Reflections on the Process of Implementing Change: Highlights from the 2016 MAINN Conference

Guest Blogger: Cindy Turner-Maffei, MA, ALC, IBCLC, Faculty, Healthy Children Project, Inc.*

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Dalarna University, Falun, Sweden

Last week a small team of Healthy Children Project (HCP) faculty members travelled to participate in the Nutrition and Nurture in Infancy and Childhood: Biocultural Perspectives conference in Falun, Sweden. This conference, which is sponsored annually by the University of Central Lancashire (UK) Maternal and Infant Nutrition and Nurture (MAINN) Unit led by the brilliant Fiona Dykes, is held on alternating years in England, or at a different co-sponsoring university. The Reproductive, Infant and Child Health (RICH) unit of Dalarna University hosted the conference, in the shadow of a giant ski jump perched atop the hill over the university campus in rural central Sweden. The conference was attended by more than 150 individuals from 17 countries.

Conference Convenor Renée Flacking

After a warm welcome from the effervescent conference convenor, Renée Flacking, Dalarna University Prov Vice Chancellor Marie Klingberg-Allvin spoke of the university, known for net-based learning as well as traditional classroom instruction.

Dr. Klingberg-Allvin highlighted a Dalarna University collaboration with Somaliland Universities to offer graduate degree program to midwives in Somalia and Somaliland, where mothers and infants die at one of the one of the highest rates in the world. The potential impact of this work on infant and maternal mortality is immense, and is the subject of a brief, moving video.

Lars Wallin

First keynote presenter and Dalarna professor Lars Wallin spoke about the NeoKIP (Neonatal Knowledge into Practice) study, which examined a community-based “bottom-up” strategy for reducing infant mortality in 44 Vietnamese communities. This project identified and trained community-based facilitators who were members of the Women’s Union. The facilitators worked with focus groups of health professionals in every targeted community to identify barriers and design and employ strategies to address key barriers using a Plan, Do, Study, Act approach. A lovely descriptive video may be found here.

Kajsa Brimdyr

During her keynote presentation, HCP faculty member Kajsa Brimdyr CLC, PhD spoke on the topic of Implementing Practice Change Immediately after Birth: An ethnographic approach. Trained as an ethnographer, one who studies cultural practices, Kajsa introduced an ethnographic research frame in the research work conducted by HCP, a midwifery team from Karolinska Institute in Sweden, and the Egyptian Lactation Consultant Association, to study hospital practice around skin-to-skin immediately after birth. Kajsa’s experience, and that of other ethnographic research teams, are also presented in the recently published book edited by MAINN team members Fiona Dykes and Renée Flacking: Ethnographic Research in Infant and Child Health.


Fatuomo Osman

Fatumo Osman, a doctoral student at Karolinska Institute, shared lessons from the Ladnaan Project. Ladnaan is a Somali word for “a sense of health and well-being). This project explored the parenting support needs of Somali refugees living in Sweden. Introducing a theme that resonated through several conference presentations, Ms. Osman highlighted the importance of involving members of the target population in identifying needs, and designing and evaluating programs to address needs.




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Anna Blair

Anna Blair of the Healthy Children Project spoke on the topic of maternal identity, social stigma, and social justice in maternal child health.





Drs. Flacking & Brimdyr introduce Happy Birth Day

On the first evening of the conference, an evening reception at the lovely modern Dalarna University library included entertainment by a musical group, a juggler, and a screening of a segment of Healthy Children’s Happy Birth Day series focusing on gentle, low-intervention birth stories.



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Karin and Cindy

Karin Cadwell and I presented a crash course on the role of breastfeeding in epigenetics, sharing knowledge about the several ways that human milk (as well as other substances ingested) may signal the expression of the infant’s genetic code.



Drs. Cadwell & Brimdyr also spoke about research they’ve conducted with Swedish-American teams exploring the impact of epidural medications and synthetic oxytocin on the expression of the primitive neonatal reflexes. (Click the links to view the article and video describing the outcomes regarding epidurals.)

We enjoyed so many other thought-provoking presentations, including these and others:

  • Ragnhild Maastrup of Denmark, sharing results of her study examining the progression of preterm infants to the breast, and factors associated with earlier breastfeeding proficiency in these little ones.
  • Schmied _ MAINN
    Virginia Schmied

    Elaine Burns and Virginia Schmied of Australia exploring the impact of professional, peer counselor and mother support on feeding outcomes. The appreciative inquiry approach of one study was particularly interesting.

