About Us

Advocating for First Food Equity

Breastfeed Durham is a health equity advocacy group located in Durham, North Carolina. It is our hope that every family in our community understands the benefits of breastfeeding, and is then able to make informed decisions that are right for them.  We celebrate any amount of breastmilk received by an infant, whether breast- or chestfeeding, given by bottle, or provided by another method (supplemental nursing system, syringe, spoon, gastrostomy tube, Haberman Feeder). Though our focus is human milk feeding, Breastfeed Durham strives to support all Durham families, including families that use formula. We are working to be sensitive to every family’s trials, tribulations, pain, exhaustion, needs, and challenges. There is a great deal of work to be done in Durham before all families will have equitable access to healthcare, breastfeeding support resources, and education. Our definition of breastfeeding “success” is defined by each family’s individual needs and by each family’s individual desires. Breastfeed Durham envisions a world in which parents, families, and babies leverage their expertise by transforming systems in order to live full and healthy lives. Unapologetically committed to racial and gender equity, Breastfeed Durham is leading the development of Breastfeeding Family Friendly Communities (BFFC) as an initiative to recognize and support the lactation goals of families in all areas of community life. We are implementing the Ten Steps to a Breastfeeding Family Friendly Community in Durham to promote policy, system, and environmental changes that reach those who have been historically marginalized, always using an equity lens to do so. We are using these innovative strategies to nurture a more chest/breastfeeding family friendly community as an integral part of the First Food Equity Movement. 

Our Mission

The mission of Breastfeed Durham is to support a more breastfeeding and family friendly Durham by advocating for policies and practices that support breastfeeding, chestfeeding, and human milk feeding, as outlined by the World Health Organization (WHO).

Our Vision

We recognize that breastfeeding is the “great equalizer,” as JP Grant expressed during his tenure as UNICEF executive director, as it impacts health equity outcomes at all stages of life. Believing that the creation of a breastfeeding family friendly community can ameliorate those inequities, we seek to provide access to education, resources, and support for all families in the Durham community, as well as to advocate for policies that protect nursing families’ rights, in order that they may meet their own personal breastfeeding goals.

Contact

Please contact us with any feedback or questions.

Our Goals

With your help, and with equity at the heart of our vision and mission, Breastfeed Durham is promoting and supporting first food equity in Durham. We encourage families to hold healthcare providers accountable for top-quality health care, help families find excellent prenatal care, and teach every family in Durham why breastfeeding matters. We support statewide and international efforts for paid family leave and teach employers how to encourage and support breast/chestfeeding families. We help families find childcare providers that understand breast/chestfeeding. We support local markets that sell healthful food, encourage businesses to fill food deserts, and support the city and county in making beneficial changes for families. We envision a future in which every family that wants to breastfeed will be able to for as long as that family chooses.

The foundation of Breastfeeding Family Friendly Communities is to transform the culture of a community so that chest/breastfeeding is normalized for not just white families, but for the whole community, especially Black families. We nurture connections between existing parts of the community, elevating the work of historically marginalized community members, and amplifying the voices of Black lactating parents. We recognize that breastfeeding, chestfeeding, and human milk feeding are “The Great Equalizer,” impacting health equity outcomes at all ages and stages of life. With a vision to improve lactation duration, BFFC developed a set of measures to guide communities in welcoming lactating families —especially Black  and historically marginalized families—in all the spaces and places in which families live and interact. BFFC works to nurture a more breastfeeding, chestfeeding, and human milk feeding friendly community by advocating for policies and practices that support optimal infant feeding, using a Ten Steps approach that complements and broadens the community scope of the World Health Organization (WHO) and UNICEF guidelines. The measures within the Ten Steps to a Breastfeeding Family Friendly Community, foster continuity of care throughout pregnancy and birth to the family’s planned time to wean. These measures are intended to build awareness of the community’s role in supporting families, eliminating disparities, and providing measures and approaches to build a welcoming environment for families, including historically marginalized families. In collaboration with advocates from our neighbors in Orange County, Breastfeed Durham supports the global movement by sharing our experience with other municipalities via technical assistance, presentations, and updates to the Breastfeeding Family Friendly Communities website.

