5. Youth choose healthy behaviors
6. All residents have access to quality health care
7. Families live in healthy, safe and supportive communities
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8. Residents have opportunities for lifelong learning
9. All families are economically self-sufficient
10. Elders and persons with disabilities are valued and live with dignity and independence
Due to Dr. Graham’s extensive work and advocacy in human services, she recognized the promotion of
breastfeeding as a viable strategy for achieving healthier children, mothers and families that in turn create
healthier communities. With this view, breastfeeding was identified and adopted as a strategy to support several
of the human services goals. In advocating the establishment of a breastfeeding initiative, a concept paper was
presented to Mayor Jones that included objectives, rationale and supporting evidence that breastfeeding improves
health and wellness outcomes for children, families, and the community. Following are highlights from the
concept paper:
Objectives:
1. Develop a Breastfeeding Commission for the City
2. Increase breastfeeding rates in the City with an emphasis on underserved, fragile women
3. Develop and implement a comprehensive multifaceted initiative that has been shown to have promise in
increasing breastfeeding numbers
4. Develop an ongoing social marketing campaign designed to increase citizen awareness and knowledge,
including related resources, regarding the benefits of breastfeeding
Why Breastfeeding is Important:
1. Breastfeeding offers an unmatched beginning for our children – Feeding infants human milk has
been scientifically demonstrated to provide babies with the most complete nutrition possible. Research
indicates that breastfed babies received the optimal mix of nutrients and antibodies necessary for the
baby to thrive. Scientific studies show that breastfed children have fewer and less serious illnesses than
those who never receive breast milk, including a reduced risk of SIDS, fewer childhood illnesses
including cancer and diabetes, and a decreased risk of becoming obese. As reported in The American
Women and Breastfeeding, and Pediatrics, post neonatal infant mortality rates in the United States were
reduced by 21 percent in breastfed infants. Further, UNICEF data on child survival rates indicate that
optimal breastfeeding could save more infant lives than almost any other single measure. If every baby
were exclusively breastfed from birth to six months and continued breastfeeding to any amount for a few
months thereafter, an estimated 1.5 million lives would be saved.
2. Mothers who choose breastfeeding are healthier – Recent studies show that women who breastfed
have decreased risks of breast and ovarian cancer, anemia, heart disease, and osteoporosis.
3. Families who breastfeed save money – Breast milk is free and breastfeeding provides savings on
health care costs and time lost to care for sick children.
4. Communities reap the benefits of breastfeeding – Research confirms there is less absenteeism from
work and less tax money required to provide assistance to properly fed children. Breastfed babies have
higher brain function, cognitive and nervous system development.
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5. The environment benefits when babies are breastfed – Scientists agree that breast milk is still the
best way to nourish babies and protect them from some of the ill effects of pollution. Because there is
no waste involved in breastfeeding, each breastfed baby is a contributor to a decline in pollution and
garbage disposal problems.
Methodology and Recommendations:
According to the Centers for Disease Control and Preventions’ Guide to Breastfeeding Interventions, while
formal evaluations of breastfeeding interventions are not yet widespread, the recommended interventions have
been reviewed by the Cochrane Collaboration and published through the Cochrane Library, a comprehensive
collection of up-to-date information on the effects of health care interventions.
The six (6) recommendations by the CDC are:
1. Maternity Care Practices (Baby Friendly Hospital Initiative-BFHI)
2. Support for Breastfeeding in the Workplace
3. Peer Support
4. Educating Mothers
5. Professional Support
6. Media and Social Marketing
Of the six recommendations, four were targeted for consideration by this Commission: 1. Maternity Care
Practices; 2. Support for Breastfeeding in the Workplace; 4. Educating Mothers; and 6. Media and Social
Marketing. The other recommendations –Peer and Professional Support (3 & 5) - were areas already being
addressed through the Women Infant and Children (WIC) breastfeeding program. A description of and rationale
for each recommendation follows.
Maternity Care Practices (Baby Friendly Hospital Initiative-BFHI)
Partner with area hospitals so they can obtain ―Baby Friendly Hospital‖ status. The United Nations Children's
Fund (UNICEF) and the World Health Organization (WHO) launched the BFHI in 1991 with the goal of
increasing rates of breastfeeding worldwide and in turn, reduce childhood illness and death. To be recognized as
Baby Friendly, a hospital must provide the best possible care for breastfeeding mothers and their infants by
following the WHO’s ―Ten Steps to Successful Breastfeeding.‖ These steps ensure that all mothers receive
breastfeeding education and support from well-trained staff.
Support Breastfeeding in the Workplace
Appoint representatives from the business community to serve on the Breastfeeding Commission. Work to
advance the Business Case for Breastfeeding - a comprehensive program designed to educate employers about
the value of supporting breastfeeding employees in the workplace. The program highlights how such support
contributes to the success of the entire business. The Business Case for Breastfeeding offers tools to help
employers provide worksite lactation support and privacy for breastfeeding mothers to express milk. The
program also offers guidance to employees on breastfeeding and working.
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Educating Mothers – A Program Specific Model – The ABCs of Breastfeeding (Healthy Hearts Plus,
Inc.)
Implement ―Living Well – The ABCs of Breastfeeding.‖ Target and provide 100 pregnant women, particularly
fragile and underserved, with life skills approach and hands-on training to become successful breastfeeding
moms and influence their attitudes toward breastfeeding. The ABCs of Breastfeeding, previously piloted by the
Richmond Healthy Start Initiative, informs, encourages and empowers mothers to A – Appreciate themselves;
B – Bond with their baby; and C – to be a Caregiver of self and baby. In addition, it promotes wellness
through healthy lifestyle practices and healthy eating patterns, thereby giving babies a healthier start in life.
Media and Social Marketing
Launch a social marketing campaign to raise the level of consciousness of City residents. Develop a
comprehensive, strategic and multifaceted campaign targeting diverse audiences.
In July 2011, Mayor’s Order #2011-5 created the Mayor’s Breastfeeding Commission to develop priorities and
strategies, and to identify potential funding sources and mechanisms by which the city could promote
breastfeeding, particularly among underserved and fragile women.
The Commission began its work with an inaugural gathering and press conference on July 12, 2011. Mayor Jones
and other notable speakers, including: Karen Remley, MD-Commissioner of the Virginia Department of Health;
Mary Ann Graf, Vice President of Women’s and Children’s Services at Bon Secours Virginia Health System; Ben
Warner, RN, MBA,CENP Chief Nursing Officer at HCA Virginia Health System; Jeniece Roane, MS, RN, NE-
BC, Director of Nursing for Women’s and Children’s Health at Virginia Commonwealth University Health
System; John Easter, Senior Vice President of Government and Community Affairs at the Greater Richmond
Chamber of Commerce; and Stormy Noland, breastfeeding mother and social worker at the Richmond
Department of Social Services. The Commission met monthly until May 31, 2012 (See monthly meeting agendas
below). The Commission’s work initial work included a review Breastfeeding Research that included Federal and
State Initiatives and Policies, The Benefits of Breastfeeding, Breastfeeding among Minority Women, and Barriers
to Breastfeeding. In addition, and because of the group’s diverse makeup (knowledge level, ethnicity, experiences,
sectors), members were provided a comprehensive notebook containing breastfeeding related reports and data
from a variety of recognized sources.
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V. Breastfeeding Research
Throughout the process, Commission members and staff were continuously engaged in conducting research on
the benefits of breastfeeding to babies, mothers and families. Countless hours were spent reviewing reports,
articles and others documents as well as talking with medical and community experts to ensure that the
Commission had the most up-to-date information on interventions and innovations in breastfeeding best
practices. In Appendix B, you will find helpful resources used for our research and cited in the report. In order to
consider possible recommendations, the Commission review Federal and State Initiatives and Polices related to
Breastfeeding.
A. Federal and State Breastfeeding Initiatives and Policy
Members were provided and reviewed historical information as a foundation to continue to build knowledge in
the field and to inform and base recommendations upon. It was extremely important that everyone be exposed
to the same information and be aware of the evolution of breastfeeding laws and policies in order to recommend
feasible breastfeeding strategies in Richmond.
One of the first reports reviewed was The Surgeon General’s Call to Action to Support Breastfeeding. The ―call to
action‖ provided exceptional information about the level of federal support for breastfeeding. The 2011 report
was the latest to express the inherent benefits of breastfeeding for Americans. Over the last 25 years, U.S.