  • Doctoral student Victoria Fallon of England, presenting “’Bottled Up’: The emotional and practical experiences of formula feeding mothers.” One of her most striking findings was that a very high percentage of mothers in the study reported feeling guilt, stigma, and the need to defend their infant feeding plans, regardless of how they intended to feed. The impact of these experiences on maternal emotional health could be detrimental.
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    Leena Hannula

    Leena Hannula of Finland presenting about the Neo-BFHI initiative, an initiative developed by a Scandinavian and Canadian team of researchers; recommendations of the Neo-BFHI group can be found here. Later Dr. Hannula presented fascinating findings from a survey of “Adolescents’ breastfeeding intentions in five countries: the influence of attitudes, social norms and shared-parenting beliefs.”

Gill Thomson
  • Gill Thomson of the University of Central Lancashire (UK) tackling the thorny topic, “Shame if you do, shame if you don’t: women’s experiences of infant feeding.” The potentially devastating impact of shame on maternal self-image is a powerful force to consider in designing campaigns and interventions.



  • Doctoral student Nicole Bridges of Australia presented “The faces of breastfeeding support: experiences of mothers seeking breastfeeding support online,” a study model utilizing Facebook for research.
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    Angela Cartwright

    Graduate student Angela Cartwright of England, presenting findings of a qualitative study of “Mothers’ experiences of feeding infants with Down Syndrome.” The themes emerging from this study indicate that much more support is needed by mothers tackling the task of feeding babies born with his challenge.

  • Dr. Elizabeth O’Sullivan of Ireland sharing quantitative findings of her research into human milk feeding strategies, intriguing findings to pair with the qualitative findings described earlier by her team.
Silke Mader

On the final day of the conference, Silke Mader spoke eloquently about her experience as a mother of twins born at 25 weeks gestation in the late 1990s in a presentation entitled Improving the Empowerment of Parents – What do parents need to take over care? The lack of emotional and physical support her family received during her emergency medical treatment, the death of her infant daughter, and the several month long NICU hospitalization of her infant son led eventually to the creation of the European Foundation for the Care of Newborn Infants (EFCNI), which works across Europe to strengthen parent support, and drive the implementation of evidence-based neonatal practice through endeavors such as benchmarking care NICU support and care practices. She reminded the group to seek parental support, and drew special attention to the needs of fathers as well as mothers, as their needs are often invisible to the health care system.

Drs. Flacking & Dykes closing MAINN 2016


Our time at this conference reinforced our belief that people-centered change in supporting birth, infant and child health, and the development of the parent-child bond is possible; in fact, it is happening throughout the world! It was wonderful to be surrounded by so many individuals questing for a better beginning for our families. We left Sweden full of gratitude for the passionate, curious, and innovative hearts and minds that are hard at work to understand the challenges and fuel progress in this crucial field.

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Celebrating MAINN 2016 at the conference dinner Back row: Flacking, Blair & Thomson Front Row: Turner-Maffei, Maastrup & Brimdyr


*(Ed. Note: Our Milk Way blogger Jess Fedenia is on parental leave for the months of July, August, and September, 2016 to welcome a third child into the family. During Jess’s leave, members of the Healthy Children Project circle are taking up the blogger role.)

Ruminations on Motherhood

By: Holly Hansen, BFA, Project Manager, Healthy Children Project, Inc.*

Holly Headshot
Holly Hansen

I don’t want children. It’s something I’ve known about myself for a long time. I always preferred playing with stuffed animals to baby dolls; I did have one, named Christina. Oddly, I never really played with Christina as if I was her mother and she my child—Christina was a character in my stories, someone who could interact with my stuffed bears as I, their director, saw fit (is it any wonder I went into the theatre?). It can be marked back to when I was six years old and watching “Sarah Plain and Tall”; there’s a particularly harsh scene of childbirth (or at least it seemed at the time). I turned to my mother and said, “I don’t want to have babies.” It’s a perfect portrait of how media portrayal of childbirth and motherhood can put us off of them. I thought motherhood meant pain.