Research has shown that optimal infant feeding not only supports infant and early childhood health, growth, and development, but also lowers the risk of childhood obesity. Beyond these focus areas, breastfeeding, chestfeeding, and human milk feeding improves maternal health and mental well-being, results in health care cost savings, and offers environmental and societal benefits. Racial and socioeconomic equity in breastfeeding rates is a critical priority for public health in the United States. However, significant racial and ethnic disparities in breastfeeding persist, particularly among infants living in the Southeast. Black mothers are 2 to 3 times less likely to initiate breastfeeding and to have 15-20% lower rates of breastfeeding at 6 months of life compared to white women.1 Differences are even more striking in the Southeast.

In Durham, in 2022, Duke Regional shared a breastfeeding initiation rate of 91.51%, Duke University Hospital’s initiation rate was at 90.38% (this is not the same as exclusive breastfeeding rate). We celebrate and applaud these breastfeeding initiation rates and, we wonder about the racial disparity rates. , 36% of infants receiving a home visit from Family Connects Durham between 2 and 12 weeks of age were exclusively breastfeeding with only 20% of Black mothers exclusively breastfeeding. This is in comparison to the state average of 43% of infants exclusively breastfeeding at 3 months.2 Despite having similar intentions to breastfeed during pregnancy, Black mothers are less likely to meet their breastfeeding intentions when compared to white women.3. The data shows that this is a systems problem, not an individual problem.

Breastfeeding has many proven health benefits for both mother and baby.4 Improving breastfeeding initiation and duration among Black mothers has the potential to reduce downstream maternal and child health outcomes that differ by race. For example, breastfeeding reduces the risk of breast cancer, of which several subtypes occur more commonly among Black women.5 In addition to maternal health outcomes, disparities in breastfeeding lead to significant child health inequities, as increases in duration and exclusivity in breastfeeding reduces the incidence of otitis media, upper and lower respiratory infections, asthma, gastroenteritis, inflammatory bowel disease, obesity, type 1 and type 2 diabetes, leukemia, eczema, celiac  disease, and sudden infant death syndrome.4 

Efforts to increase breastfeeding uptake and duration and reduce disparities in breastfeeding rates have included individual-level interventions to improve self-efficacy, knowledge, and practical support for mothers in both clinical and non-clinical settings.6 Policy interventions, such as the Baby-Friendly Hospital Initiative, have shown significant improvements in increasing breastfeeding initiation and duration.7 Recently, implementation of this initiative in hospitals in Mississippi increased initiation of breastfeeding by 10% and reduced the disparities in breastfeeding initiation between Black and white maternal-infant dyads by 17.8%. The Breastfeeding Family Friendly Community (BFFC) Designation is a program designed to complement the Global Revised, Updated and Expanded Baby-friendly Hospital Initiative. The designation is granted by the Durham BFFC Designating Group, Breastfeed Durham, currently comprising over 1000 members who work, volunteer, and serve the Durham community.

The Breastfeeding Family Friendly Communities (BFFC) initiative works to normalize the community culture around breastfeeding, particularly for historically marginalized families.

The Breastfeed Durham team has identified each of the Ten Steps to a BFFC as the optimal approach to advance health equity in Durham. Durham community-based organizations have seen firsthand how the infant feeding landscape rapidly shifted in response to the global COVID-19 pandemic and the infant formula shortage. The pandemic separated families from needed healthcare support, as well as economic and social support, and had the greatest impact on low income families and  Black families. It impacted pregnancy education, maternity care practices, and lactation support in the hospital, and it increased confusion around recommendations and uncertainty regarding separation. “Never before in our lifetime is breastfeeding and protecting [parent’s] milk supply so important.” from “Voices from the Field: COVID-19 & Infant Feeding.” 

  • Government (Steps 1 & 2 of Ten Steps model) – A countywide policy supporting breastfeeding, chestfeeding, and human milk feeding (HMF) that is routinely communicated to all. Develop a 5 year strategic plan for supporting lactating employees, supporting breastfeeding families, and addressing disparities across all parts of the Durham County Department of Public Health. Good policies and procedures will clarify obligations of both the local government and the health department in health equity and may include the addition of race-focused task forces as needed. HMF is integral to reducing disparities in Black maternal and infant mortality, and local government and health department support through public supportive policies and a strategic plan can have a transformative impact on maternal and infant health. Encouraging practices include posting ‘Breastfeeding Welcome’ signage in public parks and spaces, as well as ensuring that all first responders are trained on laws specific to breastfeeding and how to support breastfeeding in an emergency (including the current formula shortage).
  • Health Care and Wellness in the Community (Steps 3, 4, 5 & 6) – Optimal HMF is supported by health leadership and the health care system; this requires collaboration with local health departments, WIC offices, and hospitals to ensure personnel have necessary skills. Beyond healthcare, helping to ensure community support and services are available, accessible, and culturally appropriate.
  • Community Partners (Steps 7, 9 & 10) – The businesses, organizations, faith-based groups, and childcare programs in the community welcome breastfeeding, chestfeeding, and human milk feeding families. The “Business Case for Breastfeeding,” the NC Making It Work Toolkit, and local laws/policies supportive of lactating workers are shared. Education systems, including childcare, are supported to include HMF curricula at all levels including lactation spaces in public schools.

