Durham’s Report Card: Ten Steps Self-Appraisal

Durham’s Report Card: the Ten Steps, step by step

The Breastfeed Durham Report Card measures Durham’s progress on the Ten Steps to a Breastfeeding Family Friendly Community, the global criteria for designation. Durham passes a step when the Designating Team can answer yes to every measure for that step. The Durham County Human Milk Feeding Strategic Plan (2025 to 2035) reaches far beyond the Ten Steps into county policy, health systems and community initiatives, and its progress is tracked separately.

Breastfeed Durham is the pilot implementation of the Breastfeeding Family Friendly Communities designation, the second community to take up the model after Chapel Hill and Carrboro. Its members work and volunteer across Durham: the Breastfeeding Family Friendly Communities board, the Carolina Global Breastfeeding Institute, La Leche League, Durham City Council, the Durham Chamber of Commerce, the Office of the Mayor, the Durham County Department of Public Health (DCoDPH), the North Carolina Breastfeeding Coalition, Family Connects Durham and faith communities. When all ten steps are complete, the Designating Team will notify Breastfeeding Family Friendly Communities, the United States Breastfeeding Committee and the North Carolina Breastfeeding Coalition. How Durham got here is on the History page.

Last reviewed September 2026.

StepStatusLast verified
1. Written policy from leadershipPassApril 9, 2026
2. Welcoming atmospherePassJanuary 2026
3. Optimal breastfeeding supported by health leadershipPassOctober 2025
4. All families informed during pregnancyPassOctober 2023
5. Breastfeeding friendly health careIn progressOctober 2025
6. Community lactation support fully availablePassOctober 2025
7. Businesses and organizations welcome familiesIn progress: 388 of 700September 2026
8. International Code followed locallyPassNovember 17, 2025
9. Business Case for Breastfeeding promulgatedPassJanuary 2026
10. Breastfeeding friendly education at every levelPassJune 2026

Step 1. The community’s elected or appointed leadership has a written statement supporting breastfeeding that is routinely communicated to all

Status: PASS. The written policy is the Human Milk Feeding Strategic Plan, signed by DCoDPH Director Rodney Jenkins on February 28, 2025. It makes breastfeeding support a lasting, funded commitment shared by county and health department leadership with the community, so the work outlives any one person or grant.

Measure i, a written and signed policy or proclamation that includes the other nine steps. Yes.

  • August 6, 2018: Mayor Steve Schewel proclaims the City of Durham a Breastfeeding Friendly Community.
  • April 13, 2020: The Durham Board of County Commissioners proclaims Durham County a Breastfeeding Family Friendly Community. The meeting aired on Durham Television Network Channel 8 and the County’s YouTube channel.
  • April 12 and 19, 2021: County Commissioners and City Council re-proclaim Durham.
  • November 2021: DCoDPH signs its internal breastfeeding support policy with Breastfeed Durham’s support.
  • August 2024: City Council and County Commissioners re-proclaim Durham Breastfeeding Family Friendly. The health department also begins work with the County Manager on a family friendly workplace policy for county employees.
  • February 28, 2025: DCoDPH adopts the Human Milk Feeding Strategic Plan (2025 to 2035), nine goals covering every step below.
  • November 21, 2025: Infant and young child feeding in emergencies is added to the plan as Goal 9.
  • April 9, 2026: At a DCoDPH all-staff development day, staff assign a responsible office to each strategy in the plan; Director Jenkins takes Goal 1 himself. Monthly check-ins with the health department follow.

Measure ii, the policy is shared through local media and social media. Yes. Proclamation meetings aired on Durham Television Network Channel 8 and the County’s YouTube channel; the plan and proclamations are shared on the County website, Facebook and Instagram.

Measure iii, local media host a discussion of the issue with breastfeeding experts at least twice a year. Yes.

Measure iv, the designation and the local policy are widely distributed at least annually. Yes, through the monthly Durham Digest newsletter, funded by DCoDPH, and every August during National Breastfeeding Month.

Step 2. The community as a whole provides a welcoming atmosphere for breastfeeding and chestfeeding families

Status: PASS. North Carolina law (N.C. Gen. Stat. 14-190.9) protects breastfeeding in any public or private place a parent is otherwise allowed to be. Durham’s job is to make that welcome visible.

Measure i, Breastfeeding Welcome Here signage in prominent public places. Yes.

  • December 6, 2023: New park signs by local artist L Jámal Walton are unveiled with Durham Parks and Recreation, with supplemental funding from the Durham County Commissioners for 23 signs, many in East Durham.
  • February 24, 2024: The artwork is celebrated at An Evening of Change, Connection and Celebration; posters and canvas prints of the same art go to indoor spaces.
  • August 2024: More than 40 bilingual signs are up in Durham parks (INDY Week).

Measure ii, a welcome seal on city sites or flyers at the visitor bureau. Yes. Breastfeeding friendly postcards have been on the rack at the Durham Visitor Center since February 12, 2025; supplies were refilled January 9, 2026.

Measure iii, the law is enforced locally. Yes. The Designating Group works directly with law enforcement.

