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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.

Cover of The Surgeon General's Call to Action to Support Breastfeeding

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

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Appendix 3Development of the Call to Action

The Surgeon General’s Call to Action to Support Breastfeeding was prepared by the Centers for Disease Control and Prevention and the Office on Women’s Health under the direction of the Office of the Surgeon General. These three agencies are part of the U.S. Department of Health and Human Services, which published the Call to Action. Representatives from these agencies collaborated with a federal steering committee that included representatives from several other federal agencies. The members of the steering committee are listed in the Acknowledgments (page 69). The steering committee sought input from several sources to identify priority actions and directions for concerted national efforts to promote breastfeeding.

First, comments were solicited from the general public through an open Web site that allowed users to submit comments and review all previously submitted comments. The comment period was April 1–May 31, 2009. A total of 2,354 distinct comments was received, and then all comments were categorized by primary subject area. All comments were read, and a summary report that drew out major themes and specific quotes for review by the steering committee was produced.

Summary of Subject Areas Included in Public Comments on National Breastfeeding Efforts

TopicTotal No. of Comments
 Maternal and Infant Care Practices: Prenatal, Hospital, and Post-Delivery Care516
 Paid Maternity Leave302
 Access to Lactation Care and Support288
 Worksite Lactation Support, On-Site Child Care, and Expression of Milk248
 Support for Breastfeeding in Public Settings217
 Portrayal of Breastfeeding in Traditional Popular Media and New Electronic Media176
 Health Professional Education, Publications, and Conferences146
 Use of Banked Human Milk114
 Community Support for Breastfeeding in Complementary Programs (e.g., Early Head Start, Home Visitation, Parental Training)101
 Peer Support and Education of Family Members and Friends91
 Research and Surveillance57
 Other Areas98

Second, an expert panel met in Washington, DC, on April 28–29, 2009, to conduct more in-depth discussions about the content of a Call to Action (see list of participants, p. 81). The meeting began with the expert panel listening to a group of mothers describe the challenges they had faced when breastfeeding. The expert panel then offered their individual recommendations for policy and environmental changes needed to better support breastfeeding. Additionally, small groups were formed to put forward summary recommendations in key areas.

Third, in July and August of 2009, hearings for stakeholders were conducted in Arlington, Virginia, and Atlanta, Georgia, to hear from critical organizations whose work directly affects breastfeeding. Each organization was given eight minutes to present its perspective on the greatest needs in breastfeeding, followed by a short question-and-answer period. All presenters also delivered a written copy of their testimony for consideration by the steering committee.

Finally, the steering committee reviewed recommendations and priorities delineated at various meetings, including the strategic planning session of the United States Breastfeeding Committee (Washington, DC, January 2009), the Breastfeeding and Feminism Symposium (Greensboro, North Carolina, March 2009), the Academy of Breastfeeding Medicine Summit on Breastfeeding (Washington, DC, June 2009), and the USDA/CDC panel on Using Policy and Environmental Approaches to Reduce Black-White Breastfeeding Disparities (Atlanta, Georgia, December 2009).

The steering committee met frequently throughout 2009 to consider the most important actions needed to support breastfeeding and to write the present document.

Participants on the Expert Panel

April 28–29, 2009: Washington, DC

Panel of mothers

Aaliyah Alim

Bonita Butler

Kahlil Kuykendall

Rashida Jefferson

Chelai Johnson

Coyan Lewis

Jessica Silva

Damali Smith

Professional participants

Margaret E. Bentley, Ph.D., M.A.

Professor of Nutrition, Associate Dean for Global Health, Gillings School of Global Public Health

University of North Carolina at Chapel Hill

Karen Bonuck, Ph.D.

Associate Professor, Deparment of Family and Social Medicine, Department of Obstetrics & Gynecology and Women’s Health

Albert Einstein College of Medicine

Karin Cadwell, Ph.D., F.A.A.N., R.N., I.B.C.L.C.

Faculty Member, Union Institute and University; Convener, Baby-Friendly-USA

Healthy Children Project

Gerald Calnen, M.D.

Vice-President and President-Elect

Academy of Breastfeeding Medicine

Cathy Carothers, I.B.C.L.C., R.L.C.


Every Mother, Inc.

Mei Chung, M.P.H., Ph.D.(c)

Research Associate

Tufts Medical Center Evidence-Based Practice Center

Cate Colburn-Smith

Workplace Lactation Expert

Moms on Board

Kendall Cox, I.B.C.L.C., R.L.C.


Every Mother, Inc.

Roger A. Edwards, Sc.D.

Assistant Professor, Bouvé College of Health Sciences

Northeastern University

Lori Feldman-Winter, M.D., M.P.H.

Associate Professor, Pediatrics

Cooper University Hospital

Lawrence M. Gartner, M.D.

Professor Emeritus, Pediatrics and Obstetrics/Gynecology

University of Chicago

Sarah Grosshuesch, M.P.H.