Many Identities and Lived Experiences are Centered: We build Health Equity into the foundation of our work spanning  racial, ethnic, socioeconomic, geographic, and  academic/professional identities. We utilize a shared decision-making and collaborative board model. Stakeholders included community members of different backgrounds, races, ethnicities, social experiences, religious affiliations, ages, gender identities, sexual orientations, physical needs, personalities, political beliefs, opinions, heritages, and life experiences, including families that were unable to meet their planned breastfeeding goals. We are living in difficult times with pressing challenges for communities to support families. Supporting lactating people is often an underrepresented health equity issue. The health inequities around breast/chestfeeding continue to compromise the optimal growth and development of children and their families. Parents today initiate breast/chestfeeding in the hospital; however, many will stop within a few days or weeks due to social or community pressures. This is particularly true for Black mothers. With additional financing, Breastfeed Durham will create a special fund to alleviate financial barriers for BPOC volunteers to support our community—we are assisting with closing the chest/breastfeeding gap for Black families and improving health outcomes throughout the families’ lifespan. This is accomplished by incorporating a universal access and inclusive design model, while being mindful of neurological and physiological barriers faced by families in our community. Breastfeed Durham uses the term “breast” as a gender inclusive term because all mammals have breast tissue regardless of gender and to combat the hyper sexualization of breasts in our culture. When speaking directly to families, we prefer to use reflective language when referring to infant feeding by using a variety of terms including breastfeeding, chestfeeding, human milk feeding, etc

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Connection to the Birth Justice Movement: Breastfeeding, chestfeeding, and human milk feeding are part of the birthing justice movement. Building upon the reproductive justice framework, we view birthing justice to include all birthing and lactating people, inclusive of all gender and sexual identities. 

Parents  “have the right to breastfeed if you decide that this is best for you and your baby. If breastfeeding is not recommended, you have the right to have the risks and benefits of breastfeeding explained to you by your healthcare provider” – from the Birth Justice COVID 19 Bill of Rights 

Breastfeed Durham translated the Birth Justice COVID 19 Bill of Rights into Spanish at the beginning of the pandemic: Derechos del Paciente en el Periodo Perinatal. Breastfeed Durham passionately believes in the rights of birthing people and we advocate within the Durham community to support organizations with

Led and Founded by Those Most Impacted by Birth Injustice: In 2015, lactation support in Durham was a very white space. Love Anderson, one of the founders of Breastfeed Durham, wanted to change that and center Black women and families’ experiences. By the spring of 2018, Love and other advocates were successful in petitioning the city council to declare Durham a Breastfeeding Family Friendly Community. In November 2018, Breastfeed Durham held its very first meeting around Love’s kitchen table. There were 6 racially diverse members of the Durham community: two Black women, two multiracial women, and two white women. Using the Ten Steps for a Breastfeeding Family Friendly Community, the team began crafting strategic policy, system, and environmental change plans for Durham. Another key process was to recruit more members, specifically more diverse members from all races and parts of Durham. The Breastfeed Durham team was committed from the beginning to addressing racial disparities head-on by centering the voices of those with lived experience. The team also wanted to grow and transform the work that white advocates had been successfully doing in the surrounding, more predominantly white communities. In 2019, the team adopted the name Breastfeed Durham. Membership slowly grew to approximately 100 members. The first year of advocating for Breastfeeding Family Friendly policies in the Durham community started by bringing together stakeholders from diverse backgrounds, organizations, agencies, and institutions.  Community stakeholders included: local childbirth organizations, doulas, lactation service organizations, WIC staff, childcare providers, etc. In June 2020, Breastfeed Durham launched an independent website while members of the Breastfeed Durham team simultaneously worked with the Breastfeeding Family Friendly Communities Initiative to file articles of incorporation and tax-exempt status. On April 12, 2021, the Durham County Commissioners re-proclaimed Durham a Breastfeeding Family Friendly Community. The BFFC Team continues to work with important community groups, such as the LGBTQ+ community, medical professionals from the hospital(s), and city/town council members.

