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E
Excerpts from Comments Received on
the Institute of Medicine’s Website for
the Workshop to Update the USDA
National Breastfeeding Campaign
From March to May 2011, a public website was set up (www.iom.
edu/USDABreastfeeding) to provide input to the U.S. Department of Agri-
culture’s Food and Nutrition Service about the Loving Support campaign.
About 40 comments were received from health departments, hospitals,
breastfeeding coalitions, WIC offices, and other settings.
A sampling of the comments is reprinted below. They have been edited
for length, in some cases with some minor copyediting.
Question 1: How does FNS build on the success of the current Loving
Support Makes Breastfeeding Work campaign to promote breastfeeding
among WIC participants?
From a medical school professor:
Breastfeeding is an incredibly difficult skill to master. Doctors, midwives,
and lactation consultants all offer conflicting advice about breastfeed-
ing. There needs to be a consistent approach across disciplines, and
it needs to be offered early—in the hours and days immediately after
childbirth—and continued in the early weeks, and then support and
encouragement needs to happen when mothers return to work.
From a peer counselor:
I think the current food instruments allowing for more food for breast-
feeding mothers and their babies is wonderful. . . . I must add, however,
101
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102 UPDATING THE USDA NATIONAL BREASTFEEDING CAMPAIGN
that I don’t personally feel the breastfeeding package is big enough,
meaning I believe even more food choices should be allowed for these
mothers.
From a WIC staff member:
Expansion of early education/promotion with a focus on the use of
materials that truly make a difference is one strategy for building on
the success of the current campaign. Our aim was to develop an edu-
cational kit that clearly communicated that WIC moms and babies are
important and that breastfeeding is important, and this kit evidences
that. All of the products contained in the kit are of the highest quality,
effectiveness tested, and specifically targeted. We received the nicest
compliment from a nurse/IBCLC who works with middle- and upper-
income breastfeeding moms: “This kit looks like something we would
give our moms.” And indeed the kit clearly communicates to each
WIC mom, “You and your baby are important. So let’s talk about
breastfeeding.”
From a WIC nutrition/breastfeeding coordinator:
In the Southwest region we have used the campaign with an FNS-
sponsored workgroup to provide prenatal education bags for WIC
participants.
From a medical school employee:
I believe the campaign needs to focus on clear, simple, concise mes-
sages about breastfeeding that are at a reading level of participants
targeted. Although technology and media, such as Facebook and tex-
ting, are popular forms of communication, the message that exclusive
breastfeeding is best for newborns still must be comprehended by the
participants at a deeper level.
From an IBCLC:
Increase funding to hire more peer counselors in areas where there are
none, and increase their availability to WIC clients (e.g., more hours,
more activity) where programs are in existence. Provide support and
funding for clinics to offer comprehensive prenatal breastfeeding classes
and ongoing breastfeeding support groups. Fund at least one breast-
feeding expert for every clinic and recommend that states hire IBCLCs.
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APPENDIX E
Increase funding to allow for hospital and home visits by IBCLCs,
when indicated. In order to increase access to skilled breastfeeding
support, suggest clinics consider hiring non-licensed IBCLCs (meaning
without a state license such as RN or RD) as well as licensed IBCLCs.
The level of breastfeeding education and knowledge needed to pass the
IBLCE exam is equal, so clinics would not be compromising care. Ad-
ditionally, non-licensed IBCLCs may save the clinic money as they often
will work for a lower salary. Promote the campaign in the community,
especially to physicians and hospitals. Encourage hospitals to offer
care that promotes early breastfeeding initiation and bonding. Provide
ongoing breastfeeding education for peer counselors and WIC staff.
Provide clients with access to comprehensive breastfeeding information,
whether via print or online. Provide funding for current breastfeeding
education materials, including videos and demonstration models that
represent current knowledge of breast anatomy. Encourage clinics to
develop relationships with community breastfeeding resources such as
La Leche League, Black Breastfeeding Association, Breastfeeding USA,
Mocha Moms, Attachment Parenting International, etc.
From a peer counselor coordinator:
The Loving Support curriculum is engaging and inspiring. It could be
enhanced by more fully utilizing additional evidence-based materials,
such as Breastfeeding: A Magical Bond of Love.