Surgeons General has been urging support for breastfeeding as evidenced by the following information in the
report:
In 1984, Surgeon General C. Evertte Koop held the first workshop on breastfeeding and human
lactation, which drew together professional and lay experts to outline actions needed to improve
breastfeeding rates. The following recommendations were proposed: 1) strengthen the support of
breastfeeding in the health care system, 2) improve professional education in human lactation and
breastfeeding, 3) develop public education and promotional efforts, 4) develop a broad range of support
services in the community, 5) initiate a national breastfeeding promotion effort directed to women in the
workforce and expand research on human lactation and breastfeeding.
In 1985 and 1991, the follow-up reports from the Surgeon General's workshop were developed to
describe the various breastfeeding promotion activities emanating from the workshop. 1) Report of the
Surgeon General's workshop on breastfeeding and human lactation (1984), 2) Follow up report: the
Surgeon General's workshop on breastfeeding & human lactation (1985).
1990, the United States signed onto the Innocenti Declaration on the Protection, Promotion and Support of
Breastfeeding, which was adopted by the World Health Organization (WHO) and the United Nations
Children’s Fund (UNICEF). This declaration called upon all governments to nationally coordinate
breastfeeding activities, ensure optimal practices in support of breastfeeding through maternity.
In 1991, Surgeon General David Satcher requested that a departmental policy on breastfeeding be
developed, with emphasis on reducing racial and ethnic disparities in breastfeeding. The following year,
the Secretary of the U.S. Department of Health and Human Services, under the leadership of the
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Department’s Office on Women’s Health, released the HHS Blueprint for Action on Breastfeeding. This
document, which has received widespread attention in the years since its release, declared breastfeeding
to be a key public health issue in the United States.
In addition to the above, the 2011 ―call to action‖ provides information on which states have adopted supportive
breastfeeding laws and regulations. See Virginia highlighted and underlined in several bullets.
Forty-five states, the District of Columbia and the Virgin Islands have laws that specifically allow women
to breastfeed in any public or private location. (Alabama, Alaska, Arizona, Arkansas, California,
Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Illinois, Indiana, Iowa, Kansas, Kentucky,
Louisiana, Maine, Maryland, Massachusetts, Minnesota, Mississippi, Missouri, Montana, Nebraska,
Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio,
Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Vermont,
Washington, Wisconsin and Wyoming.)
Twenty-eight states, the District of Columbia and the Virgin Islands exempt breastfeeding from public
indecency laws. (Alaska, Arizona, Arkansas, Florida, Illinois, Kentucky, Louisiana, Massachusetts,
Michigan, Minnesota, Mississippi, Montana, Nevada, New Hampshire, New York, North Carolina,
North Dakota, Oklahoma, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Utah,
Virginia, Washington, Wisconsin and Wyoming.)
Twenty-four states, the District of Columbia and Puerto Rico have laws related to breastfeeding in the
workplace. (Arkansas, California, Colorado, Connecticut, Georgia, Hawaii, Illinois, Indiana, Maine,
Minnesota, Mississippi, Montana, New Mexico, New York, North Dakota, Oklahoma, Oregon, Rhode
Island, Tennessee, Texas, Vermont, Virginia, Washington and Wyoming.)
Twelve states and Puerto Rico exempt breastfeeding mothers from jury duty. (California, Idaho, Illinois,
Iowa, Kansas, Kentucky, Mississippi, Montana, Nebraska, Oklahoma, Oregon and Virginia.)
Five states and Puerto Rico have implemented or encouraged the development of a breastfeeding
awareness education campaign. (California, Illinois, Minnesota, Missouri and Vermont.)
Further, the report cites several states that have unique laws related to breastfeeding. For instance:
Virginia allows women to breastfeed on any land or property owned by the state. Puerto Rico requires
shopping malls, airports, public service government centers and other select locations to have accessible
areas designed for breastfeeding and diaper changing that is not bathrooms.
At least two states have laws related to child care facilities and breastfeeding. Louisiana prohibits any
child care facility from discriminating against breastfed babies. Mississippi requires licensed child care
facilities to provide breastfeeding mothers with a sanitary place that is not a toilet stall to breastfeed their
children or express milk, to provide a refrigerator to store expressed milk, to train staff in the safe and
proper storage and handling of human milk, and to display breastfeeding promotion information to the
clients of the facility.
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California requires the Department of Public Health to develop a training course of hospital policies and
recommendations that promote exclusive breastfeeding and specify staff for which this model training is
appropriate. The recommendation is targeted at hospitals with patients who ranked in the lowest 25
percent of the state for exclusive breastfeeding rates.
Maryland exempts the sale of tangible personal property that is manufactured for the purpose of
initiating, supporting or sustaining breastfeeding from the sales and use tax.
California, New York and Texas have laws related to the procurement, processing, distribution or use of
human milk.
New York created a Breastfeeding Mothers Bill of Rights, which is required to be posted in maternal
health care facilities. New York also created a law that allows a child under one year of age to accompany
the mother to a correctional facility if the mother is breastfeeding at the time she is committed.
B. The Benefits of Breastfeeding
Another tremendously valuable resource was www.womenshealth.gov – a project funded by the U.S. Department of
Health and Human Services, Office on Women’s Health. Womenshealth.gov provides information, resources and
links to other sites concerning the many benefits of breastfeeding. Womenshealth.gov outlines the evidence basis
for the benefits of breastfeeding for babies, mothers and society and provides:
Breastfeeding benefits for babies:
Early breast milk is liquid gold – Known as liquid gold, colostrum is the thick yellow first breast milk
that you make during pregnancy and just after birth. This milk is very rich in nutrients and antibodies to
protect your baby. Although your baby only gets a small amount of colostrum at each feeding, it matches
the amount his or her tiny stomach can hold.
Your breast milk changes as your baby grows – Colostrum changes into what is called mature milk.
By the third to fifth day after birth, this mature breast milk has just the right amount of fat, sugar, water,
and protein to help your baby continue to grow. It is a thinner type of milk than colostrum, but it
provides all of the nutrients and antibodies your baby needs.
Breast milk is easier to digest – For most babies — especially premature babies — breast milk is easier
to digest than formula. The proteins in formula are made from cow’s milk and it takes time for babies’
stomachs to adjust to digesting them.
Breast milk fights disease – The cells, hormones, and antibodies in breast milk protect babies from
illness. This protection is unique; formula cannot match the chemical makeup of human breast milk. In
fact, among formula-fed babies, ear infections and diarrhea are more common. Formula-fed babies also
have higher risks of:
Necrotizing enterocolitis, a disease that affects the gastrointestinal tract in preterm infants
THE MAYOR’S BREASTFEEDING COMMISSION JULY 2013
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Lower respiratory infections
Asthma
Obesity
Type 2 diabetes
Some research shows that breastfeeding can also reduce the risk of Type 1 diabetes,
childhood leukemia, and atopic dermatitis (a type of skin rash) in babies. Breastfeeding has
also been shown to lower the risk of SIDS (sudden infant death syndrome).
Mothers benefit from breastfeeding
Life can be easier when you breastfeed – Breastfeeding may take a little more effort than formula
feeding at first. But it can make life easier once you and your baby settle into a good routine. Plus, when
you breastfeed, there are no bottles and nipples to sterilize. You do not have to buy, measure, and mix
formula. And there are no bottles to warm in the middle of the night! You can satisfy your baby’s hunger
right away when breastfeeding.
Breastfeeding can save money – Formula and feeding supplies can cost well over $1,500 each year,
depending on how much your baby eats. Breastfed babies are also sick less often, which can lower health
care costs.
Breastfeeding can feel great – Physical contact is important to newborns. It can help them feel more
secure, warm, and comforted. Mothers can benefit from this closeness, as well. Breastfeeding requires a
mother to take some quiet relaxed time to bond. The skin-to-skin contact can boost the mother’s
oxytocin levels. Oxytocin is a hormone that helps milk flow and can calm the mother.
Breastfeeding can be good for the mother’s health– Breastfeeding is linked to a lower risk of these
health problems in women:
Type 2 diabetes
Breast cancer
Ovarian cancer
Postpartum depression
Mothers miss less work – Breastfeeding mothers miss fewer days from work because their infants are
sick less often.
