Durham’s Self-Appraisal: Approaches and Measures


Download the Global Criteria.

Durham is the second pilot initiative of the Breastfeeding Family Friendly Communities Designation which includes over 750 members. Breastfeed Durham’s members work, volunteer, and represent a multiple Durham organizations including: the board of Breastfeeding Family Friendly Communities global, Carolina Global Breastfeeding Institute (CGBI), local La Leche League (LLL), the Durham City Council, the Durham Chamber of Commerce, Chamber of Commerce, Office of the Mayors of Durham, The Durham County Department of Public Health, the North Carolina Breastfeeding Coalition, Fatherhood of Durham, Family Contacts of Durham, and faith-based groups.

In order to complete the designation, team members from Breastfeed Durham must be able to answers in the positive to all the measures listed in the Global Criteria of the Breastfeeding Family Friendly Communities designation. The Breastfeed Durham assessment is below. When all steps have been achieved, the Breastfeed Durham team will notify Breastfeed Family Friendly Communities global, the United States Breastfeeding committee, the North Carolina Breastfeeding Coalition, other national and international breastfeeding organizations (e.g., our local, national, and international breastfeeding coalitions).

Meeting the Global Criteria

The Ten Steps to the Breastfeeding Family Friendly Communities of Durham Designation

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

PASS

Rationale:

Good policies and procedures should provide insight on what management believes is important, clarify obligations and their purpose, and be consistent and last beyond the term of a particular executive. A policy/proclamation is generally formulated by top management as an integral part of organizational strategy that will guide decision-making and leave some room for managerial discretion.

Measures:

  • i. The written and signed policy/proclamation includes actions to support the following nine steps. Yes/No
    • On August 6, 2018, Mayor Stephen M. Schewel proclaimed the City of Durham a Breastfeeding Friendly Community (BFFC). BFFC Durham looks forward to future collaborations with businesses and institutions throughout the city and county to meet the needs of breastfeeding families.
    • On Monday, April 13, 2020the Durham Board of County Commissioners proclaimed Durham County a BREASTFEEDING FRIENDLY FAMILY COMMUNITY!
    • On Monday, April 12, 2021 during the Regular Session meeting of the Durham County Commissioners, Durham County was re-proclaimed a Breastfeeding Family Friendly Community.   
    • At the Durham City Council meeting on Monday, April 19, 2021, Mayor Schewel re-proclaimed Durham a Breastfeeding Friendly City.  
      • City’s YouTube Channel. City’s Facebook and Twitter pages, Durham Television Network (Spectrum Channel 8, Google Fiber Channel 8, Frontier Channel 70, and AT&T Uverse Channel 99), Roku, Apple TV & Amazon via Boxcast, City’s website.
    • We plan to proclaim again in 2022
  • The written and signed policy/proclamation is shared via all local media outlets, including newspapers, radio and television as well as social media, as available, and the majority have done so in the last year. Yes/No
    • In this post-COVID world, we viewed the meeting on the Durham Television Network (DTN) Channel 8
    • Via YouTube at www.youtube.com/DCoWebmaster
    • Via the DCo website https://www.dconc.gov/government/departments-a-e/board-of-commissioners/commissioner-meetings/bocc-live-archived-media-library.
    • Via Facebook
    • Via Instagram
  • iii. Local print and other media have hosted a discussion of this issue with breastfeeding experts and/or La Leche League or similar at least bi-annually. Yes/No
  • iv. A copy of the Ten Steps designation and the local policy/proclamation is widely distributed at least annually, possibly during World Breastfeeding Week (In US, National Breastfeeding Month) Yes/No

STEP 2. The community as a whole provides a welcoming atmosphere for breastfeeding families.

Working on Step 2i, Step 2ii

Step 2iii PASS: Breastfeeding Law is in place and supported by City of Durham Law Enforcement.

Rationale:

This step builds upon US Federal and State laws that dictate that breastfeeding may be carried out wherever a woman is lawfully allowed to be. The maintenance of milk supply is only possible when infants are fed on cue and frequently day and night. Parents know that the infant needs to breastfeed when the infant indicates, and breastfeeding must not be relegated to places where adults would not consume food, such as toilet areas.

Measures: 

  • i. “Breastfeeding welcome here” signage is posted next to the welcome signs to the city or in similar prominent positions (e.g., city-operated parks, swimming pools, senior centers, etc.), and
  • ii. A “Breastfeeding welcome here” seal/logo is posted on city websites and/or social media or similar, and/or flyers are available at visitor’s bureau.
  • iii. The Federal law or similar is enacted in this locale, e.g., North Carolina Law is enforced.
    • North Carolina law states that “…a woman may breastfeed in any public or private location where she is otherwise authorized to be, irrespective of whether the nipple of the mother’s breast is uncovered during or incidental to the breastfeeding.” Click here to read the N.C. Gen. Stat. § 14-190.9 (1993). This means that a breastfeeding parent is not in violation of indecent exposure laws. 