From a peer counselor:
By creating a net for moms who have no idea of how to find resources
or do not even consider finding them. For many of them, the thought
process begins when they are contacted by a peer counselor or some-
one asks, “What are your breastfeeding goals?” Many times it is not
on their radar until they are caught by this loving and supportive net!
From a WIC state supervisor:
Fund the WIC Peer Counselor Program so that there will be a minimum
of one WIC Peer Counselor in every WIC local agency to provide peer-
to-peer latch and position support to all WIC breastfeeding women.
Ensure that all local agencies have competent professional authorities
with certification to better support WIC participants toward successful
breastfeeding up to and beyond 12 months postpartum.
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From a lactation consultant:
My recommendation is to involve all the WIC participants’ fami -
lies, friends, and their community. Stop giving away free formula to
everyone.
From a hospital staff member:
Focus more on the hazards of formula as opposed to the benefits of
breastfeeding.
From a WIC client:
Breastfeeding needs the support of pediatricians and nurses. I have
too many friends who were unable to successfully breastfeed mostly
because of the advice or recommendation of a doctor or nurse! Parents
need to see more information on why breast milk is simply far superior
to infant formula. I would like to see breastfeeding addressed on public
television. If we run ads about the risks of drunk driving and smoking,
why can’t we run ads about the benefits of breastfeeding?
From a nutrition education coordinator:
Add to the messages so that they appeal to grandmothers, fathers,
etc. and make those people start thinking of breastfeeding as the first
choice for feeding a baby. Add messages that can be used to promote
breastfeeding to doctors, clinics, nurses, and hospitals as the first choice
for feeding a baby. Include materials to help market mother/baby
breastfeeding-friendly care protocols to the above audiences.
From a peer counselor:
Our peer counseling program has taken steps to network with the lo-
cal lactation experts to bring better service to our clients. This includes
hospitals, independent lactation consultants, schools, and home visit
nurses. By collaborating with other community resources, we have been
able to make more of a difference with our clients and in a speedier
time frame as well. We have also utilized e-mail and text messaging
with our clients who are interested. This has been especially helpful
with our younger moms who are more comfortable with this method
of communication.
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APPENDIX E
From a WIC program:
Have more specific examples and guidelines for referral to an IBCLC
as the breastfeeding expert. The guidelines should be very specific with
respect to the job functions of peer counselors.
From a lactation consultant:
To move this campaign along, there need to be more incentives for busi-
nesses to participate willingly. Currently they are being “threatened”
by new laws being passed where they have to comply with offering
breastfeeding women time/space to pump. What if we offer the busi-
nesses a way to hire an IBCLC consultant to help set up and provide
ongoing support to their breastfeeding moms?
From a WIC program:
Review current requirements for breastfeeding peer counselors (BFPCs)
to see if updating the qualifications would support women better by
making it possible to expand the program. Our state developed on-
line modules for BFPC training. If a national online training existed,
it would provide more standardization, and accessibility to training
would become more flexible.
From a lactation program coordinator:
Utilizing International Board Certified Lactation Consultants for educa-
tion and support of breastfeeding has shown to result in better breast-
feeding duration rates for areas.
From a county health department:
I would like to see more education focused on physicians and the mis-
conceptions they have about breastfeeding as well as more emphasis
on appetite and growth spurts and how to help the confidence of the
mother regarding milk supply.
From a breastfeeding counselor:
I’ve been a breastfeeding counselor for 6 months. I really admire the
title “Loving Support.” It’s when I sound a little less controlling and
more interested in caring for WIC participants that I’m more successful.
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From a prenatal education coordinator
Provide (1) consistent professional information/education for all breast-
feeding families; (2) support using easily accessible lactation counselors;
(3) physical space for lactating moms to pump at their place of work;
(4) a healthy point of reference accepting breastfeeding mothers and
babies in public places in our society; (5) education for the upcoming
generation that breastfeeding is a healthy and normal method of feed-
ing our babies; and (6) monetary support for various breastfeeding
advocacy groups and agencies.
From a breastfeeding coordinator:
Continue to support the Peer Breastfeeding Grant. It has proven very
successful in our small county. Make available free large posters of
women breastfeeding in a wide variety of settings and in a wide va-
riety of cultures. Make the sight of breastfeeding a normal, natural
phenomenon.
From a breastfeeding peer counselor manager:
The standard would be that all pregnant participants without excep-
tion (including those mothers who indicate that they don’t want to
breastfeed) would have an educational contact with a breastfeeding
peer counselor.
