Breastfeeding Promotion & Support

New Hampshire Public Health Breastfeeding Initiatives

The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) supports and promotes breastfeeding as the optimal way to feed infants. The New Hampshire WIC Program has implemented a variety of breastfeeding promotion and education initiatives to improve the rates of breastfeeding initiation and duration among mothers enrolled in WIC. Although the USDA's WIC program has always encouraged breastfeeding, federal regulations enacted as part of the 2009 appropriations for the program contain provisions that expand the scope of WIC's activities to encourage and support its participants in breastfeeding. WIC has begun a nationwide training program for all local agencies called Using Loving Support to Grow and Glow in WIC: Breastfeeding Training for Local WIC Staff, to ensure that all WIC staff can promote and support breastfeeding as well as a peer support program called Loving Support through Peer Counseling.

Exclusive breastfeeding is rewarded in the WIC program in multiple ways, including offering a food package with a higher monetary value for breastfeeding participants than for participants who do not breastfeed or who do so only partially. A variety of items, including larger amounts of fruits and vegetables, more whole grains and canned fish is included in the food package for women who breastfeed. Exclusively breastfed infants receive jarred infant meats and a larger quantity of infant jarred fruits and vegetables at 6 months old.

• WIC Breastfeeding Peer Counselor Program
  The NH WIC Breastfeeding Peer Counselor Program is available to mothers at all WIC clinics. The NH State WIC Breastfeeding Coordinator provides training for all nutrition and breastfeeding staff. The training includes advantages of breastfeeding, risks of formula feeding, 3 step counseling strategies, common breastfeeding barriers, returning to work and breastmilk handling, collection and storage guidelines. The trained peer counselors provide breastfeeding promotion and support at WIC clinics and over the phone. The peer counselors are also trained on using hospital-grade electric and manual breast pumps. Our breastfeeding initiation and duration rates are a result of many dedicated peer counselors.
   
• Breastfeeding Educational Materials
  A variety of breastfeeding brochures are available for use in local WIC agencies, healthcare provider offices, and community health centers. Printed materials include topics such as: benefits to the mother and child, returning to work or school, breastfeeding barriers and nutrition needs during breastfeeding. Select materials are available for request by e-mailing WICProgram@dhhs.nh.gov or downloading a copy of Breastfeeding in the Early Weeks brochure.
   
• ​Breastfeeding Resources
  www.ZipMilk.org is an online breastfeeding resource guide. It is available to mothers, families and professionals to enter their zipcode and find breastfeeding services in the area. Resources include free breastfeeding support groups, consultation by lactation professionals (IBCLCs), WIC breastfeeding support programs, and breastfeeding classes. Some services are available for reimbursement through insurance.
   
• Maternal and Child Health Section
  Breastfeeding benefits mothers and babies in many ways. The NH DHHS Maternal and Child Health (MCH) Section encourages its state-funded community health centers, prenatal programs, and home visiting programs to educate expecting families on the health and nutrition benefits of breast feeding, and support new mothers in continuing breast feeding through the first year. Community Health Centers are required to meet performance measure expectations and engage in quality assurance activities that support the encouragement of infants being exclusively breast fed through the first three months of life. Additionally, community health centers ensure that eligible clients are enrolled in WIC so that clients can benefit from the supports and services of the WIC program pertaining to breastfeeding. The Maternal and Child Health Section encourages the promotion of breastfeeding not only to give the best nutritional start to infants, but to help prevent obesity and other chronic health conditions in both the mother and baby.
   
• Worksite Breastfeeding Support
  Companies both large and small benefit from providing a worksite lactation support program. On March 23, 2010, the President signed the Patient Protection and Affordable Care Act, making it law that employers allow nursing mothers to express milk at work. Employers are required to provide reasonable break time for an employee to express breast milk for her nursing child for 1 year after the child’s birth each time such employee has need to express milk. Employers are also required to provide a place, other than a bathroom, that is shielded from view and free from intrusion from coworkers and the public, which may be used by an employee to express breast milk. The Department of Labor Fact Sheet #73, Break Time for Nursing Mothers (updated 1/23), provides general information on the break time requirement. The US Breastfeeding Committee has free resources for employees and employers on workplace lactation support.