Of course, as I got older and received a proper sexual education, there was a clearer understanding of the act of childbirth; pain could be involved, yes, but it was obviously about and worth more than that. But the idea of becoming a mother still wasn’t my preference. Still, in middle school (when many my age began to babysit) I went with my sister on one of her babysitting jobs.

Pandemonium. The father hadn’t even finished writing down his emergency contact information before his two toddlers were naked, screaming, and running around the house. Now I associated motherhood not with pain, but with chaos.

Through my high school years, I was far too busy with class and friends and getting into a good college to even contemplate motherhood. After all, that was a problem for Future Holly to debate about. Motherhood was a task for which I didn’t have the time.

Then came college (specifically my sophomore year), when a production of Wendy Wasserstein’s The Heidi Chronicles had me deeply considering single parenthood. Compelled by the drama of the play, the drama of being new to sexual relationships, and the overall drama of being just so complicated because I was 20 and nobody understood me I had an “epiphany” that I really wanted to be a single mom. I was looking at motherhood like a television event, a storyline to draw in ratings to my super dramatic life.

I got over that thought real quick.

Then came life post-college: truly living away from home, proper jobs, ugly bills, and actual adult relationships, where discussions of starting families and potential children’s names became the appropriate brunch time filler talk. Talks with engaged friends, married friends, pregnant friends, and so many, too many, family members—being a childless, adult female meant that I couldn’t escape conversations with any of them when it came to the subject of motherhood.

Motherhood became a topic I wished so heartily to avoid, because apparently, “it’s not for me” wasn’t a good enough answer.

Motherhood was something I resented because it wasn’t in my plans, it wasn’t something I wanted, and even now—happily engaged—it isn’t something my fiancé and I desire for our future. It can be tiring to have to constantly respond to questions about motherhood. Will there ever be an acceptable response to my lack of desire to become a parent?

But I have realized more and more, especially becoming educated about birth and breastfeeding, that there are so many ways to be a mother, even if it’s not in the traditional sense.

Motherhood is supporting my friends who have children and are happy and exhausted and content. Motherhood is listening to those who want children but cannot have them, and being compassionate. Motherhood is supporting women’s health issues and being aware and open-minded about the different debates going on in the world.

Motherhood is painful, and chaotic, and time-consuming, and dramatic, and completely normal, all at the same time.



*(Ed. Note: Our Milk Way blogger Jess Fedenia is on parental leave for the months of July, August, and September, 2016 to welcome a third child into the family. During Jess’s leave, members of the Healthy Children Project circle are taking up the blogger role.)



USBC Legacy Awardee Karin Cadwell Calls for Recognition of Structural Racism

(Ed. Note: Our Milk Way blogger Jess Fedenia is on parental leave for the months of July, August, and September, 2016 to welcome a third child into the family. During Jess’s leave, members of the Healthy Children Project, Inc. circle are taking up the blogger role.)

On August 7, 2016, the United States Breastfeeding Committee awarded legacy awards to the following legendary members of breastfeeding intelligentsia in the U.S.: Kimarie Bugg, Karin Cadwell, Miriam Labbok, and Marsha Walker. [After this post was published, we were saddened to learn of the death of Miriam Labbok on August 13, 2016. Dr. Labbok’s legacy is beautifully described here.]

This week’s post contains the Karin Cadwell’s acceptance speech, followed by remarks by USBC chair Jeannette Crenshaw regarding Karin’s work. Heartfelt congratulations, Karin, from your colleagues at Healthy Children Project for this recognition of your leadership, scholarship, and your amazing capacity to speak the truth!

20160807_162108 (1)USBC Legacy Award Acceptance Speech, Karin Cadwell, RN, PhD, ANLC, IBCLC:

First, I want to thank you for the honor of this award. I am humbled by the recognition of my years of service to mothers and babies here in the United States and in countries around the world. When Jeannette (Crenshaw, Chair of the United States Breastfeeding Committee) interviewed me about receiving the Legacy Award it gave me the unusual opportunity to take stock and consider the trajectory that brought me here.

I was breastfed because my mother and father were immigrants to this country. Breastfeeding was what they knew. So, my first experience breastfeeding my own baby should have been easy. I was

Breastfed myself!

Well educated!

Well nourished!

Well hydrated!

Well motivated!

But it wasn’t easy.