From a social marketing consultant:
My feeling is that you have a wealth of information about possible
strategies that could be part of the campaign. But the first most impor-
tant step for moving the campaign forward, in my opinion, is to do
formative research and include testing of the current campaign materi-
als in the formative research. The findings from the formative research
will then allow the USDA to select the most appropriate strategies for
the campaign, to select appropriate targets and messages, etc. I would
then recommend creating a very straightforward logic model that lays
out the goal and objectives of the campaign, the strategies you will use,
and how you will measure success based on the outcomes you expect.
The logic model, if very simple, will be an excellent educational tool
for state and local programs.
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APPENDIX E
From a medical center employee:
Work out a way to include moms willing to pump and feed. There is a
small number who cannot breastfeed due to past abuse histories, etc.,
and they should not be excluded. It can help them mend as well.
Question 2: The original Loving Support Makes Breastfeeding Work
campaign was launched in 1997. How can the campaign be improved to
better meet the needs of current WIC participants? Specifically, what are key
considerations for breastfeeding messages, communication tools (including
social media), technical assistance for WIC staff, community partners and
collaboration, and changes in laws, policies, and other initiatives?
From a medical school professor:
So many mothers stop breastfeeding when they return to work. Support
for working mothers needs to happen—support in terms of offering
materials, tips, guidance, and encouragement. Asking mothers if they
are breastfeeding and if it is working is not enough—they may not real-
ize that they are or are not doing it correctly.
From a peer counselor:
I was trained using the Loving Support module. While I feel it was
sufficient, I must admit I thought it to be a bit “dated,” from the in-
formation to the pictures. Also, more emphasis needs to be placed on
new ways of communicating such as e-mail, text messaging, and social
networking. That said, women still need to have real live communica-
tion and contact with other moms, PCs, and LCs in a support group
type setting. Whether it be at a clinic or elsewhere, I believe this is
crucial to getting the breastfeeding numbers up and keeping them up.
From a lactation consultant:
Messages need to target today’s parents in terms of language and
appearance—contemporary images, edgy messages, eye-catching de-
signs. Campaigns need to be multi-faceted, tapping into social media
platforms as a means of dissemination. The Text4Baby campaign by
Healthy Mothers Healthy Babies is a good example. Expand the WIC
Peer Counseling Program and integrate WIC programs and hospital
services so that there is seamless care throughout the perinatal period.
Change needs to occur not only among mothers, but also among em-
ployers, healthcare facilities, schools, faith-based communities, and
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108 UPDATING THE USDA NATIONAL BREASTFEEDING CAMPAIGN
state, local, and federal governments, so materials need to be targeted
but integrated. Too much time is spent telling people something they al-
ready know. We need to focus instead on “You can do this. I can help.”
From a WIC nutrition/breastfeeding coordinator:
I feel that the word “support” for many moms is taken for granted.
We make the law, we train WIC staff, we collaborate and do all these
things, but when it comes down to it, in this society a breastfeeding
mom still has to fight for her right to breastfeed. As individuals we may
support breastfeeding, but as a society we do not “support” breastfeed-
ing moms.
From a medical school:
Although computer technology is popular, I hope that that will not
be the focus of this campaign, for we see too many women ignoring
contact and interaction with their newborns while they use their cell
phones or computers. Somehow the importance of putting children
before technology needs to be stressed in this new campaign.
From an IBCLC:
So many mothers have difficulty breastfeeding in the hospital and in
the early days. Strengthening messages about getting breastfeeding
off to a good start would be incredibly helpful to mothers. Promote
ways to make breastfeeding and working easier (tips for expressing
milk, bringing baby to work, etc). Inform clients of their rights as
employees. Encourage clients to advocate for themselves. Additionally,
offer information targeted to specific communities, especially African
American, Native American, and Hispanic. Online forums and webi-
nars could be used to provide support to clients as well as to inform
the community. Offer accurate info about breast milk storage and
handling, amounts that breastfed babies take in bottles, normal infant
behavior, needs of the breastfeeding mother, etc. Encourage staff to
join or start area breastfeeding coalitions. Promote WIC breastfeeding
services through church, community, and civic groups. Provide targeted
breastfeeding promotional materials for fathers, grandparents, schools,
employers, community leaders, and healthcare providers. Lack of ac-
cess to accurate, comprehensive breastfeeding information is a barrier
to breastfeeding, at least in my community. If every clinic could provide
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APPENDIX E
a breastfeeding class specifically for clients who are returning to work
or school, attending the class could be made part of the requirement
for receiving a full-size double electric pump, too.