Suggested Approaches:

  • For i, ii: Designating Group has documentation, via site visit or photograph, and links.
  • For iii: Designating Group discussed with local law enforcement.
    •  On August 3, 2020, at 2:47:36 PM EDT the Public Information and Communications Manager of the Police Department, City of Durham 602 East Main Street Durham, NC 27701 shared information about North Carolina Breastfeeding Law and First Responders Resource Tool Kit with all staff.
    • On August 3, 2020, at 11:59:41 AM EDT the office of the Sheriff 510 South Dillard Street, Durham, North Carolina confirmed that staff was aware of North Carolina Breastfeeding Law and had reviewed the First Responders Resource Tool Kit with the Psarol Captain as well as the operations Major, so they could disseminate the information.
    • On August 13, 2021 reminder information was send again.

STEP 3. Optimal breastfeeding1 is supported by health leadership. 

PASS

Our Durham health authority (Duke, WIC, Health Department, Family Connects) accepts this definition and it is included in other steps.

Rationale:

This international definition is included in the Policy Statement/Proclamation and disseminated at appropriate times, such as World Breastfeeding Week or National Breastfeeding Month, to all health entities.

Measure:

  1. This definition of optimal breastfeeding, or that proposed by the World Health Organization, American Academy of Family Practitioners or American Academy of Pediatricians, is disseminated and confirmed with healthcare and community leadership, with discussion and corrections as needed.

1Early and exclusive breastfeeding for up to 6 months and continued breastfeeding with appropriately-timed introduction of complementary foods are encouraged for at least 1-2 years and for as long as mutually desired.

  • The Breastfeed Durham Implementation team discusses with local health care leadership (Duke, WIC, Health Department, Family Connects) how best to achieve adherence to the above.
  • The Breastfeed Durham Implementation team found that individual with in healthcare leadership are some of our greatest advocate for breastfeeding/baby friendly practices. However healthcare leadership is taking their time to ensure that nurses, staff, and parents have excepted breast/chestfeeding as optimum infant nutrition.
  • During the Durham Early Childhood Action Planning team meetings in 2020-2021, pediatricians especially, were our strongest advocates for culturally normalizing breast/chestfeeling.

STEP 4. During pregnancy, all families are informed about the benefits of breastfeeding, as well as about the risks of unnecessary formula use, and where to access support as needed

PASS when there is documentation that information has been widely distributed.

Rationale:

Breastfeeding education and support allows families to make informed decisions regarding infant feeding practices. This step is supportive of the International Code of Marketing of Breast-milk Substitutes, which calls for unbiased information in the hands of the public, especially concerning the risks of formula use for maternal and child health outcomes. Distribution should include attention to equity – ensuring that those populations who are more vulnerable receive special inputs. 

Measure:

  1. Non-commercial materials on this issue are distributed, in hard copy and/or online, through community and faith-based organizations, produced or approved by the breastfeeding authority or Designating Group, reflective of the population and culturally appropriate. Distribution may be via the health sector, local breastfeeding support groups, or breastfeeding coalition.
  • In June of 2020, the BreastfeedDurham website of launched independent of the Breastfeeding Communities website.
  • Newsletters are distributed monthly with a membership growing by 500% over the last year.
  • Information on breastfeeding is distributed in hardcopy in multitude businesses and organizations in Durham.
  • A community health worker is funded to become the “resource lady” of Durham.
  • Attended weekly events throughout the summer and fall.
  • We post regularly on Instagram and Facebook (2-3 posts/week) about breastfeeding information and resources.
  • Both our CHWs participated in the NC Lactation Educator Program, and are now certified to provide breastfeeding support.
  • Our CHWs are reaching out to businesses and families with info and support.
  • A special thank you to Bernadette Greene, who has champion this work.

STEP 5. Health care in the community is breastfeeding friendly.

PASS when Duke Health Systems is designated a Baby Friendly Hospital and 80% of clinics are designated Breastfeeding-friendly.

Rationale:

Health care within the community must be breastfeeding friendly, if a community is to support breastfeeding. Research confirms that comprehensive breastfeeding support in prenatal, maternity, and postnatal care results in improved breastfeeding success.