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Breastfeeding benefits society
Recent research shows that if 90 percent of families’ breastfed exclusively for 6 months, nearly 1,000
deaths among infants could be prevented. The United States would also save $13 billion per year —
medical care costs are lower for fully breastfed infants than never-breastfed infants. Breastfed infants
typically need fewer sick care visits, prescriptions, and hospitalizations.
Breastfeeding also contributes to a more productive workforce since mothers miss less work to care for
sick infants. Employer medical costs are also lower.
Breastfeeding is also better for the environment. There is less trash and plastic waste compared to that
produced by formula cans and bottle supplies.
C. Breastfeeding among Minority Women
The Commission focused a great deal of attention on increasing breastfeeding among at-risk and underserved
women in Richmond as these women have a much lower rate of breastfeeding, which contributes to a higher
infant mortality rate. According to the Richmond Healthy Start Initiative, while the state’s infant mortality rate is
declining, Richmond’s rate is much higher than the state average, and shows significant racial disparities (in 2011,
the infant mortality rate for blacks in Richmond was 12.1 per thousand births, compared to 3 per thousand in
whites).
D. Barriers to Breastfeeding
According to many of the sources reviewed, the obstacles to breastfeeding are numerous. The Joint Center for
Political and Economic Studies Health Policy Institute provided the following comprehensive list of obstacles in
their report – African American Women and Breastfeeding.
Insufficient prenatal education about breastfeeding;
Healthcare staff with insufficient training in lactation medicine;
Disruptive hospital policies and practices;
Commercial promotion of infant formula through distribution of hospital discharge packs,
coupons for free o discounted formula, and TV and magazine advertising;
Early use of supplements, artificial nipples, and pacifiers;
Lack of timely routine follow-up and postpartum health home visits;
Maternal employment, including short maternity leave;
Lack of workplace support, including appropriate facilities and adequate time for
breastfeeding/breast milk expression;
THE MAYOR’S BREASTFEEDING COMMISSION JULY 2013
20
Lack of peer and family support (e.g. father of baby, grandmother);
Lack of society support;
Lack of role models;
Lack of health insurance support;
Media portrayal of formula (bottle) feeding as the norm;
Misinformation/lack of access to current, accurate information; and
Lack of guidance and encouragement from health professionals.
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VI. Current Breastfeeding Activities in Richmond City
Government
As Commission members worked to identify workable strategies, there are several initiatives already taking place
to address the need to increase breastfeeding especially for low-income African-American women.
In April 2012, the Richmond City Department of Social Services (RDSS) Richmond Healthy Start
Initiative in partnership with the Virginia Commonwealth University School of Medicine received an
award for their proposed community engagement project entitled, Barriers and Facilitators to
Breastfeeding among Low-Income African-American Women in Richmond, Virginia. The
funding will be used to conduct breastfeeding community forums to hear directly from mothers about
their experiences and expectations feeding their babies. This is an extremely significant accomplishment.
The potential research findings from the community forums could position the City to be the beneficiary
of long-term breastfeeding funding from major organizations including the National Institutes of Health
and the CDC.
In May 2012, the Richmond Department of Social Services’ Richmond Healthy Start Initiative and the
Faces of Hope- a local non-profit dedicated to fighting childhood obesity- received a grant award from
the Virginia Foundation for Healthy Youth to establish The Richmond Health Action Alliance. The Alliance
will develop a comprehensive plan to prevent and control childhood obesity by promoting breastfeeding
among new mothers and increasing physical activity among youngsters.
The City’s first lactation room is located at RDSS (left) and the second was just added to City Hall (right)
THE MAYOR’S BREASTFEEDING COMMISSION JULY 2013
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The Richmond Healthy Start Initiative (RHSI) and Breastfeeding Commission members participated in
the world wide Big Latch-On campaign on August 4, 2012. The event, designed to raise awareness about
the importance of breastfeeding, was a tremendous success. RHSI, which works with low-income
pregnant women along with representatives from the three hospital systems in Richmond - HCA, Bon
Secours, and VCU Health System - joined forces to coordinate our local latch on at the state capitol.
Over 100 people attended the event and almost 50 mothers’ breastfed. The event received positive media
coverage. The major television networks along with several newspapers covered the event. (See appendix)
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VII. Sub-Committee Preliminary Recommendations
Following months of presentations, research and meetings, each sub-committee was charged with making its
recommendations to the full body. The following preliminary recommendations were submitted by each sub-
committee chair and presented to the full body.
Business Case Preliminary Recommendations
Recommendation 1: Establish an awards system with 3 tiers:
Bronze – Employer meets basic criteria of the Affordable Care Act
Silver – Employer must meet bronze level plus other criteria
Gold – Employer must meet bronze and silver level plus more criteria. They would be considered to
have the ―Luxury suite‖ of lactation rooms
Awards would be presented by Mayor Jones (or designee) at an awards breakfast, luncheon or dinner.
Recommendation 2: Present at the GRCC meeting (s) the importance of a lactation room
Solicit feedback from businesses on presentation and specify the help they need.
Technical assistance such as policy development and review.
Guidance for implementing a mom’s room.
Recommendation 3: Develop a sample policy template for employers to use, which would include 4-5 main
categories for consideration.
―Fill in the blank‖ sample policy that could be adapted by most places of business
Recommendation 4: Provide grant funding similar to the Virginia Dept of Health’s ARRA grant.
Give technical assistance to employers in Richmond City, such as helping them to develop a
workplace policy around lactation and providing needed equipment (electric breast pumps and
accompanying supplies)
Recommendation 5:
Develop a public marketing campaign to promote breastfeeding in the workplace
Staff a booth at the Greater Richmond Chamber events
Series of articles/tips in the weekly e-newsletter to Greater Richmond Chamber members
Community Educators/Programs Committee
Recommendation 1: Increase geographic access to resources and services
Strategy: Expand community breastfeeding educational forums in a manner that allows increased
accessibility to inner city locations and populations by partnering with providers and
organizations already serving those areas
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Recommendation 2: Increase access to services by identifying and listing resources in easily accessible
formats for consumers and providers.
Strategy: Create a centralized, easily updated resource of programs providing local breastfeeding
information, support, and services in web-based and print formats.
Recommendation 3: Increase one-on-one support for the childbearing experience.
Strategy: Expand the use of doulas and lactation consultants within the insurance groups so that
they are adequately reimbursed and can be utilized by an increased number of underserved
populations.
Recommendation 4: Build community knowledge and support for breastfeeding.
Strategy: Develop a marketing campaign to educate the larger community on the benefits of
breastfeeding, presented in a multi-dimensional manner so that it reaches the population being
targeted, i.e., newspaper, television, radio, website, billboards, bus signs, social media, etc.
Health Care Providers Committee
Recommendation 1: Increased Education
Health Care Providers, Nurses, and all those coming in direct contact with mothers during pre-natal
care, and infants during first year of life will receive breastfeeding awareness training at least once a
year.
Medical and Nursing students should receive breastfeeding training during their post graduate
rotations.
Update to American College of Obstetrician and Gynecologists and American Academy of Pediatrics
Guidelines to ensure that Universal screening and conversations about breastfeeding are happening at
each trimester of pregnancy, and the first year of infant’s life. Accountability measures will be in
place to ensure guidelines are being followed, and will not vary from provider to provider.
Consistent and universal distribution of breastfeeding education material. Pamphlets in OB and
Pediatric offices should consist of low literacy pamphlets. Written resources for local Breastfeeding
groups such as La Leche League, text4baby, WIC, as well as posters, and videos, should be available.
All should be universal and available, at little or no cost to public as well as private providers for
distribution.
Recommendation 2: Increased and Consistent Follow up Care
Baby nurses and/or certified lactation consultants will place follow up calls to check on progress of
breastfeeding, and refer to appropriate resources for first six months of life.
THE MAYOR’S BREASTFEEDING COMMISSION JULY 2013
25
Lactation consultants and/or nurses certified in lactation support will be on hand and available to
mother and infants during pediatric checkups for infants first year of life. An up to date referral list
of lactation support services will be available and distributed to all OB and pediatric offices.
Increase the number of interpreters, and/or availability of phone interpreters. The process of making
appointments for clients who need interpreters should be streamlined, and available to all providers,
both private and public.
Recommendation 3: Streamlining of Medicaid Process
Streamline Medicaid process to ensure that moms are covered early in pregnancy to allow for proper
pre-natal care as well as Breastfeeding Education at the beginning stages of pregnancy and
throughout.