From a peer counseling coordinator:
Include guidance on and tools for social media use and etiquette (e.g.,
following HIPAA guidelines while using Facebook, YouTube, and Twit-
ter) as well as guidance on how to go about building rapport and col-
laborating with community partners.
From a nutritionist:
Breastfeeding peer counselors (with IBCLC) in hospital setting to work
with moms on first-hour latch, more hands-on staff trainings, and
aggressive media and ad campaigns to promote breastfeeding; also
increasing community partnerships and collaborations may help.
From a peer counselor:
I am a huge advocate for using technology. Many moms will only con-
nect on a text message agenda, and although many may argue that you
just don’t have the same communication via texts, sometimes it is the
only way to establish communication and provide that support that
otherwise they would not be interested in. Establishing communication
with lactation consultants at the hospitals where my clients deliver has
made all the difference and has had a huge impact.
From a WIC state supervisor:
Provide more advanced training on resolving breastfeeding problems
that WIC participants have. Simple, direct breastfeeding messages for
WIC participants and the public, including the link to obesity. Social
media focus on breastfeeding as the norm for feeding infants. Provide
more education on the importance of skin-to-skin contact through the
first six weeks to six months of life to stabilize preemies and enhance
preemie and full-term infant health outcomes and growth. Better train-
ing on breastfeeding problem resolution; funding/support for state
breastfeeding coalitions. More laws and initiatives that support WIC
breastfeeding women and infants.
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From a lactation consultant:
Prepare women to survive the hospital experience. Most hospitals are a
barrier to breastfeeding, as reported by the CDC in the mPINC survey.
From a hospital staff member:
The Health Care Act of 2010 made time and a place for pumping at
work mandated in companies with 50 or more employees This should
be shared with WIC participants.
From a WIC client:
I have to say that the key to my success was accurate information about
milk production and babies, but also my mother-in-law works for a
WIC program certifying women and children, and she breastfed 3 boys
in her day. She came to my home to support me. We cannot give full
support over the phone! How can we create a way for WIC staff to
support mothers in their home?
From a nutrition education coordinator:
Key messages: Breastfeeding is the first and best choice in feeding a
baby; ways to talk with their healthcare provider and delivery site
about breastfeeding; go with more emotion-based messages, messages
geared toward a generation of grandparents who chose not to breast-
feed, etc.
From a peer counselor:
Our agency has been given Blackberries, which has made communica-
tion with other WIC staff much more efficient. We also have the option
of text messaging. This has been very helpful especially when clients
deliver and are too overwhelmed for phone calls. We can send quick
tips and guidance when necessary. Our teen moms have been much
more receptive to this means of communication as well.
From a breastfeeding coordinator:
USDA needs to redefine breastfeeding. Breastfeeding should not be de-
fined as a woman that breastfeeds once a day. If we are going to impact
the populations that are most at risk, we need to send clear messages
on the normalcy of infant feeding.
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APPENDIX E
From a WIC program:
Information that is factual and evidence-based allows the customer to
make a more informed feeding choice. Breastfeeding messages that are
more risk-based would be more effective; e.g., enumerate the risks of
formula feeding. Encourage the use of social media applications such
as Facebook and Twitter to connect with moms. In-person contact is
great, but many moms are unable or unwilling to connect in that man-
ner any longer due to time constraints or transportation issues.
From a lactation consultant
IBCLCs need to be reimbursed by insurance for their services. This is
the key to increasing breastfeeding rates on all levels, especially among
the WIC population, who can least afford the out-of-pocket cost of
IBCLC assistance but need the help the most.
From a WIC program:
A “Text4Baby” format with exclusively breastfeeding messages for
moms would be ideal. Any formal policy guidance for utilizing social
media formats to support breastfeeding within WIC is appreciated.
Breastfeeding messages need to be aimed at supporting duration and be
targeted to the areas identified in the Surgeon General’s Call to Action.
From a lactation program coordinator:
I would like to see stronger language to include the International
Board Certified Lactation Consultant’s role in promoting and support-
ing lactation.
