Mayor Dwight C. Jones Breastfeeding Commission€¦ · VIII. Final Draft Recommendations 27 IX. Public Forums 30 X. Final Recommendations 34 XI. Conclusion 37 XII. Appendices A. List

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

5

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


6

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.


7

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.


8

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


9

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


10

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


11

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


12

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.


13

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.


14

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.


15

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


16

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.


17

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


18

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.


19

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;


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.


21

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)


22

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)


23

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


24

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.


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.


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.


26


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.


27

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


28

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:



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.


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.


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.


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:


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%





27.2%

24.7%26.3%

21.8%






33

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%





23.8%

23.9%26.6%

25.7%






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.


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


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


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.


38

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:


Business Case Community 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)


39

January 19, 2012

Workgroup Presentations

Health Care Providers

Business Case for Breastfeeding

Health Systems Community

February 23, 2012

Workgroup Presentations


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






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


41

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


42

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.

http://www2.timesdispatch.com/news/2011/jul/25/tdmet05-richmond-panel-to-study-ways-to-encourage--ar-1194221/

http://www2.timesdispatch.com/news/2011/jul/25/tdmet05-richmond-panel-to-study-ways-to-encourage--ar-1194221/

http://www2.timesdispatch.com/

http://www2.timesdispatch.com/news/

http://www2.timesdispatch.com/news/local/


43

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."


44

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."

http://www2.timesdispatch.com/lifestyles/2012/jan/14/tdmet01-richmond-area-hospitals-move-toward-baby-f-ar-1610618/

http://www2.timesdispatch.com/lifestyles/2012/jan/14/tdmet01-richmond-area-hospitals-move-toward-baby-f-ar-1610618/

http://www2.timesdispatch.com/

http://www2.timesdispatch.com/lifestyles/

http://www2.timesdispatch.com/lifestyles/health_med_fit/


45

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.


46

"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."


47


48


49

APPENDIX E POWERPOINT PRESENTATION

Mayor Dwight C. JonesBreastfeeding Commission

Public Forums

August 9, 2012


50

AGENDA

Welcome/Mayor’s Charge – Doris Moseley

Why Breastfeeding

Breastfeeding Context – Rose Stith Singleton

Breastfeeding Commission Committee

Recommendations





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


51

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


52

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


53

WHY BREASTFEED?

WHY BREASTFEED?

Doctors and

nurses

recommend

it.

8

8


54

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


55

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


56

WHY BREASTFEED?

Benefits for Families

Economic

Efficient

Increases

bonding13

13


57

THE COMMISSION’S

RECOMMENDATIONS





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


58

RECOMMENDATION 1

Health Systems Committee

HEALTH SYSTEMS COMMITTEE

RECOMMENDATION

Baby friendly

hospitals in

Richmond

17

17


59

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


60


Skin to skin

contact

20

20


61


Inform all

pregnant

women about

breastfeeding

benefits

21

21


Initiate

within 1 hour

of birth

Practice

“rooming-in”

22

22


62


No pacifiers

or artificial

nipples

23

23

HEALTH SYSTEMS

STRATEGIES

Encourage health systems to support breastfeeding curricula

Work collaboratively with other systems

24


63

RECOMMENDATION 2

Business Case Community

Committee


64

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


65

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:



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


66

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


Committee


67


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


68


STRATEGIES

Number of doulas and lactation

consultants

Reimburse them for their services

through insurance companies35

35


69


STRATEGIES

Promote collaboration among health providers,

case workers and insurance providers for follow-up

care once mom and baby are home

36

36


STRATEGIES

Provide breast pumps

to pediatricians for

distribution during

initial post-partum

visit

37

37


70


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


71


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


STRATEGIES

Language interpreters

bebé

bébé

아가

babaմանկիկbeba

μωρό

40

40


72

RECOMMENDATION 4

Community

Educators/Programs

Committee

COMMUNITY EDUCATORS/PROGRAMS

RECOMMENDATION

Develop marketing and education

strategy

42

42


73


COMMITTEE STRATEGIES

Partner with breastfeeding groups

43

43


74



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



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


75

PUBLIC INPUT


76

YOUR KEYPAD

Press the number that corresponds to your answer

47

BUT FIRST, A TEST…

48


77

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


78

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


79

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


80

HTTP://WWW.SURVEYMONKEY.COM/S/RICH

MONDBREASTFEEDINGSURVEY

TAKE THE SURVEY!

54

DISCUSSION & QUESTIONS?


81

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

57


82

APPENDIX F BREASTFEEDING SURVEY


83


84


85


86

.


87


88


89


90


91


92


93


94


95


96

CITY OF RICHMOND, HUMAN SERVICES

900 E. BROAD STREET, SUITE 1603

RICHMOND, VIRGINIA 23219

(804) 646-5823

WWW.RICHMONDGOV.COM

Documents

Mayor Dwight C. Jones Breastfeeding Commission€¦ · VIII. Final Draft Recommendations 27 IX. Public Forums 30 X. Final Recommendations 34 XI. Conclusion 37 XII. Appendices A. List