Breastfeeding and The Continuity of Care in Breastfeeding Support Blueprint

The Centers for Disease Control and Prevention (CDC) found that most infants in the United States are not exclusively breastfed during the first 6 months of life. Most recent data from the National Immunization Survey noted that only 58% of infants were breastfed at all during the first 6 months. Even more, only 25% of infants were exclusively breastfed during that time. The 2020 - 2025 Dietary Guidelines of Americans recommends exclusive breastfeeding for the first 6 months of life, and the American Academy of Pediatrics recommends exclusive breastfeeding for up to two years and more if desired. These statistics indicate that within the first 1,000 days of life in the United States, infants are not receiving optimal nutrition through breast/human milk. Suboptimal breastfeeding and nutrition increase the risk for short-term and long-term health outcomes, such as type 1 diabetes, obesity, asthma, and more. To learn more, click here.

One of the drivers of suboptimal infant feeding and early breastfeeding discontinuation are gaps in the continuity of care (CoC) in lactation resources and support within communities. To achieve CoC, families should receive seamless delivery of lactation resources and support that aligns with healthcare services that are high-quality, consistent, and collaborative. These health care experiences are fundamental since the first 1,000 days represent a critical period for brain development and laying the groundwork for healthy eating habits.

To address CoC gaps in communities, three years ago, NACCHO launched the  Continuity of Care in Breastfeeding Support: A Blueprint for Communities (CoC Blueprint) on August 24, 2021.  In collaboration with the U.S. Breastfeeding Committee (USBC)’s Continuity of Care Constellation, and with funding support from the CDC’s Division of Nutrition, Physical Activity, and Obesity (DNPAO), this resource has been downloaded and reviewed by more than 3,100 individuals from all 50 states (and District of Columbia), four U.S. territories, and over 32 countries!

Interview with NACCHO’s Chest/Breastfeeding Team

To reflect on the 3rd anniversary of the Blueprint, NACCHO’s Senior Program Analyst Freweyni Gemerew interviewed Talei Moore, Program Analyst with NACCHO’s Maternal, Child and Adolescent Health team, to reflect on the successes and impact of the Blueprint.

Q: As of August 2024, you have been working with the Blueprint for almost two years. Can you share your perspective on what has been impressive about the Blueprint and NACCHO’s work on supporting continuity of care at the community level?

What’s impressive is that each of the recommendations are evidence-based and can be implemented in tandem with one another, but also as standalone activities. That means that each community can interpret and implement these strategies in whatever combination makes the most sense for what their community needs.

I also think that adaptability is what engages people around this resource, even on a global scale. Although NACCHO is a national organization, the Blueprint has been downloaded in 32 other countries, from Peru to Portugal, Uganda to Saudi Arabia, Thailand to Trinidad and Tobago, Philippines to Palau. The Blueprint outlines straightforward solutions that address breastfeeding disparities at the policy, systems, and environment levels – and considers the long-term impact and sustainable outcomes. Years later, NACCHO has built relationships with our grantees and partners in their communities. As a result, we continue to connect and understand how the local lactation and nutrition landscape have transformed since the implementation of the Blueprint. Witnessing how well the Blueprint has applied to such unique communities has amplified how impressive this resource is and strengthened lactation care across the nation.

Q: Can you share more about the communities that have implemented the Blueprint?

NACCHO has funded 34 communities to implement the Blueprint. Sites have represented diverse positions in the community, from local health departments, hospitals, clinics, and WIC offices to grassroots and community-based organizations; from California to Puerto Rico, from urban to rural, and whether serving 1,000 or 100,000 people.

One of our grantees was a local health department in Denver, Colorado (Jefferson County Public Health) that partnered with Cuenta Conmigo Co-Operative to develop emergency preparedness and response training for breastfeeding parents and families. These trainings provided supplies, education, and tools for families and caregivers to be better informed on how to nourish their infants and toddlers in a crisis. This cross-collaboration between teams that work in preparedness and a local collaborative that advocates for community resilience was an incredible partnership to witness, especially as trainings were provided in Spanish, both in Colorado and in other states. Now, the local health department has a community partner, and the Denver community is better equipped to breastfeed their infants and toddlers in emergency situations.