Appointment with case worker and/or insurance provider prior to hospital discharge to ensure that
mom and baby are covered at time of discharge to allow for immediate follow up care and resources.
Recommendation 5: Increase availability of Electric Breast Pumps
Increase availability of hospital grade electric pumps through WIC and/or Medicaid for moms that
plan on returning to work within the first eight weeks. Education on pumping and back to work
should also be provided.
Hospital Community Committee
Recommendation 1: The Hospital Systems Task Group of the Mayor’s Breastfeeding Commission
agrees that breastfeeding and the provision of breast milk is the optimal nutrition source for all
newborns. Further, the Health Systems Task Group agrees to collaborate to achieve the 2020 Healthy
People Goal of exclusive breastfeeding for newborns for a minimum of 6 months.
Recommendation 2: The Hospital Systems Task Group requests that the Virginia Department of
Health’s Commissioner send a communication to all hospital administrations and key stake holders
advocating for compliance with all 10 Steps of the Baby Friendly Hospital Initiative. Further, they
advocate that this communication include a recommendation that all administrations and key stake
holders encourage all staff to facilitate mothers being able to engage in skin to skin contact as soon as is
feasible when their infants are born.
Recommendation 3: The Hospital Systems Task Group of the Mayor’s Breastfeeding Commission
recommends that the maintenance of breastfeeding information and data be coordinated with the State
of Virginia’s data collection and statistics immunization records and reporting system.
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Recommendation 4: The Hospital Systems Task Group of the Mayor’s Breastfeeding Commission
recommends the establishment of a regional breastfeeding resource handbook, available in hardcopy and
on the Virginia Breastfeeding Commission website.
Recommendation 5: Requests financial support in order to develop and implement:
20 hour breastfeeding curriculum for RNs to meet the BFHI requirement.
Curriculum for ancillary staff caring for mothers and babies.
Purchase of formula at fair market value and eliminate the influence of marketing materials
from the formula manufacturers.
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VIII. Final Draft Recommendations
After each committee chair presented their recommendations, a follow-up meeting was held to discuss the
preparation of the report and the process for presenting the information to the Mayor. At the meeting, the co-
chairs, staff and committee chairs discussed each recommendation and agreed that many of the
recommendations were actually strategies that supported four general recommendations. The following is the
final draft recommendations made by the commission and presented to Dr. Graham before engaging in a public
forum process.
Breastfeeding Commission Final Recommendations
Making Richmond a “Baby Friendly-Breastfeeding” City is the vision of the
Mayor’s Breastfeeding Commission. In order to realize this, the following
recommendations are provided for consideration.
Recommendation 1. Encourage Health Systems to adopt the 10 Steps of the Baby
Friendly Hospital Initiative to achieve the 2020 Healthy People
Goal.
Recommendation 2. Support and encourage Richmond City businesses to develop
and implement a comprehensive lactation support program for
their employees and patrons.
Recommendation 3. Encourage/promote partnerships and health education among
health providers who come in contact with mothers/fathers
during preconception, pre-natal care and the infants first year of
life.
Recommendation 4. Develop a Marketing /Education Strategy
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Recommendation 1. Encourage Health Systems to adopt the 10 Steps of the Baby Friendly
Hospital Initiative to achieve the 2020 Healthy People Goals.
Strategies:
Implement the 10 Steps of the Baby Friendly Hospital Initiative:
1 - Have a written breastfeeding policy that is routinely communicated to all health care staff.
2 - Train all health care staff in skills necessary to implement this policy.
3 - Inform all pregnant women about the benefits and management of breastfeeding.
4 - Help mothers initiate breastfeeding within one hour of birth.
5 - Show mothers how to breastfeed and how to maintain lactation, even if they are separated
from their infants.
6 - Give newborn infants no food or drink other than breast milk, unless medically indicated.
7 - Practice ―rooming in‖-- allow mothers and infants to remain together 24 hours a day.
8 - Encourage breastfeeding on demand.
9 - Give no pacifiers or artificial nipples to breastfeeding infants.
10 - Foster the establishment of breastfeeding support groups and refer mothers to them on
discharge from the hospital or clinic.
Encourage health systems and community health care providers to support breastfeeding curricula for
health care professionals, paraprofessionals and ancillary staff caring for mothers and babies.
Encourage Health Systems to work collaboratively to promote breastfeeding .
Recommendation 2. Support and encourage Richmond City businesses to develop and
implement a comprehensive lactation support program for their employees
and patrons.
Strategies:
Establish a three tier awards system for the Mayor to recognize employers who actively seek to make
Richmond a ―Baby-Friendly‖ City by supporting breastfeeding. The following is recommended:
Bronze – Employer meets basic criteria of the Affordable Care Act
Silver – Employer must meet bronze level plus other criteria
Gold – Employer must meet bronze and silver level plus more criteria. They would be
considered to have the ―luxury suite‖ of lactation rooms.
Develop templates and/or sample policies for businesses to adopt that range from the businesses
meeting basic needs to those that meet or exceed HRSA Business Case for Breastfeeding
recommendations.
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29
Encourage special event venues to negotiate with activity sponsor (s) to include a contract provision for a lactation area/space at the activity to ensure that breastfeeding moms have adequate dedicated space and to advertise breastfeeding space availability in their promotions.
Recommendation 3. Encourage/promote partnerships and health education among health
providers who come in contact with mothers/fathers during preconception,
pre-natal care and the infant’s first year of life.
Expand the use of doulas and lactation consultants within the insurance groups so that they are
adequately reimbursed and can be utilized by an increased number of underserved populations.
Encourage health providers to advocate for a streamlined Medicaid process to ensure early coverage to
allow for proper pre-natal care as well as breastfeeding education.
Promote collaboration among health providers, case workers and insurance providers to ensure coverage
at the time of discharge and immediate follow-up care for mom and baby are available.
Increase and/or make available language interpreters either on-site or by phone to assist mothers.
Provide breast pumps to pediatricians for distribution during initial post-partum visit. Ensure that
lactation consultants (doulas, nurses, etc.) are on hand and available to support mother and baby during
pediatric check-ups for a least one year. Provide up-to-date referral list of lactation support services and
distribute to all OB and pediatric offices.
Support the efforts of WIC breastfeeding peer counselors through collaborations and partnerships.
Update to American Congress of Obstetrician and Gynecologists (ACOG) and the American Academy
of Pediatrics (AAP) Guidelines to ensure that universal screening and conversations about breastfeeding
are happening at each trimester of pregnancy, and the first years of an infant’s life. Ensure that
accountability measures are in place followed and consistent.
Recommendation 4. Develop a Marketing /Education Strategy
Strategies:
Educate the Richmond community on the benefits of breastfeeding using all available venues.
Develop regional breastfeeding resources handbook and other materials in easily accessible formats to
distribute to consumers and providers.
THE MAYOR’S BREASTFEEDING COMMISSION JULY 2013
30
Expand community breastfeeding educational forums to inner city locations and populations to ensure
inclusiveness.
Ensure that all health care providers (physicians, nurses, doulas, etc.) who come into contact with
mothers during prenatal care receive breastfeeding awareness training at least once a year.
Partner with local breastfeeding groups such as Le Leche League, text4baby, WIC, and etc. in the
development of and distribution of materials which supports varying literacy levels.
In addition to the recommendations above, Commission members also identified several immediate activities
that the Mayor support including:
Sponsor a breakfast/lunch with major health and insurance providers to begin the dialogue on
supporting breastfeeding initiatives in the City.
Sponsor an awards program highlighting those businesses that incorporate the Business Case for
Breastfeeding.
Proclaim a City Breastfeeding Month and encourage public and private entities to support breastfeeding.
Advocate for the 10 steps of the Baby Friendly Hospital Initiative with the Virginia Department of
Health Commissioner.
IX. Public Forums
After the presentation to Dr. Graham, the Breastfeeding Commission scheduled five city-wide public forms to ensure public participation. The meetings were strategically located to ensure input from a cross-section of Richmonders. The following notice was distributed throughout the City.
THE MAYOR’S BREASTFEEDING COMMISSION JULY 2013
31
Due to inclement weather, the first meeting was postponed until the following month. At each meeting, participants were provided with a ―clicker‖. At the presentation, the facilitator asked a series of questions and the audience responded with the ―clicker‖. The following are the results of how the public ranked the recommendations:
THE MAYOR’S BREASTFEEDING COMMISSION JULY 2013
32
July 25, 2012 - East District Resource Center
July 26, 2012 – Calhoun Center
July 26, 2012 – Southside Services Center
25%
27.2%24.3%
23.5%
Encourage adoption of the Baby Friendly Hospi...
