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Office of the Surgeon General (US); Centers for Disease Control and Prevention (US); Office on Women's Health (US). The Surgeon General's Call to Action to Support Breastfeeding. Rockville (MD): Office of the Surgeon General (US); 2011.

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The Surgeon General's Call to Action to Support Breastfeeding.

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Appendix 1Actions to Improve Breastfeeding

Mothers and Their Families

Action 1Give mothers the support they need to breastfeed their babies

Implementation StrategiesPotential Actors
 Help pregnant women to learn about the importance of breastfeeding for their babies and themselves.Women
Family members and friends
Clinicians
 Teach mothers to breastfeed.Women
Family members and friends
Clinicians
 Encourage mothers to talk to their maternity care providers about plans to breastfeed.Women
Family members and friends
Clinicians
 Support mothers to have time and flexibility to breastfeed.Women
Family members and friends
Clinicians
 Encourage mothers to ask for help with breastfeeding when needed.Women
Family members and friends
Clinicians

Action 2Develop programs to educate fathers and grandmothers about breastfeeding

Implementation StrategiesPotential Actors
 Launch or establish campaigns for breastfeeding education that target a mother’s primary support network, including fathers and grandmothers.Public health entities
Community organizations
 Offer classes on breastfeeding that are convenient for family members to attend.Community organizations
Hospitals

Communities

Action 3Strengthen programs that provide mother-to-mother support and peer counseling

Implementation StrategiesPotential Actors
 Create and maintain a sustainable infrastructure for mother-to-mother support groups and for peer counseling programs in hospitals and community health care settings.Public health entities
Community organizations
 Establish peer counseling as a core service available to all women in WIC.*Federal, state, and local WIC programs
*

WIC = Special Supplemental Nutrition Program for Women, Infants, and Children; U.S. Department of Agriculture.

Action 4Use community-based organizations to promote and support breastfeeding

Implementation StrategiesPotential Actors
 Support and fund small nonprofit organizations that promote breastfeeding in communities of color.Federal, state, and local governments
Foundations
 Integrate education and support for breastfeeding into public health programs that serve new families.Public health entities
Community organizations
 Ensure around-the-clock access to resources that provide assistance with breastfeeding.Public health entities
Community organizations

Action 5Create a national campaign to promote breastfeeding

Implementation StrategiesPotential Actors
 Develop and implement a national public health campaign on breastfeeding that relies heavily on social marketing.Federal, state, and local partners
 Use a variety of media venues to reach young women and their families.Public health entities
Community organizations

Action 6Ensure that the marketing of infant formula is conducted in a way that minimizes its negative impacts on exclusive breastfeeding

Implementation StrategiesPotential Actors
 Hold marketers of infant formula accountable for complying with the International Code of Marketing of Breast-milk Substitutes.Public health entities
Infant formula manufacturers
 Take steps to ensure that claims about formula are truthful and not misleading.HHS/FDA
Federal Trade Commission
 Ensure that health care clinicians do not serve as advertisers for infant formula.Health care professionals

HHS/FDA = U.S. Department of Health and Human Services/U.S. Food and Drug Administration.

Health Care

Action 7Ensure that maternity care practices throughout the United States are fully supportive of breastfeeding

Implementation StrategiesPotential Actors
 Accelerate implementation of the Baby-Friendly Hospital Initiative.Public health entities
 Establish transparent, accountable public reporting of maternity care practices in the United States.HHS/CDC*
The Joint Commission
 Establish a new advanced certification program for perinatal patient care.Public health entities
The Joint Commission
 Establish systems to control the distribution of infant formula in hospitals and ambulatory care facilities.Hospitals
Ambulatory care facilities
*

HHS/CDC = U.S. Department of Health and Human Services/Centers for Disease Control and Prevention.

Action 8Develop systems to guarantee continuity of skilled support for lactation between hospitals and health care settings in the community

Implementation StrategiesPotential Actors
 Create comprehensive statewide networks for home- or clinic-based follow-up care to be provided to every newborn in the state.Public health entities
Community organizations
 Establish partnerships for integrated and continuous follow-up care after discharge from the hospital.Hospitals
Health care systems
Primary care clinicians
Community organizations
 Establish and implement policies and programs to ensure that participants in WIC have services in place before discharge from the hospital.Federal, state, and local WIC programs
Hospitals
Primary care clinicians
Community organizations

WIC = Special Supplemental Nutrition Program for Women, Infants, and Children; U.S. Department of Agriculture.

Action 9Provide education and training in breastfeeding for all health professionals who care for women and children

Implementation StrategiesPotential Actors
 Improve the breastfeeding content in undergraduate and graduate education and training for health professionals.Health professional organizations
Medical schools
 Establish and incorporate minimum requirements for competency in lactation care into health professional credentialing, licensing, and certification processes.Health professional organizations
Credentialing boards
 Increase opportunities for continuing education on the management of lactation to ensure the maintenance of minimum competencies and skills.Health professional organizations
Medical schools

Action 10Include basic support for breastfeeding as a standard of care for midwives, obstetricians, family physicians, nurse practitioners, and pediatricians

Implementation StrategiesPotential Actors
 Define standards for clinical practice that will ensure continuity of care for pregnant women and mother-baby pairs in the first four weeks of life.HHS/HRSA
Health professional organizations
 Conduct analyses and disseminate their findings on the comparative effectiveness of different models for integrating skilled lactation support into settings where midwives, obstetricians, family physicians, nurse practitioners, and pediatricians practice.HHS/AHRQ§

HHS/HRSA = U.S. Department of Health and Human Services/Health Resources and Services Administration.

