Making Breastfeeding the Norm through The Breastfeeding Family-Friendly Community Designation (BFCD)

by Donna Walls, RN, BSN, ICCE, IBCLC, ANLC

The Breastfeeding Family- Friendly Community Designation (BFCD) was developed as a request from the World Alliance for Breastfeeding Action (WABA) to implement a community breastfeeding program which enhances breastfeeding support at the local level. A pilot designation program was launched in 2015 in Chapel Hill and Carrboro, NC. The implementation team includes: the Carolina Global Breastfeeding Institute, Chapel Hill- Carrboro Chamber of Commerce, Chapel Hill Rotary, Inter-Faith Council for Social Services (IFC), La Leche League of Chapel Hill (LLL), Office of the Mayors of Chapel Hill and Carrboro, Orange County Department of Health, and faith-based groups. It was designed to complement the Global Revised, Updated and Expanded Baby Friendly Hospital Initiative. Included in the revised Global Criteria is the updated BFHI Step Ten. The head/director of maternity services reports that:

  1. Mothers are given information on where they can get support if they need help with feeding their babies after returning home, and the head/director can also mention at least one source of information.
  2. The facility fosters the establishment of and/or coordinates with mother support groups andother community services that provide breastfeeding/infant feeding support to mothers and can describe at least one way this is done.
  3. The staff encourages mothers and their babies to be seen soon after discharge (preferably 2-4 days after birth and again the second week) at the facility or in the community by a skilled breastfeeding support person who can assess feeding and give any support needed and can describe an appropriate referral system and adequate timing for the visits.

This Designation sends the message that the community respects a family’s desires and appreciates the benefits of breastfeeding to the health of the child, the mother, the family, and the community. The BFCD also incorporates steps from The Surgeon General’s Call to Action to Support Breastfeeding of 2011 by Dr Regina Benjamin. The Steps in the 20 step action plan included in the BFCD are:

  • Action 3. Strengthen programs that provide mother-to mother support and peer counseling.
  • Action 4. Use community-based organizations to promote and support breastfeeding.

Strategies for implementation if this initiative

  • Support and assist in securing funding for small nonprofit organizations that promote breastfeeding with a focus on communities of color. Educational and training opportunities as well as all support resources need to reflect cultural integrity, culturally appropriate resources, and include ethnicities within the community in the development of all activities.
  • Integrate education and support for breastfeeding into public health programs that serve extended families including grandparents and caregivers for families. Develop informational programs for infant and childcare programs that include the handling and feeding of expressed breastmilk.
  • Encourage elementary, middle school and high school curriculum to include breastfeeding information in all human reproduction and health classes including health benefits to both mother and child.
  • Work with those organizations who work with expectant and new families including childbirth educators, home visitors, community-based doulas, advocates for prevention of domestic violence, public health nurses, and early childhood and Healthy Start programs to include early breastfeeding management and other topics such as breastfeeding in public and consoling techniques.
  • Ensure 24/7 access to resources that provide breastfeeding support. This should include telephone triage, “warmlines,” hotlines, online networks, reviewed social media, and appropriate referral sources in all communities. Work to ensure affordable lactation care in areas that are geographically accessible for all of those in the community.
  • Get involved with your community hospitals and encourage them to become designated as Baby Friendly. Volunteer to work with the childbirth education and lactation care departments to work as a liaison with breastfeeding and maternal child related community groups. Help to establish communication systems to ensure continued care once moms and newborns leave the hospital.
  • Talk with local businesses to encourage them to be welcoming to breastfeeding mothers and provide a comfortable nursing mothers area. Ensure all employees are provided time for expressing their milk in a place other than a bathroom. Post the international breastfeeding symbol as a signal to breastfeeding moms that they are welcome in this establishment.
  • Display breastfeeding art in public areas especially areas where families tend to gather to make breastfeeding the norm. Avoid or at least minimize displays of formula and formula supplies and pictures or photos of bottle feeding mothers/families.
  • Contact local milk banks and milk depot stations to assess availability of human milk for vulnerable and all newborns. Assure that information is made available for the donation process to all mothers and work to provide transportation and/or supplies for donating mothers if needed.

Ten Steps to becoming designated as a Breastfeeding Family Friendly Community

  1. The community/city’s elected or appointed leadership has a written statement of policy supporting breastfeeding that is routinely communicated to all.
  2. The community/city provides a welcoming atmosphere for breastfeeding families.
  3. Early and Exclusive breastfeeding for up to 6 months, and continued breastfeeding with appropriately-timed introduction of complementary foods, are encouraged for at least a year and for as long as the mother and child desire.
  4. All pregnant women in the community are informed about the benefits of breastfeeding, and risks of unnecessary formula use, where to access support as needed.
  5. Health care in the community/city is breastfeeding-friendly.
  6. Non-health system breastfeeding support groups and services are fully available in the community, including the Special Supplemental Nutrition Program for Women, Infants, and Children Program (WIC), La Leche League (LLL), and other skilled breastfeeding support.
  7. The business and social organizations in the community/city as a whole provide a welcoming atmosphere for breastfeeding families.
  8. Local businesses and healthcare clinics/offices follow the principles of the International Code of Marketing of Breast-Milk Substitutes.
  9. The World Alliance for Breastfeeding Action/WABA Maternity Care or the The US Business Case for Breastfeeding is promulgated by the U.S. government Department of Health and Human Services and the Chamber of Commerce.
  10. Education systems, including childcare, K-12, colleges and universities, are encouraged to include breastfeeding-friendly curricula at all levels.

Areas to include education and support for breastfeeding:

  • Informal support such as Baby Cafe, La Leche League, playgroups
  • Lactation care providers: OB, Midwife, Pediatrician and Family Physician Offices/Clinics, CLEs, CLCs, IBCLCs, WIC Clinics
  • Health care facilities-hospitals including maternity, surgery, emergency departments and urgent care centers
  • City, county and state policy makers: Proclamations, lawmakers such as state representatives, public safety, transportation, state departments of health
  • Media coverage- events (World Breastfeeding Week) as well as breastfeeding-related stories
  • Child care and preschool centers
  • Schools, colleges, and universities for employees and students
  • Recreational venues (sporting events, museums, concerts, shopping areas, airports)
  • Workplace and business policies including paid leave and worksite daycare
  • All places of worship
  • Correctional facilities
  • Homeless shelters & organizations serving moms with substance abuse
  • Military bases
  • Infant feeding in disasters and emergencies


Breastfeeding Family-friendly Communities Carolina Global Breastfeeding Institute CGBI: Resources- Breastfeeding-Friendly Child Care Toolkit International Baby Food Action Network The Academy of Breastfeeding Medicine World Alliance for Breastfeeding Action Breastfeeding Programs and Policies, Breastfeeding Uptake, and Maternal Health Outcomes in Developed Countries.   Agency for Healthcare Quality and Research. La Leche League International

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