The hospital policy was

               Day 1: 1 breast 1 minute every 4 hours

               Day 2: 1 breast 2 minutes every 4 hours

on up to day 5 – BOTH BREASTS, 5 minutes on each side, every 4 hours.

When I brought the baby home on day 5, I followed the instructions and nursed her on each breast for 5 minutes at 6pm and put her in the crib. She cried. I checked the discharge instructions to be sure I had gotten them right – Do NOT pick the baby up or feed her from 6 at night to 6 in the morning- OR ELSE! (The scariest or else was that she wouldn’t have friends in kindergarten.)

While she was crying I decided to unpack baby clothes sent to me by a relative who thought (wrongly as it turned out!) that she would no longer have any use for them. On the top of the first box was an original and well-worn copy of the Womanly Art of Breastfeeding. I probably was only a few pages in when I picked up the baby and nursed her. The next morning, I walked to the pay phone on the corner and called up my mother. She drove 10 hours to come and get me.

There was a lot of social justice in the milk my mother gave me and I have been compelled to ask why breastfeeding, an act that is necessary to the survival of a species, is so difficult. I have spent more than 40 years travelling around the country giving lectures and workshops, facilitating problem solving with mothers who are struggling with breastfeeding, done research, written books and articles and served as a mentor to you women coming up in the field. In the asking I always found more work to be done,

               As a teacher trainer for ICEA

               As a breastfeeding counselor for CEA-GP

               As a founder of ILCA and NABA and NABA REAL

               As convener of Baby-Friendly USA

               As chair of international Baby-Friendly Coordinators meetings

As a founder of the Breastfeeding Leadership Roundtable which became the United States Breastfeeding Committee

As a facilitator of the US submission of the WBTi.

Since 1991, the Innocenti Declaration has been my map:

               Baby-Friendly in the US :  √ (check)

               A National Multi-Sectoral Breastfeeding Committee – √ (check)

Imaginative Workplace Legislation – hmmm more is needed, especially for non-hourly employees and we need PAID MATERNITY LEAVE!

Legislating the International Code on the Marketing of Breast Milk Substitutes. USBC has a group working on that! I’m hopeful.

But equity…..we have a long way to go to achieve equity. There are surmountable hurdles….but hurdles nonetheless. Hurdles of individual and structural racism. I believe that individual racism feeds into structural racism. As a teenager, I thought these were easily overcome.

I hopped on the bus inspired by Mrs. Peabody, our governor’s mother, to sit-in and integrate lunch counters and restaurants. But it’s not as simple as I thought it was as a high school girl. I was SO young and naïve. But not now.

Which races of babies have the highest rate of mortality in the US?

 African American (11/1000) and Native American (7/1000… US Average 6/1000).

Which US babies have the highest risk of dying from pneumonia?

Native American and Alaska Native babies are 4 times more likely to die from pneumonia.

Which babies have the highest risk of becoming diabetic?

Native American babies. And diabetes is significantly related to higher death rates in later life.

Which babies could benefit most from the miracle of mother’s milk?

African American, Native American and Alaska Native babies, since being breastfed reduces the risk of mortality in general and of contracting diabetes and pneumonia.

Which babies are the least likely to be breastfed?

African and Alaska Native and Native American babies

Which race of women is most likely to have breast cancer diagnosed at a later stage and die of breast cancer?

African American women who die of breast cancer at the rate of 28/100,000. The US average is 20/100,000.

Which race of women is most likely to have metabolic syndrome and die from the resulting heart disease and stroke?

If you guessed African American women you are right!

Who are the women that breastfeed at the lowest rates in the US?

 If you thought it was African American, Native American and Alaska Natives, you would be correct!

Which women could benefit the most from having breastfed?

If you thought it was African American, Native American and Alaska Natives, you would be correct again!

I believe the low breastfeeding rates among African Americans, Native Americans and Alaska Natives is because of STRUCTURAL RACISM.

Several states have recently had their restrictive voting laws overturned. The rationale for passing these restrictive laws was given as “voter fraud” however, it was demonstrated that the legislators had requested data about African American and Native American voting practices before knowingly and systematically legislating to disenfranchise these peoples.


They say “voter fraud”.  I’ll say “structural racism”. The courts agreed with me!

Which hospitals are least likely to be Baby-Friendly in the US? 