Support and encourage lactation support progr...
Promote partnerships and education among care...
Develop Marketing / Education Campaign
24.2%
26.6%24.5%
24.7%
Encourage adoption of the Baby Friendly Hospi...
Support and encourage lactation support progr...
Promote partnerships and education among care...
Develop Marketing / Education Campaign
27.2%
24.7%26.3%
21.8%
Encourage adoption of the Baby Friendly Hospi...
Support and encourage lactation support progr...
Promote partnerships and education among care...
Develop Marketing / Education Campaign
THE MAYOR’S BREASTFEEDING COMMISSION JULY 2013
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July 31, 2012– Pine Camp Culture Arts and Community Center
August 9, 2012- Byrd Park Round House
22.4%
24.2%26.7%
26.7%
Encourage adoption of the Baby Friendly Hospi...
Support and encourage lactation support progr...
Promote partnerships and education among care...
Develop Marketing / Education Campaign
23.8%
23.9%26.6%
25.7%
Encourage adoption of the Baby Friendly Hospi...
Support and encourage lactation support progr...
Promote partnerships and education among care...
Develop Marketing / Education Campaign
THE MAYOR’S BREASTFEEDING COMMISSION JULY 2013
34
X. Final Recommendations
The Breastfeeding Commission Final Recommendations Based on Public Input
1. Health Care Providers Committee
Recommendation 1 - Promote partnerships and education among care providers who come into
contact with mothers, fathers, partners, and families before, during, and after childbirth, and during
the infant’s first year of life.
Encourage/promote partnerships and health education among health providers who come in
contact with mothers/fathers during preconception, pre-natal care and the infants first year of
life.
Promote collaboration among health providers, case workers and insurance providers for follow-
up care once mom and baby are home.
Provide breast pumps to pediatricians for distribution during initial post-partum visit.
Ensure that lactation consultants (doulas, nurses, etc.) are on hand and available to support
mother and baby during pediatric check-ups for a least one year.
Provide up-to-date referral list of lactation support services and distribute to all OB and pediatric
offices.
Support efforts of WIC Breastfeeding Peer Counselors.
Target women of childbearing age to teach about the benefits of breastfeeding prior to
conception.
2. Business Case Community Committee
Recommendation 2 - Support and encourage Richmond City businesses to develop and implement
a comprehensive lactation support program for their employees and patrons.
Richmond businesses implement lactation support programs.
Establish a three tier awards system for the Mayor to recognize employers who actively seek to
make Richmond a ―Baby-Friendly Breastfeeding‖ City by supporting breastfeeding. The
following is recommended:
Bronze – Employer meets basic criteria of the Affordable Care Act.
Silver – Employer must meet bronze level plus other criteria.
Gold – Employer must meet bronze and silver level plus more criteria. They would be
considered to have the ―luxury suite‖ of lactation rooms.
THE MAYOR’S BREASTFEEDING COMMISSION JULY 2013
35
Develop templates and/or sample policies for businesses to adopt that range from the businesses
meeting basic needs to those that meet or exceed HRSA Business Case for Breastfeeding
recommendations.
Encourage special event venues to negotiate with activity sponsor (s) to include a contract
provision for a lactation area/space at the activity to ensure that breastfeeding moms have
adequate dedicated space and to advertise breastfeeding space availability in their promotions.
3. Community Educators/Programs Committee
Recommendation 3 - Develop Education /Marketing Strategy.
Partner with breastfeeding groups to develop to coordinated strategy.
Develop a regional breastfeeding resource handbook and other materials in easily accessible and
updateable formats to distribute to consumers and providers.
Expand community breastfeeding educational forums to inner city location and populations to
ensure inclusiveness.
Update to American Congress of Obstetrician (ACOG) and the American Academy of Pediatrics
Guidelines to ensure that universal screening and conversations about breastfeeding are
happening at each trimester of pregnancy, and the first years of an infant’s life. Ensure that
accountability measures are in place, followed and consistent.
Ensure that all care providers (physicians, nurses, doulas, etc.) who come into contact with
mother before, during, and after childbirth receive breastfeeding awareness training at least once a
year.
4. Hospital Community Committee
Recommendation 4 - Encourage Health Systems to adopt the 10 Steps of the Baby Friendly Hospital
Initiative to achieve the 2020 Healthy People Goal.
Implement the 10 Steps:
1 - Have a written breastfeeding policy that is routinely communicated to all health care staff
2 - Train all health care staff in skills necessary to implement this policy
3 - Inform all pregnant women about the benefits and management of breastfeeding
4 - Help mothers initiate breastfeeding within one hour of birth
5 - Show mothers how to breastfeed and how to maintain lactation, even if they are separated from
their infants
THE MAYOR’S BREASTFEEDING COMMISSION JULY 2013
36
6 - Give newborn infants no food or drink other than breast milk, unless medically indicated
7 - Practice ―rooming in‖-- allow mothers and infants to remain together 24 hours a day
8 - Encourage breastfeeding on demand
9 - Give no pacifiers or artificial nipples to breastfeeding infants
10 - Foster the establishment of breastfeeding support groups and refer mothers to them on
discharge from the hospital or clinic
Encourage health systems to support breastfeeding curricula
Work collaboratively with other health systems
THE MAYOR’S BREASTFEEDING COMMISSION JULY 2013
37
XI. Conclusion
The Mayor’s Breastfeeding Commission was established to develop recommendations the City might pursue to
increase the number of women exclusively breastfeeding for six or more months as a viable means to address
both health care disparities and school readiness. The research is clear and positive outcomes linked to
breastfeeding are beyond doubt. The sound recommendations made by the Commission are another progression
on the path to becoming a ―baby-friendly‖ city.
The Commission’s work can be best summarized by the following commentary provided by Commission
member, Leslie Lytle in her on-line publication – OmMama.com:
…….. This commission, of which I was a member, was remarkable in its diversity and commitment. Consisting of pediatricians,
obstetricians, nurses, lactation consultants, childbirth educators, doulas, community activists, representatives from the business and
insurance companies, members of the faith community, (and yes, a prenatal yoga instructor!), all of us share a passion for improving
the health of women and babies. Most of us have been down in the trenches with new mothers, and have first-hand experience with the
social, structural, and economic barriers women face in attempting to breastfeed their infants. It was a powerful group, and if we ruled
the world . . . well, breastfeeding in Richmond would be a whole different experience. It was an honor to be part of a collection of
(mostly) women, who broke down cultural, economic, and professional walls to come up with recommendations for the common good of
mothers and babies in our community.
THE MAYOR’S BREASTFEEDING COMMISSION JULY 2013
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XII APPENDICES
APPENDIX A List of Meeting Dates and Topics Covered
August 4, 2011
Summary/Introduction of Task Groups - Rose Stith Singleton, Program Director, Richmond Healthy Start Initiative
The ABCs of Breastfeeding, Alice Freeman - Healthy Heart Plus
Baby Friendly Hospital Initiative, Valerie Coleman, RN VCU Health System and Amy Turner, Bon Secours
September 7, 2011
Business Case for Breastfeeding - Lisa Aikers, MS, RD, IBCLC, RLC - Breastfeeding Coordinator State
of VAWomen, Infants, and Children (WIC)
Vernessa Holmes, WIC Breastfeeding Coordinator and Nutritionist
October 13, 2011
Health Care Providers -Sulola Adekoya, MD, OB/GYN, Richmond City Health District and Gauri Gulati, MD, Pediatrician/Lactation Consultant, VCU Health System
Doula –Bashmah Karriem, Doula, This is Your Birth
November 3, 2011
Commission members self-selected Task Groups and conducted individual task group
Meetings:
Hospital Community Committee
Business Case Community Committee
Health Care Providers Committee
Community Educators/Programs Committee
December 1, 2011
Social Media Presentation
May Kennedy, Ph.D.