Public Health Educator

Municipality of Anchorage, AK

Jane Heinig, Ph.D. (in absentia)

Executive Director, Human Lactation Center

University of California at Davis

Cynthia R. Howard, M.D., M.P.H.

Associate Professor of Pediatrics, University of Rochester

Rochester General Hospital

Carol Kolar, R.N., C.M.P.

Director of Education

La Leche League International

Michael S. Kramer, M.D.

James McGill Professor of Pediatrics and of Epidemiology and Biostatistics

McGill University

Miriam H. Labbok, M.D., M.P.H., M.M.S., F.A.C.P.M., F.A.B.M., I.B.C.L.C.

Professor, Gillings School of Global Public Health; Director, Carolina Global Breastfeeding Institute

University of North Carolina at Chapel Hill

Ruth A. Lawrence, M.D., F.A.A.P., F.A.A.C.T.

Professor of Pediatrics, School of Medicine and Dentistry

University of Rochester

Katy Lebbing, I.B.C.L.C., R.L.C.

Lactation Consultant

Silver Cross Hospital

Rebecca Mannel, I.B.C.L.C., F.I.L.C.A.

Clinical Operations Manager, Women’s & Newborn Service, Oklahoma University Medical Center; Clinical Instructor

University of Oklahoma Health Sciences Center

Joan Meek, M.D., M.S.

Clinical Associate Professor, Clerkship Director, Department of Clinical Sciences

Florida State University

Paula Meier, D.N.Sc., R.N., F.A.A.N.

Director of Clinical Research and Lactation, Special Care Nursery; Professor, Women, Children, and Family Nursing, College of Nursing

Rush Medical College

Karen Minatelli

Director, Work and Family Programs

National Partnership for Women and Families

Georgia Morrow, R.N., I.B.C.L.C.


Mothers’ Milk Bank of Ohio

Judy Norsigian

Co-Founder, Boston Women’s Health Book Collective; Co-Author, Our Bodies, Ourselves

Boston Women’s Health Collective

Amanda Perez, M.S.W.

Senior Training Specialist

Early Head Start National Resource Center @ ZERO TO THREE

Amelia Psmythe


Breastfeeding Coalition of Oregon

Kiddada Ramey, M.A.T.

Founder and President

Black Mothers’ Breastfeeding Association

Phyllis Sharps, Ph.D., R.N., F.A.A.N.

Associate Professor, School of Nursing

Johns Hopkins University

Wendy Slavit, M.P.H., C.H.E.S.

Manager, Center for Prevention and Health Services

National Business Group on Health

Julie Smith, Ph.D.

Research Fellow, Australian Centre for Economic Research on Health

Australian National University

Alison Stuebe, M.D., M.Sc.

Assistant Professor, Obstetrics and Gynecology

University of North Carolina at Chapel Hill

Lisa Summers, M.S.N., Dr.P.H., C.N.N.

Director of Professional Services

American College of Nurse-Midwives

Letty D. Thall, M.S.S.

Director of Public Policy

Maternity Care Coalition

Anne Butzen Thornill, M.P.H.

Senior Health Promotion Manager

North Carolina Prevention Partners

Mary Rose Tully, M.P.H., I.B.C.L.C.

Director of Lactation Services, Women’s and Children’s Hospitals, University of North Carolina Health Care, Gillings School of Global Public Health

University of North Carolina at Chapel Hill

Jill Youse

Executive Director

International Breast Milk Project

Participants at Stakeholder Hearings

July 30, 2009: Arlington, Virginia

  • American Academy of Family Physicians
  • American Academy of Pediatrics
  • American Breastfeeding Institute
  • American College of Nurse-Midwives
  • American Nurses Association
  • American Public Health Association
  • Association of State and Territorial Public Health Nutrition Directors
  • Association of Women’s Health, Obstetric and Neonatal Nurses
  • Baby-Friendly USA
  • Breastfeeding Coalition of the Uniformed Services
  • Breastfeeding Task Force of Greater Los Angeles, California Breastfeeding Coalition
  • Carolina Global Breastfeeding Institute
  • Healthy Children Project
  • Human Milk Banking Association of North America
  • International Board of Lactation Consultant Examiners
  • La Leche League International
  • Lamaze International
  • National Alliance for Breastfeeding Advocacy
  • National Association of Pediatric Nurse Practitioners
  • National Business Group on Health
  • National WIC Association, Breastfeeding Committee
  • Pennsylvania Breastfeeding Coalition
  • United States Breastfeeding Committee
  • United States Lactation Consultant Association
  • Wellstart International

August 13, 2009: Atlanta, Georgia

  • Abbott Nutrition
  • Ameda Breastfeeding Products
  • Evenflo Company, Inc.
  • Greenberg Quinlan Rosner Research
  • International Formula Council
  • Lansinoh Laboratories, Inc.
  • Mead Johnson Nutrition
  • Medela, Inc.
  • Nestlé Infant Nutrition
  • Prolacta Bioscience, Inc.
  • Wyeth Nutrition


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