According to Lind and colleagues at the U.S. Centers for Disease Control and Prevention (2014),  hospitals that serve African American families.

To those who say that “Baby-Friendly is too hard (too expensive) (too whatever),” I’ll say “structural racism”

Groups that put forth restrictive licensure legislation or diatribes against other professional lactation care givers when they know (and have admitted publically) that they are not a group representative of the population of the US, are enforcing structural racism.

When I hear that lactation legislation will improve “access to care” but the sayers are not able to articulate what this really means, I’ll say “structural racism.”

When I hear that licensure is for “protecting the public” but that sayers are not able to articulate what this really means because what it really seems to mean is “protecting members of your club” (that is known to be, let’s just say, not-representational), I’ll say “structural racism”.

The problem is (as been written before me so articulately) that

“When you are accustomed to privilege, equality feels like oppression.”

Until we face structural racism head on–acknowledge it, name it–we cannot work on it. Breastfeeding rates will continue to climb at the barely noticeable pace they are now. Mothers and babies will continue to be denied their right to optimal health.

As Doctor King so wisely told us

               “Injustice anywhere is a threat to justice everywhere.”


Jeannette T. Crenshaw, DNP, RN LCCE, IBCLC, NEA-BC, FAAN, Chair, United States Breastfeeding Committee introduced Dr. Cadwell’s award with the following remarks:

Karin Cadwell’s introduction to breastfeeding came from a person near to her heart, her mother. In a time when not many women were doing so,  Karin’s mother  nsisted on breastfeeding her from birth, and in fact, while they were still in the hospital, Karin’s mother’s milk was used to help an extremely ill baby in the hospital at the same time as them. The baby survived and went to school with Karin, and as she grew up she identified as the mother of a “milk goddess.” When she gave birth to her first child, she struggled to follow the hospital and obstetrician’s guidelines on breastfeeding. When she found a fatefully placed copy of The Womanly Art of Breastfeeding in a box of donated baby things, she quickly knew she would dedicate her life to making sure women had access to breastfeeding support. As she says, “how could I, the daughter of a milk goddess, a well-educated, well-read, well-motivated woman, a woman with every privilege, how could it have been so hard for me to breastfeed?” That’s the question she has been asking and answering ever since.

When people who have been on the long journey with USBC look back at our growth, Karin Cadwell, together with fellow Legacy awardee Marsha Walker, are appreciated for their role in recognizing the need to form a multi-sectorial organization to elevate breastfeeding in the United States, as called for in the international Innocenti Declaration.

When Karin is asked to look back on her accomplishments in the breastfeeding field, she promptly informed me that she doesn’t look back, she just looks forward at “the work there is still to do.” She speaks of continually finding new challenges and continually responding to new generations and their needs.

Like her organization,  the Healthy Children Project,  Karin’s legacy and mission is one that holds space and creates opportunities for others to succeed. Her vision of the idea that babies have a right to good health right from the beginning of their lives inspires women coming up in the field, both as a role model and a mentor. Her close colleague,  Cindy Turner-Maffei points to Karin’s “amazing mind, amazing heart, and amazing commitment to serve all families” when speaking about her legacy. In 25 years, Karin hopes the legacy Award will go to people who have worked for legislation to hold in place all of the current and future achievements of the breastfeeding field, ensuring a world where breastfeeding is protected and supported.


Reflections on Karin’s Contributions to the Field with Cindy Turner-Maffei

Taking Stock of Progress in Supporting, Protecting & Promoting Breastfeeding: The National Immunization Survey and the World Breastfeeding Trends Initiative

CindyBy Guest Blogger, Cindy Turner-Maffei, MA, ALC, IBCLC, Faculty, Healthy Children Project, Inc., Affiliated Faculty, Union Institute & University

(Ed. Note: Our Milk Way blogger Jess Fedenia is on parental leave for the months of July, August, and September, 2016 to welcome a third child into the family. During Jess’s leave, members of the Healthy Children Project, Inc. circle are taking up the blogger role.)

National Breastfeeding Data Updated

As World Breastfeeding Week (August 1-7) draws to a close, our celebration of National Breastfeeding Month continues.

This week marked the annual meeting of the United States Breastfeeding Committee (USBC) on August 4, followed by the Sixth National Breastfeeding Coalitions Conference, August 5-7, 2016.