§

HHS/AHRQ = U.S. Department of Health and Human Services/Agency for Healthcare Research and Quality.

Action 11Ensure access to services provided by International Board Certified Lactation Consultants

Implementation StrategiesPotential Actors
 Include support for lactation as an essential medical service for pregnant women, breastfeeding mothers, and children.HHS/CMS
Third-party payers
 Provide reimbursement for International Board Certified Lactation Consultants (IBCLCs) independent of their having other professional certification or licensure.HHS/CMS
Third-party payers
 Work to increase the number of racial and ethnic minority IBCLCs to better mirror the U.S. population.HHS/HRSA

HHS/CMS = U.S. Department of Health and Human Services/Centers for Medicare & Medicaid Services.

Action 12Identify and address obstacles to greater availability of safe banked donor milk for fragile infants

Implementation StrategiesPotential Actors
 Conduct a systematic review of the current evidence on the safety and efficacy of donor human milk.HHS/AHRQ
 Establish evidence-based clinical guidelines for the use of banked donor milk.HHS/MCHB**
Health professional organizations
 Convene a study on federal regulation and support of donor milk banks.Institute of Medicine
**

HHS/MCHB = U.S. Department of Health and Human Services/Maternal and Child Health Bureau.

Employment

Action 13Work toward establishing paid maternity leave for all employed mothers

Implementation StrategiesPotential Actors
 Add maternity leave to the categories of paid leave for federal civil servants.Federal government
State governments
 Develop and implement programs in states to establish a funding mechanism for paid maternity leave.State governments

Action 14Ensure that employers establish and maintain comprehensive, high-quality lactation support programs for their employees

Implementation StrategiesPotential Actors
 Develop resources to help employers comply with federal law that requires employers to provide the time and a place for nursing mothers to express breast milk.DOL, HHS*
Public health entities
Employer organizations
 Design and disseminate materials to educate employers about the benefits of providing more comprehensive, high-quality support for breastfeeding employees.Public health entities
 Develop and share innovative solutions to the obstacles to breastfeeding that women face when returning to work in non-office settings.DOL, HHS
Public health entities
Employers
 Promote comprehensive, high-quality lactation support programs as part of a basic employee benefits package.Employers
*

DOL, HHS = U.S. Department of Labor; U.S. Department of Health and Human Services.

Action 15Expand the use of programs in the workplace that allow lactating mothers to have direct access to their babies

Implementation StrategiesPotential Actors
 Create incentive or recognition programs for businesses that establish, subsidize, and support child care centers at or near the business site.Federal government
State governments
Community organizations
 Identify and promote innovative programs that allow mothers to directly breastfeed their babies after they return to work.Public health entities
Employers
Chambers of Commerce

Action 16Ensure that all child care providers accommodate the needs of breastfeeding mothers and infants

Implementation StrategyPotential Actors
 Promote adoption of the breastfeeding standards in Caring for Our Children: National Health and Safety Performance Standards: Guidelines for Out-of-Home Child Care.HHS/HRSA
State governments

HHS/HRSA = U.S. Department of Health and Human Services/Health Resources and Services Administration.

Research and Surveillance

Action 17Increase funding of high-quality research on breastfeeding

Implementation StrategyPotential Actors
 Designate additional research funding for studies on how to increase breastfeeding rates, the economics of breastfeeding, and management of lactation.HHS/NIH*
Foundations
*

HHS/NIH = U.S. Department of Health and Human Services/National Institutes of Health.

Action 18Strengthen existing capacity and develop future capacity for conducting research on breastfeeding

Implementation StrategiesPotential Actors
 Develop a national consortium on breastfeeding research.HHS/NIH
Researchers
 Enhance the training of scientists in basic and applied research on lactation, breastfeeding, and women’s and children’s health.HHS/NIH
Universities and medical schools

Action 19Develop a national monitoring system to improve the tracking of breastfeeding rates as well as the policies and environmental factors that affect breastfeeding

Implementation StrategiesPotential Actors
 Enhance the CDC Breastfeeding Report Card by including a broader array of process indicators and showing trends over time.HHS/CDC
 Collect data in all states on the initiation of breastfeeding and in-hospital supplementation with formula through the U.S. Standard Certificate of Live Birth.State governments
 Develop systems to collect key information on policy and environmental supports for breastfeeding.HHS/CDC

HHS/CDC = U.S. Department of Health and Human Services/Centers for Disease Control and Prevention.

Public Health Infrastructure

Action 20Improve national leadership on the promotion and support of breastfeeding

Implementation StrategiesPotential Actors
 Create a federal interagency work group on breastfeeding.Federal government
 Increase the capacity of the United States Breastfeeding Committee and affiliated state coalitions to support breastfeeding.Public health entities

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