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Office of the Surgeon General (US); Centers for Disease Control and Prevention (US); Office on Women's Health (US). The Surgeon General's Call to Action to Support Breastfeeding. Rockville (MD): Office of the Surgeon General (US); 2011.
Mothers and Their Families
Action 1Give mothers the support they need to breastfeed their babies
| Implementation Strategies | Potential Actors |
|---|---|
| Help pregnant women to learn about the importance of breastfeeding for their babies and themselves. | Women Family members and friends Clinicians |
| Teach mothers to breastfeed. | Women Family members and friends Clinicians |
| Encourage mothers to talk to their maternity care providers about plans to breastfeed. | Women Family members and friends Clinicians |
| Support mothers to have time and flexibility to breastfeed. | Women Family members and friends Clinicians |
| Encourage mothers to ask for help with breastfeeding when needed. | Women Family members and friends Clinicians |
Action 2Develop programs to educate fathers and grandmothers about breastfeeding
| Implementation Strategies | Potential Actors |
|---|---|
| Launch or establish campaigns for breastfeeding education that target a mother’s primary support network, including fathers and grandmothers. | Public health entities Community organizations |
| Offer classes on breastfeeding that are convenient for family members to attend. | Community organizations Hospitals |
Communities
Action 3Strengthen programs that provide mother-to-mother support and peer counseling
| Implementation Strategies | Potential Actors |
|---|---|
| Create and maintain a sustainable infrastructure for mother-to-mother support groups and for peer counseling programs in hospitals and community health care settings. | Public health entities Community organizations |
| Establish peer counseling as a core service available to all women in WIC.* | Federal, state, and local WIC programs |
- *
WIC = Special Supplemental Nutrition Program for Women, Infants, and Children; U.S. Department of Agriculture.
Action 4Use community-based organizations to promote and support breastfeeding
| Implementation Strategies | Potential Actors |
|---|---|
| Support and fund small nonprofit organizations that promote breastfeeding in communities of color. | Federal, state, and local governments Foundations |
| Integrate education and support for breastfeeding into public health programs that serve new families. | Public health entities Community organizations |
| Ensure around-the-clock access to resources that provide assistance with breastfeeding. | Public health entities Community organizations |
Action 5Create a national campaign to promote breastfeeding
| Implementation Strategies | Potential Actors |
|---|---|
| Develop and implement a national public health campaign on breastfeeding that relies heavily on social marketing. | Federal, state, and local partners |
| Use a variety of media venues to reach young women and their families. | Public health entities Community organizations |
Action 6Ensure that the marketing of infant formula is conducted in a way that minimizes its negative impacts on exclusive breastfeeding
| Implementation Strategies | Potential Actors |
|---|---|
| Hold marketers of infant formula accountable for complying with the International Code of Marketing of Breast-milk Substitutes. | Public health entities Infant formula manufacturers |
| Take steps to ensure that claims about formula are truthful and not misleading. | HHS/FDA† Federal Trade Commission |
| Ensure that health care clinicians do not serve as advertisers for infant formula. | Health care professionals |
- †
HHS/FDA = U.S. Department of Health and Human Services/U.S. Food and Drug Administration.
Health Care
Action 7Ensure that maternity care practices throughout the United States are fully supportive of breastfeeding
| Implementation Strategies | Potential Actors |
|---|---|
| Accelerate implementation of the Baby-Friendly Hospital Initiative. | Public health entities |
| Establish transparent, accountable public reporting of maternity care practices in the United States. | HHS/CDC* The Joint Commission |
| Establish a new advanced certification program for perinatal patient care. | Public health entities The Joint Commission |
| Establish systems to control the distribution of infant formula in hospitals and ambulatory care facilities. | Hospitals Ambulatory care facilities |
- *
HHS/CDC = U.S. Department of Health and Human Services/Centers for Disease Control and Prevention.
Action 8Develop systems to guarantee continuity of skilled support for lactation between hospitals and health care settings in the community
| Implementation Strategies | Potential Actors |
|---|---|
| Create comprehensive statewide networks for home- or clinic-based follow-up care to be provided to every newborn in the state. | Public health entities Community organizations |
| Establish partnerships for integrated and continuous follow-up care after discharge from the hospital. | Hospitals Health care systems Primary care clinicians Community organizations |
| Establish and implement policies and programs to ensure that participants in WIC† have services in place before discharge from the hospital. | Federal, state, and local WIC programs Hospitals Primary care clinicians Community organizations |
- †
WIC = Special Supplemental Nutrition Program for Women, Infants, and Children; U.S. Department of Agriculture.
Action 9Provide education and training in breastfeeding for all health professionals who care for women and children
| Implementation Strategies | Potential Actors |
|---|---|
| Improve the breastfeeding content in undergraduate and graduate education and training for health professionals. | Health professional organizations Medical schools |
| Establish and incorporate minimum requirements for competency in lactation care into health professional credentialing, licensing, and certification processes. | Health professional organizations Credentialing boards |
| Increase opportunities for continuing education on the management of lactation to ensure the maintenance of minimum competencies and skills. | Health professional organizations Medical schools |
Action 10Include basic support for breastfeeding as a standard of care for midwives, obstetricians, family physicians, nurse practitioners, and pediatricians
| Implementation Strategies | Potential Actors |
|---|---|
| Define standards for clinical practice that will ensure continuity of care for pregnant women and mother-baby pairs in the first four weeks of life. | HHS/HRSA‡ Health professional organizations |
| Conduct analyses and disseminate their findings on the comparative effectiveness of different models for integrating skilled lactation support into settings where midwives, obstetricians, family physicians, nurse practitioners, and pediatricians practice. | HHS/AHRQ§ |
- ‡
HHS/HRSA = U.S. Department of Health and Human Services/Health Resources and Services Administration.