At the USBC Annual Meeting, Carol MacGowan of the Centers for Disease Control & Prevention (CDC) noted that the National Immunization Survey (NIS) data for babies born in 2013 has been released on the CDC website[i]. The data indicates that 81.1% of US babies born in 2013 were breastfed immediately after birth, within striking distance of the Healthy People 2020 goal of 81.9%. Yay!

There have been incremental increases in breastfeeding duration and intensity (see table below).

The hard work of so many dedicated advocates, supporters, lactation care providers, health care providers, government partners, and others is having positive impact on breastfeeding success of new families. Yet, we are aware that much work lies ahead of us. There are still significant disparities in the rates of breastfeeding from one community to another, one from state to another, from one ethnic group to another.

This calls to mind a powerful finding the Baby-Friendly team at Boston Medical Center (BMC), one of our nation’s first Baby-Friendly birth facilities, reported as they examined the breastfeeding data collected over the years they strove to implement the Ten Steps to Successful Breastfeeding. At the beginning of their journey toward Baby-Friendly status, the BMC team found that women of color who were not born in the U.S. were twice as likely to breastfeed when compared with women of color who had been born in the U.S. As they implemented the Ten Steps, breastfeeding rates rose among all women, nearly doubling (34% to 74%) among the women of color born in the U.S., while breastfeeding among those born outside the U.S. increased in initiation from 78% to 96% after Baby-Friendly designation was achieved (Philipp et al., 2001).This indicates the powerful role that system factors play in supporting or eroding personal intentions and cultural traditions around infant feeding.

Boston Medical Center’s experience is echoed in recent findings of researchers from Centers for Disease Control & Prevention (2014), who examined the implementation of Baby-Friendly practices in nationwide hospitals:

The findings suggest that the implementation of maternity care practices supportive of breastfeeding vary based on the racial composition of the area, which means women living in areas with higher percentages of blacks might have less access to these services. Although the reasons for these disparities are unclear, the results might provide some insight into why there has been a persistent gap in breastfeeding initiation and duration rates between black and white infants in the United States. All facilities, regardless of the racial/ethnic composition of the populations they serve, can support the breastfeeding decisions of their patients by implementing evidence-based policies and practices shown to be critical for establishing breastfeeding, so that more infants are able to reap the numerous health benefits of breastfeeding. (p. 728)


Objective Healthy People 2020 Goal Rate among babies born in 2013 (NIS/CDC, 2016)
Ever breastfed 81.9% 81.1%
At 6 months 60.6 51.8
At 12 months 34.1 30.7
Exclusively through 4 months 46.2 44.4
Exclusively through 6 months 25.5 22.3


World Breastfeeding Trends Initiative

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Members of the Expert Panel announcing the WBTI launch at USBC, 8/4/16

At the end of the August 4 USBC annual meeting, a full day of progress reports on the progress of many initiatives underway through the USBC and its taskforces, or constellations, all attendees were invited to a celebration of the launch of the U.S.’s draft report to the World Breastfeeding Trend Initiative (WBTi). Many attended the launch, obtained copies of the draft report, and engaged in dialogue about its findings.

The WBTi was developed by International Baby Food Action Network (IBFAN) Asia in order to provide a platform for the assessment of achievement and progress toward the goals of the WHO/UNICEF Global Strategy for Infant and Young Child Feeding (“Global Strategy”). The process of engaging in the WBTi builds on the GLOPAR (Global Participatory Action) initiative of the 90’s in that it encourages careful self-assessment of the strengths and weaknesses of policies and programs toward the goal of “strengthening and stimulating breastfeeding action worldwide.”

Attendees of the WBTi Launch at USBC explore the report

Currently 107 countries have completed their WBTi assessment. Among these are many countries from Africa, Asia, and Latin America, but only 8 from Europe. The completed WBTi country reports allow immediate visual access to the status of breastfeeding in each participating country. A simple “traffic light” coding system (red/yellow/green) indicates level of achievement of each aspect of the Global Strategy.