  • August 3, 2020: The City of Durham Police Department’s Public Information and Communications Manager shares the North Carolina breastfeeding law and the First Responders Resource Toolkit with all staff. The same day, the Durham County Sheriff’s Office confirms its patrol captain and operations major have reviewed the toolkit for dissemination.
  • August 13, 2021: Reminder information sent again.
  • April 12, 2023: Durham Community Safety confirms staff remain aware of the law and regularly review the resources.

Step 3. Optimal breastfeeding is supported by health leadership

Status: PASS. Optimal breastfeeding means early and exclusive breastfeeding for about six months, then continued breastfeeding with appropriately timed complementary foods for at least one to two years and as long as mutually desired. Durham’s health leadership (Duke Health, WIC, DCoDPH and Family Connects) accepts this definition and it is built into the other steps.

  • 2020 to 2021: During Durham Early Childhood Action Plan meetings, pediatricians are among the strongest advocates for culturally normalizing breastfeeding.
  • 2021: Durham passes Step 3. In the years after, the working relationship with the WIC office thinned.
  • January 2024: WIC and DCoDPH sit down together again at the strategic planning session, a reset worth celebrating.
  • October 2025: The Designating Team confirms that DCoDPH, WIC, Family Connects and Duke Health reaffirm the World Health Organization definition and have integrated it into local training materials and the strategic plan.

Step 4. During pregnancy, all families are informed about the benefits of breastfeeding, the risks of unnecessary formula use, and where to find support

Status: PASS (passed October 2023). Non-commercial information reaches families through community and faith organizations, the health sector, support groups and the coalition, with attention to the families most often left out.

  • June 2020: breastfeeddurham.org launches, independent of breastfeedingcommunities.org, as Durham’s resource map.
  • Durham Digest newsletter: 120 subscribers in June 2020, more than 500 in 2021, more than 1,000 in 2022, more than 2,300 in June 2025, and more than 2,800 in 2026.
  • June 2020 to June 2022: A funded community health worker serves as Durham’s “resource lady,” attending weekly events through the summer and fall. Both community health workers complete the NC Lactation Educator program.
  • Regular Instagram and Facebook posts (two to three a week) on breastfeeding information and resources; hard-copy materials in businesses and organizations across Durham.
  • June 2022 to June 2023: At least seven virtual trainings for health care providers through the First Food Equity series.
  • Childcare training videos co-produced with Breastfeeding Family Friendly Communities, from Breastfeeding Friendly Childcare: An Overview through Writing a Breastfeeding Policy.
  • May 2022: The first Family Festival draws more than 300 people; at least 12 educational outreach events that year.
  • 2023: Four new culturally specific resources: the Black Breastfeeding Coalition, LGBTQ+ Human Milk Feeding, Asian and Pacific Islander resources and Comunidades Hispanas/Latinx.
  • A special thank you to Bernadette Greene, who has championed this work.

Step 5. Health care in the community is breastfeeding friendly

Status: IN PROGRESS. Passes when every maternity care center in Durham is Baby-Friendly or holds the state maternity care breastfeeding designation.

Measure 5i, maternity care centers. Partially met.

  • June 2023: Duke Regional Hospital earns Baby-Friendly designation, a model for the county.
  • Duke University Hospital is not yet designated Baby-Friendly or the state equivalent. Duke leadership has described internal plans to work toward designation; no written commitment has been issued. Breastfeed Durham’s advocacy with Duke University Health System continues.
  • March 2024: Breastfeed Durham meets with Duke University Hospital OB/GYNs for the first time; engagement with outpatient departments grew through 2024 and 2025.

Measure 5ii, outpatient clinics informed of the NC Breastfeeding-Friendly Clinic designation, with at least half documenting supportive practices. Met.

  • January 2024: All clinics in Durham informed of the North Carolina Family Friendly Clinic award.
  • A multi-year outreach and documentation effort contacted every known prenatal, pediatric, family medicine and postpartum clinic in Durham County. Documentation shows more than half meet Step 5 criteria, including breastfeeding support tools, trained staff and written lactation support policies, in line with AAP, ACOG and ABM guidance. Completed October 2025.
  • Formula marketing in outpatient settings decreased noticeably after the 2025 outreach campaign.
  • This was a one-time effort. Records are kept and updated when a clinic shares a change or a new clinic opens; the full survey will not be repeated.

Provider awareness. Met. Providers across Durham receive evidence-based practice recommendations through the newsletter, meetings, clinical partnerships and statewide guidance.

2026 action items: continue advocacy for maternity designation at Duke University Hospital; support Duke’s progress toward the state maternity care breastfeeding requirements; maintain Step 5 documentation only when clinics or systems initiate changes; strengthen health system relationships through statewide maternal and child health policy work.

Step 6. Non-health-system breastfeeding support is fully available, including IBCLCs, La Leche League and other skilled support

Status: PASS. Support must extend beyond the clinic, with active referral from hospitals and clinics and collaboration between providers and community supporters.