Workgroup Presentations Business Case for Breastfeeding
Lisa Akers (Co-Chair) and Michelle Mason (Co-Chairs)
Health Systems Community
Valarie Coleman (Chair)
THE MAYOR’S BREASTFEEDING COMMISSION JULY 2013
39
January 19, 2012
Workgroup Presentations
Health Care Providers
Business Case for Breastfeeding
Health Systems Community
February 23, 2012
Workgroup Presentations
Health Care Providers
Community Educators/Programs
Susan L. Lindner, RNC, MSN, Clinical Assistant Professor, VCU School of Nursing and
Breastfeeding Initiatives
March 22, 2012
Co-Chairs met to prioritize recommendations
May 31, 2012
Co- Chairs Workgroup Presentations
Hospital Community Committee
Business Case Community Committee
Health Care Providers Committee
Community Educators/Programs Committee
THE MAYOR’S BREASTFEEDING COMMISSION JULY 2013
40
APPENDIX B BREASTFEEDING RESEARCH LISTING
The Surgeon General’s Call to Action to Support Breastfeeding
The Centers for Disease Control (CDC) and Prevention’s Breastfeeding Card – United States, 2010 and
the CDC Guide to Breastfeeding Interventions
Joint Center for Political and Economic Studies Health Policy Institute, African American Women and
Breastfeeding – The Courage to Love: Infant Mortality Commission
U.S. Department of Health and Human Services, Office on Women’s Health – Your Guide to Breast
Feeding
USDA Fathers Supporting Breastfeeding – Adapted from original materials developed by Center for Male
and Family Research and Resources, Morgan State University, Baltimore, Maryland
Virginia Breastfeeding Taskforce - Summary of Enacted Breastfeeding Legislation in Virginia (June 6,
2011)
The Washington Post - Obama orders breastfeeding policy for federal workplace (June 6, 2011)
Politics Daily – Michelle Obama to Promote Breastfeeding as IRS Gives Tax Breaks for Nursing
(February 14, 2011)
Healthy Heart Plus II – Living Well – The ABC’s of Breastfeeding
Baby-Friendly USA, Inc. – Guidelines and Evaluation Criteria for the U.S. Baby-Friendly Hospital
Initiative, 2010
U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA)
– The Business Case for Breastfeeding, Steps for Creating Breastfeeding Friendly Worksite
Virginia Department of Health – Virginia Breastfeeding Advisory Committee site
THE MAYOR’S BREASTFEEDING COMMISSION JULY 2013
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APPENDIX C BREASTFEEDING COMMISSION NOTEBOOK CONTENTS LISTING
Letter from Mayor Dwight C. Jones to Commission Members (July 8, 2011)
Mayor’s Order
Directory of Commission Members
Commission inaugural meeting agenda
Annual Meeting Schedule
Overview of the City’s Breastfeeding Initiative
Relevant Research and Information:
The Surgeon General’s Call to Action to Support Breastfeeding
CDC Breastfeeding Report Card- United States, 2010
Virginia Department of health – Breastfeeding Initiation by selected maternal
characteristics, 2007-2008
CDC Maternity Practices in Infant Nutrition and care in Virginia
The CDC Guide to Breastfeeding Interventions
Joint Center for Political and Economic Studies Health Policy Institute – African
American Women and Breastfeeding, The Courage to Love: Infant Mortality Commission
U.S. Department of Health and Human Services, Office on Women’s Health – Your
Guide to Breastfeeding
USDA – Fathers Supporting Breastfeeding, Breastfeeding Your baby, Making the
Decision Together
The Washing Post – Obama Orders Breastfeeding Policy for federal workplace
Politics Daily- Michelle Obama to Promote Breastfeeding as IRS Gives Tax Breaks for
Nursing
Healthy Hearts Plus – Living Well – The ABC’s of Breastfeeding
The Baby-Friendly Hospital Initiative – Guidelines and Evaluation Criteria for Facilities
Seeking Baby-Friendly Designation (2010 Edition Baby-Friendly USA, INC.)
U.S. Department of Health and Human Services, Health Resources and Services
Administration – The Business Case for Breastfeeding, Steps For Creating a Breastfeeding
Friendly Worksite
District of Columbia Breastfeeding Resource Guide, A Publication of the DC
Breastfeeding Coalition
THE MAYOR’S BREASTFEEDING COMMISSION JULY 2013
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APPENDIX D MEDIA COVERAGE
http://www2.timesdispatch.com/news/2011/jul/25/tdmet05-richmond-panel-to-study-ways-to-encourage--ar-
1194221/
Published: July 25, 2011
Home / news / local /
Panel to study ways to encourage breast-feeding By Kristen Green
In an effort to encourage low-income new
mothers to breast-feed, Richmond Mayor
Dwight C. Jones has formed a commission to
study how to help women after they head
home from the hospital with their newborn.
The panel — the first on breast-feeding in
Virginia to bring together businesses,
government and health-care advocates — will
meet monthly through the end of the year.
Among their goals: to come up with ways to
increase breast-feeding among Richmond's
most fragile residents, particularly low-income
black women.
"They don't have the resources they need and the support that they need," said Dr. Gauri Gulati, a
commission member who founded a lactation clinic at VCU's Children's Medical Center, where she is a
pediatrician.
Advocates of breast-feeding say nursing reduces the risk of infant mortality and guards against obesity and
other illnesses. It also increases babies' cognitive functioning. Breast-feeding is good for moms, too, helping
them shed unwanted pregnancy weight and reducing their risk for breast and ovarian cancers. The practice
also enables mother and child to bond and offers a considerable cost savings over formula.
Gulati said it's important to try to remove some of the barriers to breast-feeding by educating whole families
on the early challenges, to ensure hospitals promote nursing and to find places for women to pump at work.
"It's not as easy as it should be," she said.
Valerie Coleman, a lactation consultant with VCU Health System, said she's excited about being part of the
panel. "We see this as a wonderful opportunity to improve the health of our city," she said.
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She wants the panel to recommend a public awareness campaign that would educate the general population
about the benefits of breast-feeding.
"People don't understand if all infants were given breast milk exclusively in the hospital, it's like giving your
baby medicine," she said. Giving them breast milk, she said, is "giving the gift of the best start in life."
Lisa Akers, the breast-feeding coordinator for the Virginia Department of Health, said she thinks more needs
to be done to support women after they head home with their babies. She said the percentage of women who
initiate breast-feeding is high — about 77 percent — but that figure drops off considerably after they've left
the supportive hospital environment.
An American Academy of Pediatrics study found that if 90 percent of U.S. families would exclusively
breast-feed for six months, it would result in $13 billion in annual cost savings and prevent more than 900
deaths — nearly all of which would be infants. At 80 percent compliance, the savings would be $10.5 billion
and 741 deaths, according to the study, published last year in the journal Pediatrics.
The mayor's goal is to encourage one out of four Richmond mothers to exclusively nurse their babies for at
least six months, rather than use infant formula. Nationwide, 13.6 percent nurse for six months, experts say.
The number of women who breast-feed newborns has increased in recent years, but federal health statistics
show that low-income black mothers remain the least likely to nurse. At the same time, lower-income black
infants as a group suffer higher mortality rates and health risks than their counterparts from other racial and
poorer backgrounds.
Dr. Ann L. Kellams, newborn-nursery medical director at the University of Virginia Health System, said
poorer mothers can face challenges that make it harder to sustain breastfeeding, such as being single parents
or lacking paid maternity leave. There also are some cultural factors at play for some new mothers, including
having peers that aren't supportive of breast-feeding, she said.
"In fairness, most women have heard that it's a good thing to do, but there are a lot of barriers," Kellams said.
"The more challenged you are in other parts of your life, the harder it is to keep breast-feeding."
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http://www2.timesdispatch.com/lifestyles/2012/jan/14/tdmet01-richmond-area-hospitals-move-toward-baby-
f-ar-1610618/
Published: January 14, 2012
Home / lifestyles / health_med_fit /
Richmond-area hospitals move toward baby-
friendly status
By Tammie Smith
Richmond-area hospitals offer families plenty of childbirth and new-baby perks — whirlpool tubs to labor in,
free parenting classes and, at one health system, an
uninterrupted "magic hour" right after birth for mother-infant
bonding.
New mothers get goody bags from the hospitals, which
accept free infant formula from manufacturers worth
thousands of dollars, practices that conflict with an initiative
that recognizes "baby-friendly hospitals" based on
breastfeeding promotion practices.
The Centers for Disease Control and Prevention is trying to
increase the number from the 125 baby-friendly hospitals in
the U.S. that had earned that status as of December.
No hospital in the Richmond area has met all the initiative's
guidelines.
Giving up the free infant formula is one challenge. Culture change is another, said hospital officials.