From a WIC program:
I think a key breastfeeding message might be not the benefits of breast-
feeding but rather the hazards of formula feeding. Community part-
ners: reaching out to middle school health classes. Changes in laws:
healthcare reform and tax-deductable pumps would be a major step in
the right direction. Make breastfeeding the norm.
From a county health department:
More emphasis on hospitals limiting formula offered, and increase
Baby-Friendly Hospitals.
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From a breastfeeding coordinator:
Make it a law that insurance companies have to cover a certain number
of visits with an IBCLC after the baby is born so that if a mom needs
help she can get it. Make it a law that formula bags are not allowed to
be given out at hospitals. It is unethical, but now is the time to become
Baby Friendly. Give personal-use pumps to each WIC mother the last
month of her pregnancy. The cost is so much cheaper than formula and
would save the government hundreds of dollars from just one doctor’s
visit alone. Make lactation management an entire mandatory course
for pediatricians, OB/GYNs, and family practice doctors, as well as
labor and delivery nurses, NICU nurses, and registered dietitians. Get
a celebrity to campaign it so that it can become more popular.
From a breastfeeding counselor:
Many issues crop up in regard to pumping and working, and many
participants seem to know all about benefits, but I have trouble getting
them to answer until it’s too late.
From a breastfeeding coordinator:
Put some teeth in the law. The small businesses and factories in our area
all think they are exempt because pumping is a “hardship” on their
business hours. Give WICs more money for IBCLCs and breastfeeding
messages.
From a breastfeeding peer counselor manager:
Use Facebook and Twitter accounts to communicate with moms. Es-
tablish a model workplace breastfeeding program in WIC.
From a breastfeeding coordinator:
I think that prenatal education should be a focus. I think it should
be mandatory that all prenatal clients receive an instructional breast-
feeding class regardless of whether they plan to breastfeed or not.
Performance bonuses for peer counselors would be helpful in retaining
effective peer counselors.
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APPENDIX E
From a WIC project director:
It would be helpful if more representation of breastfeeding moms for
the promotional and educational materials included the populations
that are least likely to breastfeed (African American women, blue-collar
workers, and young teen moms).
From a U.S. Public Health Service employee:
Cell phones for breastfeeding peer counselors need to be funded.
From an IBCLC:
WIC mothers need the support to breastfeed most critically in the 1-
to 3-day hospital stay. Mothers state their first WIC appointment is in
two weeks, but they are losing heart to continue breastfeeding by day
2, especially if the hospital is not providing hour-to-hour bedside sup-
port to help mom and baby be successful. How can WIC provide lov-
ing support during the critical early hours and days of breastfeeding?
Can phone communication or hospital visits be incorporated into the
program? Can peer assignments develop a stronger bond prenatally?
From a social marketing consultant:
These questions are best answered through formative research. Wom-
en’s circumstances haven’t changed all that much (still too busy, still
embarrassed to feed in public, still pressured to bottle feed by family
and friends). I think the world of technology, and how we communi-
cate with target audiences is where the big change has occurred. We
should inquire about preferred communications methods with audi-
ences (WIC-eligibles, medical staff, employers of low wage earners,
etc.) in the formative research.
From a peer counselor at a county health department:
The key is to go out into the community and make them aware. We can
post as many posters as we want out there, but the better advertisement
is word of mouth.
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From a medical center staff person:
Our WIC offices are different in their education, opinions, how they
are run, and what they do to support moms. We need more consistency.
From a WIC program director:
There appears to be a shifting direction in the program. The concern:
Are peer counselors intended to encourage and support mothers, and
only directly address (counsel) low-risk issues? Or are they expected to
also address more high-risk situations with a mother? I believe future
changes in the Loving Support Program need to address the “scope
creep” that can occur as the peer counselors get more experience and
feel more confident in their “scope of practice.” Continuing educa-
tion needs to remain limited to the “normal” breastfeeding condition.
Understanding the WIC program does not enrich the peer counselor’s
knowledge as much as understanding the same struggles that our cli-
ents experience. The ideal peer counselor also does not need to be of a
similar age as the WIC clients (usually under 30). Our experience has
shown that an older woman can provide as much, or more, comfort to
a young mother who is having problems. The peer counselor program
needs to be more integrated with the WIC Program.