Centering Black: In late 2021, Breastfeed Durham changed leadership and elevated Bernadette Greene, a Black woman from Durham with years of lived experience as a health department patient and a community volunteer. Bernadette brings with her years of experience and passion for breastfeeding and supporting the Durham community. When we work with the community, our goal is to support all the parents like Bernadette, a mother of 5 receiving services through Head Start, the health department, the WIC office, etc. We also know that we, Durham’s Black community members, must advocate to establish a consistent system of care that meets the needs of every community member. We are working to establish quality care for Black families within the Durham community. Right now, many Black families who have the privilege of access to insurance and transportation choose to leave Durham County for care. Conversely, those without means simply do not receive adequate levels of care. Deep inequities exist for indigenous people living in Durham, especially those originally from South and Central America, whose second language is Spanish, and have very little English proficiency. COVID changed everything for Breastfeed Durham. We received reports that, at our local hospital, three indigenous families from the South and Central American regions, who spoke no English and had only partial Spanish proficiency, were separated from their babies due to  COVID protocols. This was not explained to the families because Spanish translators were not allowed in the building, and no native translators were available. These parents believed that their babies were dead rather than just separated due to COVID protocols. In response to this, Breastfeed Durham mobilized in force. We were able to start engaging with a new group of community advocates. By working with Duke Hospital, we helped establish a protocol that all non-native English speakers would have a live video stream to their baby. We translated the COVID birthing justice materials from Breastfeed LA into Spanish and we began meeting monthly with a group of Spanish-speaking advocates. It became clear that in order to continue our mission we were going to need money. Our white volunteers were able to show up, but our Black volunteers repeatedly mentioned that a $10 grocery gift card would make the difference between them being able to attend a meeting and not being able to attend the meeting. We were unable to secure ongoing funding to help with this, even from our institutional partners.

 

The Challenging Experience of Middle and Upper Income Black Mothers: Durham is home to two major universities and yet we find Black parents are returning to work as early as two weeks postpartum. Even with PhDs and professional jobs, many Blacks feel pressured to return to work quickly to hide their parenthood. Many of us fear that if we were to disclose that we are women and parents we would be fired before our white colleagues. Durham will continue to advocate for lactation spaces and lactation accommodations for our Durham public school teachers. There is a shamefully long global and national history of advertising formulas to Black, poor, and other marginalized communities to the detriment of infant health. The lived experience of the Fultz sisters tells how formula companies used Black babies to sell their product.9 At Breastfeed Durham, we celebrate every family, regardless of how they feed their babies. There is a difference between using formulas and advertising formulas. Standing against formula advertising is a racial and food justice issue. Formula advertising is pervasive and persuasive, and there is a lot of evidence to support that it can undermine breastfeeding. The WHO and other institutions have tried to mitigate the effects of formula advertising (again, different from the necessary use of formula) by providing guidelines for organizations like ours and Breastfeeding Family Friendly Communities that include asking businesses not to advertise formula (they may sell formula, just can’t advertise it). Ultimately, Breastfeed Durham exists because no family in this country gets enough support. Though HMF infant feeding is often framed as a “choice,” there is no real choice when there is no federal paid time off, no universal and affordable/free childcare, no living wage requirements, and inequitable lactation support. If you are a parent in Durham, we support you and we are walking this journey with you

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Movement Building and Organizing Strategies: At Breastfeed Durham we are advocating for a sustainable countywide breastfeeding policy, for embedded lactation support within our health department, and for signage welcoming breastfeeding throughout our community to provide a safe place where parents will not be shamed or chastised. We want to work with our hospitals and our providers so that they all receive breastfeeding friendly designations and are actually talking to parents about breastfeeding during pregnancy rather than assuming parents’ intentions based on race. Over the course of the next year, we will be providing a minimum of two training sessions open to all healthcare providers in our community.  With funding, we would like to increase this number of training to four and be able to pay Black community advocates to come in and share our stories and experiences. We will continue to create educational opportunities for providers, parents, and community advocates to listen and learn from each other. Our goal is to elevate and uplift Black lactation support providers and celebrate Black breastfeeding families. Over the past four years, we have been able to recruit 31 Breastfeeding Community Partners, with most of this recruitment happening over the last year. We have now created a method of locally celebrating our community partners on our website and communicating that information to our Durham parents. Durham parents now know where the safe places are to go and breastfeed. Durham parents now have a list of supportive organizations and businesses where they can put their time and money. The health department has done a tremendous amount of work over the past two years. We have worked with them to create a space where breastfeeding is welcomed throughout the building. 