The WBTi process has three phases:

  1. A National Assessment of the implementation of the Global Strategy. In this phase, multiple partners analyze and document the situation in their country and identify gaps according to 15 indicators.
  2. The scoring, rating grading and ranking of each country or region according to the findings of the national assessment.
  3. The repetition of the assessment after 3-5 years to analyze trends.
WBTI Workshop
Participants of the WBTi Assessment Workshop, April 2016

The National Assessment in the United States has been conducted according to the activities set forth by the WBTi Guide Book. Lois Arnold PhD and Linda Smith MPH (from the American Breastfeeding Institute), Karin Cadwell PhD, Kajsa Brimdyr PhD, and Cindy Turner-Maffei MA (from the Healthy Children Project) served as Assessment Coordinators.

Holly Hansen is the Assessment’s Editor. With funding from the Healthy Children Project, Inc., an Expert Panel with representatives from key sectors was convened and met for 5 days to collect information and draft a preliminary report. The report went through 3 rounds of editing resulting in the current draft (August 2016), and was circulated to the entire membership of the USBC and the attendees of the Breastfeeding Coalitions Conference for comment. Participating organizations are invited to include their logo on the cover of the final submission which is expected to be sent to IBFAN Asia on September 4, 2016.

Ultimately the addition of the U.S. data to the WBTi databank will provide other ways to examine and direct our efforts. Which aspects of support for optimal infant nutrition are well in place in our country? Which need some beefing up? And which are unimplemented, or unevenly implemented? How does our status compare with that of other countries? How can we learn from their experience, and apply lessons learned to improvements here? The inclusion of the U.S. National Report in the WBTi databank will allow us to explore the answers to these and other questions.




[i] Carol MacGowan reported that CDC’s 2016 Breastfeeding Report Card will be released soon, hopefully by September. This document reports on metrics including the NIS data but also data from the Maternity Practices in Infant Nutrition & Care (mPINC) survey as well as reporting on system factors in support of achievement of all of the HP2020 goals, including decreasing supplementation of breastfed newborns, increasing births in Baby-Friendly hospitals, increasing workplace support for breastfeeding. The 2014 Report Card also reported data on factors such as the number of lactation care providers, breastfeeding support groups, child care regulations in support of breastfeeding, etc. Report Card data is reported both in the aggregate as well as state by state.


Happy World Breastfeeding Week & National Breastfeeding Month!!

By Guest Blogger, Cindy Turner-Maffei, MA, ALC, IBCLC, Faculty, Healthy Children Project, Inc., Affiliated Faculty, Union Institute & University

(Ed. Note: Our Milk Way blogger Jess Fedenia is on parental leave for the months of July, August, and September, 2016 to welcome a third child into the family. During Jess’s leave, members of the Healthy Children Project, Inc. circle are taking up the blogger role.)

Happy WBW to You!

WBW Logo
Copyright © 2016 World Breastfeeding Week/WABA

Today marks the beginning of the World Alliance for Breastfeeding Action’s (WABA) World Breastfeeding Week (WBW) Celebration.

The WBW theme for this year, Breastfeeding: A Key to Sustainable Development, will be celebrated worldwide from August 1 through 7, 2016.

In 2011, the United States Breastfeeding Committee officially declared the month of August each year to be National Breastfeeding Month. Thus the U.S. celebrates WBW for an entire month!

World Breastfeeding Week, 2016

WABA’s Objectives for WBW 2016 are four-fold:

  1. Inform people about the Sustainable Development goals and how they relate to breastfeeding and Infant and young child feeding (IYCF)
  2. Firmly anchor breastfeeding and IYCF as a key component of sustainable development
  3. Galvanize actions at many levels to support breastfeeding and appropriate IYCF
  4. Engage and collaborate with a wider range of actors to around promotion, protection and support of appropriate IYC

The Sustainable Development Goals (SDG) were approved by the United Nations member states in 2015, to replace the Millennium Development Goals which were targeted for achievement in 2015. In the preamble of the full document, Transforming Our World: The 2030 Agenda for Sustainable Development, the SDGs are described as intended to stimulate action in areas critical to sustainable development, including People, Planet, Prosperity, Peace and Partnership. The vision statement of the document’s introduction is striking (recommended reading, p. 7). The scope and intent of the SDGs is broad, visionary, and monumental; it identifies 17 goals with 169 targets.