When the following simple, cost-effective components are provided to breastfeeding women, companies enjoy savings.

• Privacy to express milk
  For women who do not work in a private office, a small, private (free from intrusion) space that can be set up for lactation needs throughout the day will be needed. A nursing mother may need to express milk up to three times a day, while separated from her infant. A small room with an electrical outlet, chair and within close proximity to a sink is ideal. An employee should never be asked to express milk or breastfeed in a bathroom.
   
• Flexible breaks
  Each milk expression can be unique to the mother and age of the infant, with a typically session around 15-20 minutes for expression plus time to get to and from the lactation room. Flexible breaks can easily be divided between usual breaks and meal periods. Allowing a mother to come in early or stay late should be considered if milk expression takes longer than anticipated.
   
• Education
  Educational materials available at the workplace, lunchtime prenatal classes and access to a lactation consultant can help employees feel more prepared.
   
• Support
  Supportive policies and practices that enable women to return to work and successfully continue to breastfeed send a message to all employees that breastfeeding is valued. Management can encourage supervisors to work with breastfeeding employees in making reasonable accommodations to help them reach their breastfeeding goals and encourage other employees to exhibit a positive and accepting attitude.

The US DHHS, Business Case for Breastfeeding, a toolkit for employers and employees to create a breastfeeding friendly worksite, is available for download online or can be ordered free of charge.

National Public Health Breastfeeding Initiatives

• In January 2011, the US Surgeon General issued a Call to Action to Support Breastfeeding. The Call to Action calls upon healthcare providers, employers, insurers, policymakers, researchers, and the community at large to take 20 concrete action steps to support mothers in reaching their personal breastfeeding goals. The New Hampshire Department of Health and Human Services (NH DHHS) supports these steps as the best way to help ensure babies have a healthy start.
• The CDC Guide to Breastfeeding Interventions provides guidance in selecting evidence-based and promising breastfeeding promotion and support activities. It is available for download online, free of charge.
• Preventing obesity begins in the hospital. Childhood obesity is an epidemic. In the US, 1 preschooler in 5 is at least overweight, and half of these are obese. Breastfeeding helps protect against childhood obesity. Download the CDC Vital Signs, Hospital Support for Breastfeeding, for the full report.
• The CDC Breastfeeding Report Card provides state-by-state data so that health professionals, legislators, employers, business owners, community advocates and family members can work together to protect, promote, and support breastfeeding. The Report Card indicators measure types of support in key community settings as well as the most current data on the breastfeeding goals. The Breastfeeding Report Card also includes data from the mPINC (Maternity Practices in Infant Nutrition and Care) Survey.
• The CDC mPINC Survey is completed by the person most knowledgeable about the facility's maternity care practices related to healthy newborn feeding and care and is collected every two years.
• The Six Steps to Achieve Breastfeeding Goals for WIC Clinics are an integral part of the NWA Breastfeeding Strategic Plan and will assist WIC agencies with achieving these goals. To help with achieving all six steps, local agencies can use the Six Steps to Achieve Breastfeeding Goals Checklist, which provides specific criteria for WIC clinic staff to assess their progress towards meeting these goals. By implementing the Six-Steps, WIC clinics can collectively promote breastfeeding friendly environments that support exclusive breastfeeding.
• The Baby-Friendly Hospital Initiative (BFHI) established by WHO and UNICEF in 1991 includes maternity practices, which are known as the Ten Steps to Successful Breastfeeding. When the Ten Steps are implemented together, mothers have better breastfeeding outcomes. New Hampshire currently has seven Baby-Friendly Hospitals: Alice Peck Day Memorial Hospital, Catholic Medical Center, Concord Hospital, Mary Hitchcock Memorial Hospital, Monadnock Community Hospital, St. Joseph Hospital and Wentworth-Douglas Hospital. To learn more about the BFHI and the Ten Steps to Successful Breastfeeding, visit the website www.babyfriendlyusa.org.
• See the National WIC Association’s Statement on the Baby-Friendly Hospital Initiative
• World Breastfeeding Week