Breastfeed Durham’s current organizational priorities and our local and state policy and systems change outcomes:

  • Address health disparities by addressing our own biases. We will continue to connect all our communities and our leadership to first food race equity training with all board members attending at least one training per year.
  • Advocate for a county wide breastfeeding policy. 
  • Offer technical assistance to the Durham County Department of Public Health, childcare providers, nonprofits, faith-based organizations, and other community-based organizations as they develop breastfeeding friendly policies and practices.
  • Provide education via virtual meetings to Durham community organizers to support the implementation of the Ten Steps to a Breastfeeding Family Friendly Community with particular attention to meeting the needs of Black families, Indigenous families, families of Color,  and addressing racial disparities. This is currently happening monthly/bi-monthly.
  • Offer technical assistance/consultation to address specific questions from potential community organizers. We know that with financial support, more of our Black led organizations would be interested.
  • Develop additional culturally appropriate child care focused training/workshops, working to engage childcare centers that are in predominantly Black  neighborhoods. The previous work was a collaboration between our Orange, Durham, and Buncombe county organizers, and we have created 10 initial recorded training videos.
  • Share culturally sensitive printed materials on optimal infant feeding and community support. The cost of printing is a challenge to sharing information. With funding, we will organize printing of handouts, rack cards, etc.
  • Expand development, hosting, and maintenance of the Breastfeed Durham websites. With funding, we would be able to hire a part-time website support staff person and translate more of our information.
  • Continue to fund 2 part-time Black, Indigenous, and/or People of Color (BIPOC) community workers to support the 1,900 BIPOC babies born in Durham per year.
  • Encourage Black families to hold healthcare providers accountable for top quality health care, helping families find excellent prenatal and postpartum care. (See Approaches and Measures in Steps 4, 5, & 8)
  • Continue to commit 10% of all efforts to supporting national and international efforts focused on equity, including paid family leave, workplace lactation support, and maternal health. 
  • With a racial inclusion mindset, support individual communities to make beneficial changes in government, healthcare, business, education, and all aspects of community life (e.g., parks, food banks, faith programs, childcare). (See Approaches and Measures). 
  • Since 2018, the pilot project of Breastfeeding Family Friendly Communities now called Breatfeed Durham is making progress in all the parts of the designation, completing steps 1, 3, 6, & 9.

Impact of Funding on Organization and Community: It is our hope that you will accept not only our grant application but additional grant applications from our partner organizations in Durham. We need a WIC Office that’s capable of providing pumps and lactation support. We are seeking funds to continue to nurture continuity of care by supporting chest/breastfeeding families throughout our community. Using the Ten Steps to a Breastfeeding Family Friendly Community, we will provide education, mentorship, and assistance to communities as they work to make changes so that every family that is chest/breastfeeding will be able to do so in a space that is welcoming and supportive of their efforts. With our guidance, these Durham communities are able to engage with local businesses, child care centers, and health care providers to support breast/chestfeeding families. 

Links to materials that give insight into Breastfeed Durham’s work:

References 

  1.  Jones KM, Power ML, Queenan JT, Schulkin J. Racial and ethnic disparities in breastfeeding. Breastfeed Med. 2015;10(4):186-196. 
  2. Centers for Disease Control and Prevention. Breastfeeding report cards.  https://www.cdc.gov/breastfeeding/data/reportcard.htm. Accessed March 24, 2022.
  3. Hamner HC, Beauregard JL, Li R, Nelson JM, Perrine CG. Meeting breastfeeding intentions differ by race/ethnicity, Infant and Toddler Feeding Practices Study-2. Matern Child Nutr. 2021;17(2):e13093. 
  4. Breastfeeding and the Use of Human Milk. Pediatrics. 2012;129(3):e827-e841. 
  5. Anstey EH, Shoemaker ML, Barrera CM, O’Neil ME, Verma AB, Holman DM. Breastfeeding and Breast Cancer Risk Reduction: Implications for Black Mothers. Am J Prev Med. 2017;53(3s1):S40-s46. 
  6. Balogun OO, O’Sullivan EJ, McFadden A, et al. Interventions for promoting the initiation of breastfeeding. Cochrane Database Syst Rev. 2016;11(11):Cd001688. 
  7. Pérez-Escamilla R, Martinez JL, Segura-Pérez S. Impact of the Baby-friendly Hospital Initiative on breastfeeding and child health outcomes: a systematic review. Matern Child Nutr. 2016;12(3):402-417. 
  8. Burnham L, Knapp R, Bugg K, et al. Mississippi CHAMPS: Decreasing Racial Inequities in Breastfeeding. Pediatrics. 2022;149(2). 
  9. “LIttle Known Black History Fact: The Fultz Quadruplets“. Black America Web. 2015-06-10. Retrieved 2018-12-11.
  10.  Breastfeeding | Nutrition site – World Health Organization
  11. Rev Obstet Gynecol,. 2009 Fall; 2(4): 222–231., The Risks of Not Breastfeeding for Mothers and Infants 