Bon Secours Virginia Health System is pursuing baby-friendly status for its facilities, said Amy Turner, its
director of women and children's education and outreach.
"We already have Memorial Regional (Medical Center) on the pathway and hope to accomplish that in the
next 18 months to get full status," Turner said. "Both St. Mary's and Memorial are in the application
process."
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VCU Health System is also working toward baby-friendly status, said Valerie Coleman, a nurse educator in
the VCU Women's Health division.
"We have department work groups and breastfeeding champions on every unit to help with education and
implementation of the 10 steps to baby friendly. We do have a timetable and monthly goals for practice
changes and overcoming barriers," Coleman said.
The 10 steps include having a written breastfeeding policy; helping mothers initiate breastfeeding within an
hour of giving birth; giving newborns no food or drink other than breast milk unless medically necessary;
allowing mothers and newborns to room together 24 hours a day; and giving no pacifiers or artificial nipples
to breastfeeding infants.
HCA Virginia hospitals actively promote breastfeeding and are implementing the baby-friendly practices but
not applying for official baby-friendly status at this time, said Sharon McCoy, director of women's services at
CJW Medical Center, which includes Chippenham and Johnston-Willis hospitals.
"We're working toward most of the goals … but I would say the toughest piece is the supplementing with
formula and the diaper bags that traditionally all the hospitals gave out for years with samples," McCoy said.
"It will be a bit of a culture change for our pediatricians, also, who are concerned that the baby is doing well
and gaining weight during those first couple of weeks. But I would say the majority of the baby-friendly
steps are doable and we are actively trying to make improvements," McCoy said.
McCoy said the pacifier prohibition is another area that poses some difficulty. Introducing a pacifier can
make it more difficult for babies to learn to breastfeed.
On the other hand, pacifiers are encouraged to prevent sudden infant death syndrome, and they also help
soothe babies undergoing procedures, McCoy said. "We are not a completely no-pacifier hospital. We use
pacifiers for pain control and soothing."
All the hospitals get free infant formula from companies. To be baby friendly, they have to start paying for it
and stop automatically giving new mothers formula to take home.
New mothers at Bon Secours hospitals, for instance, traditionally have gone home with a goody bag with two
containers of infant formula, said Amy Turner. They still get the bags, but the hospitals do not include
formula unless the mother asks for it. But the hospitals are not totally eliminating formula. Some babies need
supplemental feeding, and some mothers prefer it.
The goody bags, though, are now being refashioned as breastfeeding support bags and include a book about
breastfeeding, nursing pads, creams and gel packs and breast milk collection bottles. Hospitals will start
purchasing formula instead of accepting freebies.
A 2007 survey of 3,207 maternity sites found that 91 percent distributed infant formula sample packs. A
follow-up survey found evidence that more hospitals are going sample-free.
All three health systems have representatives on a Richmond breastfeeding commission appointed by Mayor
Dwight C. Jones in July. At the state level, the Virginia Breastfeeding Task Force is working to make
breastfeeding the cultural norm.
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"It's not just the mechanics of breastfeeding that contributes to successful breastfeeding, it's having the
supports in place that say 'This is good and we want to support you,'" said Rose Stith-Singleton, project
director for Richmond Healthy Start initiative.
Support made all the difference for Allison Sweet who became a new mom two weeks ago.
"I was trying to breastfeed. It was not working. My milk had not come in yet. It's just stressful for a mother
when your baby is crying and you want to give her the best," Sweet said.
Her milk started flowing and with the help of a lactation consultant who provided some tips, she started
breastfeeding. Her daughter received infant formula to supplement the milk Sweet provided. But to avoid
"nipple confusion," where the baby gets used to the bottle nipple and won't latch on, Sweet gave her infant
formula by a syringe or dropper. "We actually would put it in a syringe and I would put my pinky in her
mouth, and I would kind of syringe it like a little bird," Sweet said. "Those sorts of tricks, I would have never known to do."
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APPENDIX E POWERPOINT PRESENTATION
Mayor Dwight C. JonesBreastfeeding Commission
Public Forums
August 9, 2012
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AGENDA
Welcome/Mayor’s Charge – Doris Moseley
Why Breastfeeding
Breastfeeding Context – Rose Stith Singleton
Breastfeeding Commission Committee
Recommendations
Hospital Community Committee
Business Case Community Committee
Health Care Providers Committee
Community Educators/Programs Committee
Next Steps
Closing
1
MAYOR’S CHARGE FOR THE BREASTFEEDING COMMISSION
1. To develop a Breastfeeding Commission for the City of Richmond
2. To increase breastfeeding numbers among women in the City of Richmond with an emphasis on underserved, fragile women
3. To develop and implement a comprehensive multifaceted initiative that has been shown to have promise in increasing breastfeeding numbers
4. To develop an ongoing social marketing campaign designed to increase citizens awareness and knowledge, including related resources, regarding the benefits of breastfeeding
3
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THE COMMISSION
BREASTFEEDING COMMISSION
CO-CHAIRS
Doris Moseley, MM/HRM
Director
Department of Social Services
City of Richmond
Stephanie Ferguson, Ph.D., RN, FAAN
Associate Professor
School of Nursing, Community Nursing Organization
Virginia Commonwealth University
5
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BREASTFEEDING COMMISSION MEMBERS
Sololá Adekoya
Lisa H. Akers
Laneka Austin
Cecilia Barbosa
Ashley Barton
Chris Bennett
Guenet Beshah
Gurdeep Bhatia
Sarah Boyd
Joyce Branch
Kelly Braxton
Kendall Brooks
J.D. Carpenter
Tracey Causey
Valerie Coleman
CeCee Cowans
Angela Davis
Denise Dicicco
Abby Dini
Valena Dixon
Susie Dunton
Sonyia Elder
Laurinda Finn-Davis
Christine Flavin
Lajune Fowlkes
April Fraiser
Alice Freeman
Carolyn Graham
Gauri Gulati
Chinary Hall
Patsy Hataway
Carolyn Hawley
Melanie Headly
Vernessa Holmes
Karen Jefferson
Basmah Karriem
Melinda King
Susan Linder
Vicki Lovings
Carolina Lugo
Leslie Lytle
Shawna Manning
Anoa Marshall
Lea Marshall
Saba Masho
Michelle Mason
Patricia Mills
Stormy Noland
Cherry Peters
George Peyton
Norma Ryan
Deborah Simmons
Theresa Sirles
Martina Smith
Curtis Smith
Carol Stanley
Kathy Stewart
Freda Thornton
Monica Tinsley
Amy Turner
Adrienne Uphoff
Lynn Vogel
Rachel Watson
Carol Williams
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WHY BREASTFEED?
WHY BREASTFEED?
Doctors and
nurses
recommend
it.
8
8
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WHY BREASTFEED?
Benefits for Children:
diarrhea
urinary tract
infectionsear
infections
respiratory
infections
rates of
obesity9
9
WHY BREASTFEED?
Protects against
Benefits for Children
SIDS
Diabetes Type II
Lymphoma
Allergies
Other digestive disorders10
10
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WHY BREASTFEED?
Benefits for Mothers:
Risk of
breast cancer
Risk of
Ovarian cancer11
11
WHY BREASTFEED?
Benefits for Mothers:
Child
Spacing
Quicker return
to pre-pregnancy
weight 12
12
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WHY BREASTFEED?
Benefits for Families
Economic
Efficient
Increases
bonding13
13
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THE COMMISSION’S
RECOMMENDATIONS
Hospital Community Committee
Business Case Community Committee
Health Care Providers Committee
Community Educators/Programs Committee
BREASTFEEDING RECOMMENDATIONS
Recommendation 1. Encourage Health Systems to adopt the 10 Steps of the Baby Friendly Hospital Initiative to achieve the 2020 Healthy People Goal.
Recommendation 2. Support and encourage Richmond City businesses to develop and implement a comprehensive lactation support program for their employees and patrons.
Recommendation 3. Promote partnerships and education among care providers who come into contact with mothers, fathers, partners, and families before, during, and after childbirth, and during the infant’s first year of life.