Another grantee, the Breastfeeding Taskforce of Greater Los Angeles, based in California, initiated scholarship programs to onboard and train Black, Indigenous, and other people of color to become trained lactation consultants. This initiative was incredibly meaningful to their organization and their community, as Los Angeles represents one of the most diverse cities in the United States. Culturally responsive and relevant care and resources can create opportunities to welcome community into care, further creating opportunities to connect people to services that alleviate challenges tied to other social determinants of health. Even more, the trained lactation consultants would lead identity-specific support groups, where they nurtured safe spaces for parents and caregivers to ask questions, build networks in the community, and provide culturally responsive care and support to their clients.

Q: It sounds like there are some lessons learned about how to implement a successful project. What are some shared lessons that communities can take away from previous grantees?

There are many shared lessons to share! The first lesson would be that small efforts can create larger movements in the community. A great example is Sauk County Health Department. This local health department worked with their local chamber of commerce to commit local businesses to being lactation-friendly and to post a decal in their windows displaying their commitment. This was so well-received in the community that businesses in neighboring counties were contacting the health department to ask how to make the commitment and receive a decal, and community members posted about the local libraries transforming their facilities to include a designated space for lactation across social media sites.

Another lesson is that sustainable activities address policy, system, or environment in some way. The cool thing about these three types of solutions is that they are very interconnected. Focus on policies, systems, and environmental solutions. This helps us to think backward from the goal outcome and break it down.

The third, and I think most important for any project to be successful and sustainable is building and solidifying strong partnerships. One grantee was having a difficult time partnering with their local WIC office to engage them around mutual referrals, so we encouraged their team to reach out and offer scholarship funding to train a WIC staff person to become an Internationally Board-Certified Lactation Consultant (IBCLC). It can also look like scheduling recurring meetings with coalitions and local leaders in healthcare to plan for their National Breastfeeding Month events around the town, or recurring meetings with EPIC to streamline the county referral system so that lactation consultants might be flagged when food insecurity is flagged. It can also look like purchasing materials or printing resources for community baby showers, health fairs, and community resource centers.

Finally, as a funding organization that provides technical guidance and support, it’s important that in our role, we understand that these organizations know their communities best, and so they are best fit to identify what success looks like to their community. For some communities, having 1-2 organizations adopt 1-2 breastfeeding-friendly policies is an extreme success when we factor in the political and social context in their community. For others, engaging 25 unique families on their virtual or hybrid support groups over a couple of months means they can provide the needed lactation and other support to their family units. It’s critical to our relationships that we build that trust with our grantees, and that they build trust within the community, so that these recommendations and strategies have intentional and meaningful long-lasting impact.

Q: If there are communities interested in learning more about successful implementations of the Blueprint, where can they locate these success stories? Is there anything else that would be helpful online for anyone interested in learning how to start implementing the Blueprint?

NACCHO is extremely proud of each of our grantee communities for their implementation of the Blueprint, and we really view our grantees as partners in this work. These are just some of the successes from the communities NACCHO has partnered with. There are more success stories, resources, tools, and webinars available on the Blueprint website and on NACCHO’s Chest/Breastfeeding and Early Childhood Nutrition webpage. In the fall of 2024, more successes from our most recent cohort will be available on our website!

The Blueprint Website 

The CoC Blueprint website also serves as a national repository of community breastfeeding programs, success stories from our previous grantees, stories, and resources in the CoC Resource Library. The Chest/Breastfeeding website also includes recordings of the accredited eight-part webinar series #EveryStepoftheWay through the First 1,000 Days, with sessions that focus on each of the seven recommendations of the CoC Blueprint. Continuing education credits for most of the webinars in the series are still available, along with recordings and resource guides.

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To contribute resources and other materials to the CoC Resource Library, please contact [email protected].