 FAQS ON THE BREASTFEEDING FAMILY FRIENDLY COMMUNITY DESIGNATION

Breastfeeding Family Friendly Communities (BFFC) nurture a more breastfeeding, chestfeeding, and human milk feeding family friendly community by advocating for policies and practices that support optimal infant feeding. The BFFC uses a Ten Steps approach that complements and broadens the community scope of the World Health Organization (WHO) and UNICEF guidelines. The Breastfeeding Family Friendly Communities Initiative began as a pilot project in Chapel Hill and Carrboro, North Carolina in 2014 with a vision to improve lactation duration. This would be achieved by developing a set of measures to guide communities to welcome lactating families in all the spaces and places in which families live, work, shop, and play. The measures, fondly called the Ten Steps to a Breastfeeding Family Friendly Community, foster continuity of care from pregnancy to birth to the family’s intended time to wean by building awareness of the community’s role in supporting families and providing measures and approaches to build a welcoming environment. In 2018, Breastfeeding Family Friendly Communities of Durham, now Breastfeed Durham, became the second community to begin the Ten Steps journey.  In 2020, with the enthusiasm and vision of new partners, the initiative in Chapel Hill and Carrboro grew to include communities in the entire county. To further support the initiative, Breastfeeding Family Friendly Communities incorporated in May 2020 and was awarded 501c3 status in October 2020. Currently, Breastfeeding Family Friendly Communities provides ongoing technical assistance and support to active communities in four states and ten  communities and has provided preliminary support to additional communities to explore the Ten Steps. 

WHY should we have a designation for breastfeeding? 

Optimal infant feeding, that is feeding the infant at the chest or breast, especially exclusive chest/breastfeeding, is associated with lower rates of obesity, diabetes, infectious diseases, and other child illnesses, as well as less maternal breast and ovarian cancers, diabetes and a faster recovery from childbirth as compared to formula feeding.10  Chest/breastfeeding is also associated with overall a better chance for lifelong health and development, as well as better school performance and other achievements.11 In addition, exclusive breastfeeding has been referred to as “The Great Equalizer,” because breastfeeding “goes a long way toward canceling out the health difference between being born into poverty or being born into affluence” (JP Grant, UNICEF Executive Director). We recognize that chest/breastfeeding is “The Great Equalizer” because it impacts health equity outcomes at all ages and stages of life. A chest/breastfeeding family friendly community is a healthier, more welcoming community for young families of all races and ethnicities. 

WHY should a community become designated? 

This award provides recognition of the quality of care for breastfeeding, chestfeeding, human milk feeding, and nursing families that is afforded in that community. Since the majority of parents in the US and worldwide are deciding to chest/breastfeed, this sends the message that the community respects their desires and appreciates the benefits of chest/breastfeeding to the health of the child, the family, and the community.

HOW do we measure if we have achieved the Ten Steps? To be designated a “Breastfeeding Family Friendly Community,” the community (e.g., city, town, county) must be able to honestly respond in the positive to all the measures under each of the Ten Steps to a Breastfeeding Friendly Community and allow each to be verified by the local Designating Group (Breastfeed Durham Board of Directors) and reviewed by BFFC Global Leadership. Breastfeed Durham will assess the following measures using suggested approaches annually for 3 years, then every 3 years thereafter. When all steps have been achieved, Breastfeed Durham will notify national and/or international chest/breastfeeding organizations: United States Breastfeeding Committee, Breastfeeding Family Friendly Communities Global, North Carolina Breastfeeding Coalition, Triangle Breastfeeding Alliance, Mahogany Milk, Raising Our Sisters Everywhere (ROSE), Born in Durham, Grown in Durham, etc.