Recommendation 4. Develop Education /Marketing Strategy15
15
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RECOMMENDATION 1
Health Systems Committee
HEALTH SYSTEMS COMMITTEE
RECOMMENDATION
Baby friendly
hospitals in
Richmond
17
17
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HOSPITAL COMMUNITY COMMITTEE
STRATEGIES
18
Implement the 10 Steps of the Baby Friendly Hospital Initiative:
1 - Have a written breastfeeding policy that is routinely communicated to all health care
staff
2 - Train all health care staff in skills necessary to implement this policy
3 - Inform all pregnant women about the benefits and management of breastfeeding
4 - Help mothers initiate breastfeeding within one hour of birth
5 - Show mothers how to breastfeed and how to maintain lactation, even if they are separated from their infants
6 - Give newborn infants no food or drink other than breast milk, unless medically indicated
7 - Practice “rooming in”-- allow mothers and infants to remain together 24 hours a day
8 - Encourage breastfeeding on demand
9 - Give no pacifiers or artificial nipples to breastfeeding infants
10 - Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic
18
BABY-FRIENDLY HOSPITAL
Have a
breastfeeding
policy
19
19
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BABY-FRIENDLY HOSPITAL
Skin to skin
contact
20
20
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BABY-FRIENDLY HOSPITAL
Inform all
pregnant
women about
breastfeeding
benefits
21
21
BABY-FRIENDLY HOSPITAL
Initiate
within 1 hour
of birth
Practice
“rooming-in”
22
22
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BABY-FRIENDLY HOSPITAL
No pacifiers
or artificial
nipples
23
23
HEALTH SYSTEMS
STRATEGIES
Encourage health systems to support breastfeeding curricula
Work collaboratively with other systems
24
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RECOMMENDATION 2
Business Case Community
Committee
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BUSINESS CASE COMMUNITY
COMMITTEE RECOMMENDATION
Richmond
businesses
implement
lactation
support
programs
26
26
BUSINESS CASE COMMUNITY
COMMITTEE RECOMMENDATION
Richmond
businesses
implement
lactation
support
programs
26
26
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DS
S E
MP
LO
YE
EL
AC
TA
TIO
NC
EN
TE
R
29
29
BUSINESS CASE COMMITTEE
STRATEGIES
Establish a three tier awards system for the Mayor to recognize employers who actively seek to make Richmond a “Baby-Friendly Breastfeeding” City by supporting breastfeeding. The following is recommended:
Bronze – Employer meets basic criteria of the Affordable Care Act
Silver – Employer must meet bronze level plus other criteria
Gold – Employer must meet bronze and silver level plus more criteria. They would be considered to have the “luxury suite” of lactation rooms.
30 30
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BUSINESS CASE COMMITTEE
STRATEGIES
Develop templates and/or sample policies for businesses toadopt that range from the businesses meeting basic needsto those that meet or exceed HRSA Business Case forBreastfeeding recommendations
Encourage special event venues to negotiate with activitysponsor (s) to include a contract provision for a lactationarea/space at the activity to ensure that breastfeedingmoms have adequate dedicated space and to advertisebreastfeeding space availability in their promotions
31 31
RECOMMENDATION 3
Health Care Providers
Committee
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Health Care Providers Committee
Recommendation
Encourage/promote partnerships and health education among health providers who come in contact with mothers/fathers during preconception, pre-natal care and the infants first year of life.
33
33
HEALTH CARE PROVIDERS COMMITTEE
STRATEGIES
Update to American Congress of Obstetrician (ACOG) and the American Academy of Pediatrics Guidelines to ensure that universal screening and conversations about breastfeeding are happening at each trimester of pregnancy, and the first years of an infant’s life. Ensure that accountability measures are in place, followed and consistent
34 34
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HEALTH CARE PROVIDERS COMMITTEE
STRATEGIES
Number of doulas and lactation
consultants
Reimburse them for their services
through insurance companies35
35
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HEALTH CARE PROVIDERS COMMITTEE
STRATEGIES
Promote collaboration among health providers,
case workers and insurance providers for follow-up
care once mom and baby are home
36
36
HEALTH CARE PROVIDERS COMMITTEE
STRATEGIES
Provide breast pumps
to pediatricians for
distribution during
initial post-partum
visit
37
37
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HEALTH CARE PROVIDERS COMMITTEE
STRATEGIES
Ensure that lactation consultants (doulas, nurses, etc.) are on hand and available to support mother and baby during pediatric check-ups for a least one year
Provide up-to-date referral list of lactation support services and distribute to all OB and pediatric offices
38
38
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HEALTH CARE PROVIDERS COMMITTEE
STRATEGIES
Support efforts of
WIC Breastfeeding
Peer Counselors
Target women of
childbearing age to
teach about the
benefits of
breastfeeding prior to
conception
39
39
HEALTH CARE PROVIDERS COMMITTEE
STRATEGIES
Language interpreters
bebé
bébé
아가
babaմանկիկbeba
μωρό
40
40
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RECOMMENDATION 4
Community
Educators/Programs
Committee
COMMUNITY EDUCATORS/PROGRAMS
RECOMMENDATION
Develop marketing and education
strategy
42
42
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COMMUNITY EDUCATORS/PROGRAMS
COMMITTEE STRATEGIES
Partner with breastfeeding groups
43
43
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COMMUNITY EDUCATORS/PROGRAMS
COMMITTEE STRATEGIES
Develop a regional breastfeeding resource handbook and other materials in easily accessible and updateable formats to distribute to consumers and providers
Expand community breastfeeding educational forums to inner city location and populations to ensure inclusiveness
44 44
COMMUNITY EDUCATORS/PROGRAMS
COMMITTEE STRATEGIES
Ensure that all care providers (physicians, nurses, doulas, etc.) who come into contact with mother before, during, and after childbirth receive breastfeeding awareness training at least once a year
45 45
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PUBLIC INPUT
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YOUR KEYPAD
Press the number that corresponds to your answer
47
BUT FIRST, A TEST…
48
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WHO WON THE NBA PLAYOFFS?
1 2 3 4 5 6
0% 0% 0%0%0%0%
1. Heat
2. Lakers
3. Celtics
4. Thunder
5. Spurs
6. Yankees
49
BREASTFEEDING RECOMMENDATIONS
50
Recommendation 1. Encourage Health Systems to adopt the 10 Steps of the Baby Friendly Hospital Initiative to achieve the 2020 Healthy People Goal.
Recommendation 2. Support and encourage Richmond City businesses to develop and implement a comprehensive lactation support program for their employees and patrons.
Recommendation 3. Promote partnerships and education among care providers who come into contact with mothers, fathers, partners, and families before, during, and after childbirth, and during the infant’s first year of life.
Recommendation 4. Develop Marketing /Education Campaign
50
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RANK ORDER RECOMMENDATIONS BY PRIORITY
1 2 3 4
1817
14
19
51
1. Encourage adoption
of the Baby Friendly
Hospital Initiative
2. Support and
encourage lactation
support program in
local businesses
3. Promote
partnerships and
education among
care providers
4. Develop Marketing /
Education Campaign
FUTURE CONSIDERATIONS
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NEXT STEPS
Finalization of Recommendations
Incorporate feedback from residents
Prioritize recommendations
Development of Final Report
Final Presentation to the Mayor
Establish Social Marketing Strategy
53
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HTTP://WWW.SURVEYMONKEY.COM/S/RICH
MONDBREASTFEEDINGSURVEY
TAKE THE SURVEY!
54
DISCUSSION & QUESTIONS?
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FUTURE PUBLIC FORUMS
Tuesday, July 24, 2012– 6:00 to 8:00 pm
Byrd Park Round House, 600 South Davis Street
Wednesday, July 25, 2012– 6:00 to 8:00 pm
East District Family Resource Center, 2405 Jefferson Avenue
Thursday, July 26, 2012– 10:00 am – 1:00 pm
Calhoun Center, 436 Calhoun Street
Thursday, July 26, 2012– 6:00 to 8:00 pm
Southside Community Services Center, 1400 Hull Street
Tuesday, July 31, 2012– 6:00 to 8:00 pm
Pine Camp Culture Arts and Community Center, 4901 Old Brook Road
56
Office of Deputy Chief Administrative Officer, Human Services900 E. Broad Street, Suite 1603 Richmond, Virginia 23219Phone: (804) 646-5823 • Fax: (804) 646-7441
MAYOR’S BREASTFEEDING COMMISSION
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APPENDIX F BREASTFEEDING SURVEY
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CITY OF RICHMOND, HUMAN SERVICES
900 E. BROAD STREET, SUITE 1603
RICHMOND, VIRGINIA 23219
(804) 646-5823
WWW.RICHMONDGOV.COM