World Breastfeeding Week 2021 is upon us! There is so much to celebrate this week and through the month of August with National Breastfeeding Month (NBM) while acknowledging all the work there’s left to do. Our Milky Way caught up with National Association of County and City Health Officials (NACCHO) Lead Program Analyst Harumi Reis-Reilly, MS, CNS, LDN CHES, IBCLC and Senior Program Assistant Erika Ennis, CLC, and we are pleased to help announce the launch of the Continuity of Care (CoC) in Breastfeeding Support: a Blueprint for communities. The blueprint is designed to support local-level organizations to strengthen their community lactation landscape to ensure that families are supported throughout their infant feeding journey. The Blueprint will launch during National Breastfeeding Month #NBM21 on August 24th.
Learn more in this extensive Q&A.
Q: Back in 2018, NACCHO released Breastfeeding in the Community: Program Implementation Guide: Reducing Disparities in Breastfeeding through Peer and Professional Support which quickly became the most downloaded resource from the Community Health & Maternal Child Health e-newsletter reaching thousands of local health professionals. Now, NACCHO is about to release the Continuity of Care in Breastfeeding Support Blueprint in partnership with USBC. How has this work evolved and grown from a few years ago to today?
A: We have been working on this diligently for the past two years with so many people across the country. This was truly a collaborative process, with collective intellectual inputs.
The blueprint project has been developed with funding through a cooperative agreement with the Centers for Disease Control and Prevention, Division of Nutrition, Physical Activity and Obesity (DNPAO), and in partnership with the U.S. Breastfeeding Committee (USBC).
It all started in September 2018, through the reconvening of the dormant Continuity of Care (CoC) Constellation. The CoC Constellation met monthly throughout 2019. The Constellation conducted two information gathering surveys to identify additional resources, stakeholders to finalize the development of the CoC concept. The Constellation was then divided into five subgroups that reflect the first 1,000 days and beyond. This process allowed the group to identify and welcome additional experts from each field and was divided into five subgroups based on participants’ expertise. The five subgroup themes were:
- Preconception & Prenatal period
- Birth and Discharge
- First Few Weeks
- Return to Work/School
- and Baby’s 4+ Months.
The subgroups discussed the landscape of breastfeeding support and transitions of care for each of these lactation journey periods. They identified both barriers and facilitators to establish CoC and relevant resources, such as useful tools and successful examples from the field. These findings are translated into this Blueprint’s strategies and recommendations. During June and July 2020, all subgroup participants and additional experts (71 participants in the first meeting, 58 in the second meeting) participated in an interactive virtual workshop (originally planned as an in-person meeting, and canceled due to the COVID-19 pandemic) to identify specific roles of key stakeholders responsible for establishing breastfeeding support within a community. Additionally, participants provided input regarding resources needed by stakeholders to establish continuity of care. Data were analyzed and categorized in themes, resulting in the seven core CoC recommendations. These recommendations and strategies were sent for final review and feedback to all who participated in any of the Blueprint development meetings, and a final feedback call was hosted.
Q: World Breastfeeding Week’s 2021 theme is “A Shared Responsibility”. This jives perfectly well with the idea of Continuity of Care, where breastfeeding support becomes less of an individual burden and places responsibility on the networks and systems that families find themselves in. Will you please speak to this idea?
A: This year’s theme for both World Breastfeeding Week and National Breastfeeding Month #NBM21 (continuity of care theme “Every Step of the Way”) sets the perfect timing and atmosphere for the launch of the CoC blueprint. The blueprint reinforces the idea that we all have a role and a collective responsibility to make the healthy choice the easy, default and feasible one. If the policies, systems and environments where families live, work, play and raise children are not proactively supportive and conducive of chest/breastfeeding, and skilled lactation support are not easily accessible, families will discontinue chest/breastfeeding prematurely, even if they did not plan to do so. This is evidenced by data that shows that most parents in the United States do not reach their breastfeeding goals. The new blueprint will include an image of the chest/breastfeeding local health system to show the wide range of community stakeholders that need to be engaged to build this lactation safety net in the community, so families do not fall through the cracks and sub-optimally breastfeed.
Q: Will you please share a few examples of how stakeholders are answering the call to support healthy infant feeding?