- §
HHS/AHRQ = U.S. Department of Health and Human Services/Agency for Healthcare Research and Quality.
Action 11Ensure access to services provided by International Board Certified Lactation Consultants
| Implementation Strategies | Potential Actors |
|---|---|
| Include support for lactation as an essential medical service for pregnant women, breastfeeding mothers, and children. | HHS/CMS¶ Third-party payers |
| Provide reimbursement for International Board Certified Lactation Consultants (IBCLCs) independent of their having other professional certification or licensure. | HHS/CMS Third-party payers |
| Work to increase the number of racial and ethnic minority IBCLCs to better mirror the U.S. population. | HHS/HRSA |
- ¶
HHS/CMS = U.S. Department of Health and Human Services/Centers for Medicare & Medicaid Services.
Action 12Identify and address obstacles to greater availability of safe banked donor milk for fragile infants
| Implementation Strategies | Potential Actors |
|---|---|
| Conduct a systematic review of the current evidence on the safety and efficacy of donor human milk. | HHS/AHRQ |
| Establish evidence-based clinical guidelines for the use of banked donor milk. | HHS/MCHB** Health professional organizations |
| Convene a study on federal regulation and support of donor milk banks. | Institute of Medicine |
- **
HHS/MCHB = U.S. Department of Health and Human Services/Maternal and Child Health Bureau.
Employment
Action 13Work toward establishing paid maternity leave for all employed mothers
| Implementation Strategies | Potential Actors |
|---|---|
| Add maternity leave to the categories of paid leave for federal civil servants. | Federal government State governments |
| Develop and implement programs in states to establish a funding mechanism for paid maternity leave. | State governments |
Action 14Ensure that employers establish and maintain comprehensive, high-quality lactation support programs for their employees
| Implementation Strategies | Potential Actors |
|---|---|
| Develop resources to help employers comply with federal law that requires employers to provide the time and a place for nursing mothers to express breast milk. | DOL, HHS* Public health entities Employer organizations |
| Design and disseminate materials to educate employers about the benefits of providing more comprehensive, high-quality support for breastfeeding employees. | Public health entities |
| Develop and share innovative solutions to the obstacles to breastfeeding that women face when returning to work in non-office settings. | DOL, HHS Public health entities Employers |
| Promote comprehensive, high-quality lactation support programs as part of a basic employee benefits package. | Employers |
- *
DOL, HHS = U.S. Department of Labor; U.S. Department of Health and Human Services.
Action 15Expand the use of programs in the workplace that allow lactating mothers to have direct access to their babies
| Implementation Strategies | Potential Actors |
|---|---|
| Create incentive or recognition programs for businesses that establish, subsidize, and support child care centers at or near the business site. | Federal government State governments Community organizations |
| Identify and promote innovative programs that allow mothers to directly breastfeed their babies after they return to work. | Public health entities Employers Chambers of Commerce |
Action 16Ensure that all child care providers accommodate the needs of breastfeeding mothers and infants
| Implementation Strategy | Potential Actors |
|---|---|
| Promote adoption of the breastfeeding standards in Caring for Our Children: National Health and Safety Performance Standards: Guidelines for Out-of-Home Child Care. | HHS/HRSA† State governments |
- †
HHS/HRSA = U.S. Department of Health and Human Services/Health Resources and Services Administration.
Research and Surveillance
Action 17Increase funding of high-quality research on breastfeeding
| Implementation Strategy | Potential Actors |
|---|---|
| Designate additional research funding for studies on how to increase breastfeeding rates, the economics of breastfeeding, and management of lactation. | HHS/NIH* Foundations |
- *
HHS/NIH = U.S. Department of Health and Human Services/National Institutes of Health.
Action 18Strengthen existing capacity and develop future capacity for conducting research on breastfeeding
| Implementation Strategies | Potential Actors |
|---|---|
| Develop a national consortium on breastfeeding research. | HHS/NIH Researchers |
| Enhance the training of scientists in basic and applied research on lactation, breastfeeding, and women’s and children’s health. | HHS/NIH Universities and medical schools |
Action 19Develop a national monitoring system to improve the tracking of breastfeeding rates as well as the policies and environmental factors that affect breastfeeding
| Implementation Strategies | Potential Actors |
|---|---|
| Enhance the CDC Breastfeeding Report Card by including a broader array of process indicators and showing trends over time. | HHS/CDC† |
| Collect data in all states on the initiation of breastfeeding and in-hospital supplementation with formula through the U.S. Standard Certificate of Live Birth. | State governments |
| Develop systems to collect key information on policy and environmental supports for breastfeeding. | HHS/CDC |
- †
HHS/CDC = U.S. Department of Health and Human Services/Centers for Disease Control and Prevention.
Public Health Infrastructure
Action 20Improve national leadership on the promotion and support of breastfeeding
| Implementation Strategies | Potential Actors |
|---|---|
| Create a federal interagency work group on breastfeeding. | Federal government |
| Increase the capacity of the United States Breastfeeding Committee and affiliated state coalitions to support breastfeeding. | Public health entities |
- Actions to Improve Breastfeeding - The Surgeon General's Call to Action to Suppo...Actions to Improve Breastfeeding - The Surgeon General's Call to Action to Support Breastfeeding
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