  • Breastfeed Durham continuously reviews gaps in lactation support and maintains the public listing of support groups and services, with attention to racial and ethnic communities.
  • January 2020: Breastfeed Durham facilitates the first all-provider meeting; one meeting is held each year and one public communication on the shared effort is documented annually.
  • April 2024: Two new support groups for Black families and one for Spanish-speaking families launch. See the support group calendar.
  • September 2025: The Lactation Collaborative launches, co-founded by Nicola Young and Jess Woon: free home, clinic and virtual visits from volunteer IBCLCs for uninsured, underinsured and linguistically diverse families. Marissa Griffith has coordinated the Collaborative since June 2026; funding is secured through July 2027.
  • October 2025: The Designating Team verifies that Durham’s community lactation services meet and exceed Step 6.

Step 7. The businesses and social organizations in the community are welcoming to breastfeeding families

Status: IN PROGRESS, 388 of 700. The measure is one welcoming business for every 500 residents, each having signed a form and displayed the Breastfeeding Welcome Here logo. For Durham that is about 700. As of September 2026, 388 businesses, clinics, organizations and childcare programs are recognized. This is the last Ten Steps criterion Durham controls and Breastfeed Durham’s focus for the next two years.

  • See the current list of recognized partners and how the awards work.
  • 2020 to 2021: Community health workers email 500 businesses; Downtown Durham, Inc. shares the program in its newsletter; the first award letters go out in October 2021.
  • Summer 2022: Friday Acts of Advocacy begin, with staff visiting businesses about lactation spaces and partnership.
  • Spring 2023: 38 new lactation areas in Durham businesses.
  • Summer 2025: A Community Choice award lets families nominate a business without an application; 200 welcome boxes go out to businesses.
  • 2026: A Durham Chamber of Commerce partnership, the Family Festival’s partner drive, a Durham County Cooperative Extension contract for business outreach and lactation spaces, and door-to-door outreach during National Breastfeeding Month.

Step 8. Local businesses and health care clinics follow the principles of the International Code of Marketing of Breast-milk Substitutes

Status: PASS (completed November 17, 2025). The International Code protects families from inappropriate marketing of formula by health facilities and retailers.

  • Parents receive breastfeeding education and support from health care facilities. Done.
  • Health care facilities do not promote formula through ads or free samples, and provide expressed milk when supplementation is medically indicated. Done.
  • No locally controlled grocery, food market, convenience store or pharmacy promotes formula through preferential shelf placement or ads. Done. August 2021: every locally owned grocery and pharmacy emailed about breastfeeding rack cards; to our knowledge no locally owned pharmacy sells formula without a prescription and no locally owned grocery sells formula. From summer 2022, locally controlled food stores visited twice a month with rack cards, including Tropicana and the Harris Teeter at Woodcroft.
  • National chains are encouraged to prevent local formula advertising and to allow space for lactation support information. Done. Summer 2025: Jess Woon leads a full assessment of Durham’s retail and pharmacy sectors; every pharmacy in ZIP code 27705 and every national grocery and pharmacy chain is offered bilingual lactation support signage. All declined, all locally controlled stores remained Code compliant, and the process became a replicable Step 8.4 toolkit, Durham’s first verified implementation record for Step 8.

Step 9. The US Business Case for Breastfeeding is promulgated by government and the Chamber of Commerce

Status: PASS. Workplace accommodation is required by federal law and is what makes breastfeeding possible after a return to work. Read more.

  • July 1, 2020: The Durham Chamber of Commerce shares the law and support materials with all members in its newsletter.
  • May 7, 2021: Downtown Durham, Inc. does the same for its members.
  • 2022 to 2023: DCoDPH funds Breastfeed Durham to promulgate the information, about 40 flyers a month to local businesses, and annually since.
  • January 2026: A renewed partnership with the Durham Chamber of Commerce.

Step 10. Education systems, including childcare, K-12, colleges and universities, include breastfeeding friendly curricula at every level

Status: PASS. For breastfeeding to be normal, people of all ages should see it as part of health and family education.

Childcare: PASS.

  • The team approached the heads of all 240+ childcare programs in Durham, works with Durham’s technical assistance providers, and created a local Breastfeeding Friendly Childcare designation.
  • Breastfeed Durham supports the statewide Building Blocks for Breastfeeding Friendly Child Care series and co-produced the training videos listed under Step 4.
  • 2024 to 2025: Breastfeeding friendly curriculum delivered to all 189 childcare providers serving ages 0 to 3 in Durham; the childcare survey project is completed in February 2025. More than 90 childcare centers are now recognized.

K-12: PASS.

  • 2020: All Durham Public Schools teachers informed about normalizing breastfeeding, with classroom tools.
  • 2021: Durham food equity organizations agree to normalize breastfeeding in cooking classes open to all Durham school children and many parents.
  • 2022 to 2023: Breastfeed Durham approaches Durham Public Schools about lactation spaces and normalizing breastfeeding.
  • Spring 2025: Durham Public Schools issues a proclamation in support of lactating students and staff.
  • November 2025: Ninety Breastfeeding Welcome Here clings delivered to Durham Public Schools; June 2026: the district is recognized as breastfeeding family friendly.

Colleges and universities: PASS.