A: Our team has been closely following CDC’s Racial Ethnic Approaches to Community Health (REACH) recipients and providing technical assistance to their lactation support continuity of care implementations in their communities for the past three years. They have been doing such great work, even during the current pandemic and its restrictions. Here are some highlights to share:
The County of San Diego, Health and Human Services Agency, implemented a community-wide environment improvement strategy, by successfully launching a digital social marketing campaign to normalize breastfeeding. The goal was to promote the uptake of the county’s REACH-adapted “It’s Only Natural” campaign by supporting services organizations. Their integrated advertising campaign utilized zip code geofencing strategies and specifically targeted their audience by age, race, location, and income. Check out their video: Breastfeeding Video for San Diego County HHSA
The University of Arkansas for Medical Services developed the UAMS Breastfeeding Series, a set of 12 microlearning videos that includes lactation education and address concerns for providers and families.
The YMCA, Healthy Savannah, in Georgia engaged their community through an innovative breastfeeding photovoice project aimed to identify issues around breastfeeding continuity of care in their jurisdiction. The photovoice method was used as a way for Black/African-Americans mothers in the community to capture their own images and perspectives that represent barriers to breastfeeding. Check out their final project here.
When the pandemic started, the City of Miami Gardens collaborated with community partners to host virtual discussions, and onsite support, to ensure internet stability and privacy. They host several online events that included local participants, and attendees from other states and countries! In addition, they conducted train -the- trainer workshops to increase organizational capacity to promote, protect and support breastfeeding virtually. To learn more check out one of their Facebook master class videos.
Q: How do you envision the infant feeding landscape changing as a result of the release of the blueprint?
A: One important thing to note is that the Blueprint is specifically intended to influence the local lactation landscape only, with suggested evidence-based action steps that are in the sphere of influence of community-level organizations. There are definitely many actions that must be taken by state- and national-level organizations that directly or indirectly influence chest/breastfeeding continuity of care in the community, but those are not outlined in this blueprint. With that said, we envision that long-term, with full blueprint implementations by many communities, there will be no families falling through the cracks because they will be fully supported in their infant feeding journey, therefore leading to an increase of breastfeeding exclusivity and duration rates, particularly in communities with low breastfeeding rates. Focusing attention and efforts on these communities will lead to a more equitable lactation landscape. Hopefully, this will help the nation reach the Healthy People 2030 goals of exclusive 6-month exclusive breastfeeding and 12 months duration rates for all groups. Also, achieving CoC will reflect sustained, collaborative efforts among stakeholders and the establishment of a community lactation safety net, for those who need the most, with the implementation of sustainable policies, systems and environment solutions.
Q: How can our readers help promote this work and get involved in the mission?
A: We would love to engage with you all. There are several ways to get involved:
First, we would love to get everyone’s help to promote the blueprint launch, by sharing the promotional images and event registration link: http://bit.ly/CoCBlueprintLaunch
During the event, we will also be announcing a Request for Applications (RFA) for organizations interested in implementing the blueprint.
We will be maintaining a continuity of care resources website. We would love to hear your story and useful tools and resources you developed in your community to advance continuity of care and improve your lactation support infrastructure. So if you would like to share your resource, you can email us at breastfeeding@naccho.org
Also, if you have expertise in any of the blueprint recommended actions, we will be interested in working with you to further develop tools and resources for each recommendation and help us provide technical assistance to local communities implementing the blueprint. Stay tuned for more upcoming information about that during the Fall 202.
Finally, if you are not yet currently subscribed to our Breastfeeding in the Community monthly newsletter, please follow the instructions below to sign up for our newsletter.
- To subscribe, please log-in to your MyNACCHO account. If you do not have a “MyNACCHO” account, you can sign up here.
- Once logged on, click on “My Subscriptions” in the left navigation menu
- Check the box for Breastfeeding in the Community
- Click “Save” at the bottom of the page
Q: Is there anything else you’d like to add?
A: The blueprint launch event will be a kick-off of the 8-part webinar series on Continuity of Care in chest/breastfeeding support. No-cost Continuing education credits for lactation support providers and dietitians/nutritionists (1.0 CPEU) will be available for each session. Other continuing education credits (CMEs, CNEs, CECHs, CPHs, CEUs) are pending approval. 
We would like to shout out a BIG THANK YOU to all who participated on our national surveys, monthly virtual meetings, and workshops throughout these past two years. We are grateful for those who shared their own perspectives on continuity of care in breastfeeding support gaps and their visions for the future of the field.
Another shout out goes to our major partner in this project, the U.S. Breastfeeding Committee, who worked side-by-side with us. Check out what they are up to for the National Breastfeeding Month at http://www.usbreastfeeding.org/nbm