Of the 17 SDG goals, WABA’s WBW16 Poster identifies the following impact areas of IYCF:

  • Environment & Climate Change
  • Nutrition, Food Security and Poverty Reduction
  • Survival, Health & Wellbeing
  • Women’s Productivity & Employment
  • Sustainable Partnership and the Rule of Law

The ways in which infants and young children are fed do indeed have wide- and far-ranging impacts on survival, health, environment, productivity, and sustainability of life on earth.

This blog post focuses on the last bullet above: Sustainable Partnership.

Insights about Sustaining Change: The 2016 ROSE Summit

This past week I had the joy of attending the powerful Reaching Our Sisters Everywhere (ROSE) Summit in New Orleans. This experience, combined with my study of the WBW 2016 topic, has led me to ponder what it takes to generate and sustain genuine change.

I was touched deeply by the energy, spirit and passion of the ROSE gathering of hundreds of breastfeeding advocates who are in the process of transforming breastfeeding promotion, protection and support for families of color.

The problems ROSE supporters tackle in their daily work are monumental: disparities in prenatal and breastfeeding care, disparities in infant mortality, disparities in breastfeeding outcomes, lifelong disparities in health.

The theme of the 2016 ROSE symposium was “The Rose That Grew From Concrete”, based on the poem by Tupac Shakur.

Although serious and heartrending information was shared in some parts of conference presentations, the overarching messages were affirming and positive.

Celebrating ROSE, New Orleans Style
Celebrating ROSE, New Orleans Style         ~Photo Courtesy of Andrea Serano

The amazing Kimarie Bugg and the ROSE team are experts at building and sustaining energy through music, laughter, connection and fun, as well as through deep, thought-provoking lectures and presentations. Where else does a conference begin and end with a procession led by a New Orleans jazz band? (Check out the videos posted here)


The ROSE Summit shared news of many inspired initiatives, such as those ongoing under ROSE’s umbrella as well as many others. Here I highlight just two initiatives of several featured at the summit:  the CHAMPS Initiative and Breastfeeding: Strengthening the Heart of the Community.

›♦ Communities and Hospitals Advancing Maternity Practices (CHAMPS) is working to implement the Ten Steps in many hospitals in the Mississippi Delta and other South Central areas with low breastfeeding rates. The initiative brings together community leaders and members, health care staff, and experts in breastfeeding and the Ten Steps to Successful Breastfeeding.

In describing lessons learned to date from the CHAMPS experience, Anne Merewood emphasized that effective and lasting change requires community involvement.

Event Poster

› ♦ Breastfeeding: Strengthening the Heart of the Community, Reclaiming the African American Tradition is an artistic collaboration of breastfeeding families, poets, and artists supported by the Ashé Cultural Arts Center, Healthy Start New Orleans, the New Orleans Health Department, and other local sponsors.

Several of the artists, poets, photographers, and mothers who created the multimedia breastfeeding exhibit at the Ashé Cultural Arts Center spoke of the power of collaboration, of individual artisans learning together from the experience of community members and from one another’s process.


These and other initiatives have great promise to foster not only breastfeeding outcomes, but also the achievement of many of the SDG focal areas. One can’t help but think that the type of collaboration necessary to create a welcoming atmosphere for breastfeeding families in a birth center, health center, workplace, or community is the same type of collaboration necessary to make other crucial social changes.


Sustaining Ourselves and Crucial Partnerships

Those of us fortunate enough to work as lactation support providers (LSPs) know the joy of working with babies and parents, and how their successes in achieving goals fuel us to continue the work.

As LSPs, we also face some very real forces that can erode our energy, ranging from giant commercial forces to the incessant need to improve policy and practice on many different levels.

It’s particularly painful to see so much energy drained by divisions among LSPs over issues such as licensure and reimbursement.

We all share interest, knowledge, skill, and passion to support breastfeeding families. Ideally we would merge our energies and resources, as CHAMPS and the group presented by the Ashé Cultural Arts Center did, to strengthen the network around our families, and to address the very real outside forces that threaten our shared work, and the future health of Americans.

I’d like to share the simple messages I have received from this week’s experiences:

  • Seek out and integrate new voices and new perspectives
  • Celebrate the successes of others, as well as of our own
  • Seek connection with all who influence new families (build those oxytocin levels together!)
  • Be aware that all do not share the same benefits, resources, and experiences; remain open to differences
  • Cultivate a spirit of gratitude for the roles all play in supporting new families
  • Whenever possible, Dance!