Measures:

  1. All maternity care centres are either designated Baby-friendly (BF) (or designated as fully qualified by their state maternity care breastfeeding designation) or a state-level designation. This designation must include at least the following: Healthcare personnel involved in the care of mothers and babies are trained in the skills necessary to support optimal breastfeeding. 
  2. All clinics have been informed about the new BF Clinic/Office designation (e.g., see NCBC website), and at least 50% of offices have applied for the designation, OR, offices provide documentation concerning the prenatal breastfeeding support, such as educational tools, or practice behaviours, that they employ with all patients, regardless of race or ethnicity.

Suggested Approaches:

  1. For i: Designating Group has requested and received documentation of BFHI designation or State-level equivalent designations. If there is no local designation process, this may be achieved initially by documentation that 80% of local health care providers have completed an existing on-line study or direct training, and documentation of this is provided to the Designating Group.
  2. For ii: Designating Group has surveyed offices or has received documentation from local healthcare organization that at least 80% of offices/clinics are seeking or have achieved designation. (In North Carolina, the Designating Group for the Office designation http://ncbfc.org/mother-baby-friendly-clinic-award/  is NCBC.)

STEP 6: Non-health system breastfeeding support groups and services are fully available in the community, including International Board Certified Lactation Consultants (IBCLCs), La Leche League (LLL), and other skilled breastfeeding support. 

PASS

Rationale:

Breastfeeding support must extend beyond the clinic. Therefore, there must be active community support for referral and independent action by breastfeeding mothers to find the support they need. Once these are established, all clinics and hospitals should be called upon to provide active referral. Active collaboration between health care providers and community breastfeeding support entities is needed to support this Step.

Measure:

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

PASS when 50% of Durham businesses are Breastfeeding Welcome Here designated.

Rationale:

For a community to support breastfeeding, there is a need to provide locations where families are comfortable breastfeeding.

Measures:

  1. At least 50% of the Durham Chamber of Commerce (CoC) member organizations, economic development organizations, and non-member organizations have signed a form (see Business Application) that they welcome breastfeeding in their place of business, and display welcome signs or “Breastfeeding Welcome Here” logo (e.g. window clings). These may be provided by the Team.
    1. Read more about the designation.
    2. See the current list of awardees.
    3. Current demographics on term businesses. We need approximately 700 Breastfeeding Friendly Community Partners.
  • Downtown Durham, Inc. to send out info via their newsletter. Read more about the designation.
  • Hand-delivered some flyers to a few places with an easy-to-scan QR code leading to the application.
  • We’ve developed a local “breastfeeding welcomed here” designation and recruited businesses to apply and earn the designation. See the current list of awardees.
  • Our CHWs reached out to 500 businesses about Breastfeeding Welcomed Here in January via email. So far none have applied for the designation, but we’re hoping that as things start to open up a bit, and we start a local designation, it might be easier soon to reach out to places and help them apply (even in person!)
  • We’ve reached out to a number of restaurants with info on how to support breastfeeding employees and encouraging them to apply for the program.

Suggested Approaches:

  1. Designating Group interacts with Durham Chamber of Commerce CoC and/or Durham Rotary Club or other stakeholders to confirm provision and use of window clings/magnets for those who agree.
  2. Local organizations (e.g., breastfeeding coalitions, La Leche League or other breastfeeding support groups, Rotary) may participate in distribution of window clings/magnets and hanging unit for breastfeeding materials.

STEP 8. Local businesses and healthcare clinics/offices follow the principles of the International Code of Marketing of Breast-Milk Substitutes

PASS when no locally controlled businesses advertise infant formula and when at least 50% of food stores agree to provide breastfeeding-supportive materials near formula shelf placement.

Rationale:

The International Code of Marketing of Breast-milk Substitutes (“Code of Marketing/WHO Code”) affirms that “the encouragement and protection of breastfeeding is an important part of the health, nutrition and other social measures required to promote healthy growth and development of infants and young children.” It strives to protect, promote, and support breastfeeding for the health and well-being of infants, especially during the vulnerable early months of life. Breastfeeding education and support allows families to make informed decisions regarding infant feeding practices. While realizing that manufacturers and distributors of breastmilk substitutes have a role to play in relation to infant feeding, the Code of Marketing recognizes that inappropriate and unnecessary marketing and distribution of breastmilk substitutes by healthcare facilities and businesses can impact the infant feeding practices of families.

Measures: 

  1. Parents will received breastfeeding education and support from the healthcare facilities.
  2. Healthcare facilities will not promote commercial infant or related toddler formula through ads or free samples and, when supplementation is medically-indicated, will make every effort to provide expressed milk from parent or donor human milk before infant formula.
  3. Businesses that sell or promote commercial infant formula agree to offer pamphlets on the benefits of breastfeeding provided by a breastfeeding-support entity that receives no support from any part of the infant formula industry on the aisle or area where formula is sold.
  4. No locally controlled groceries, food markets, convenience stores or pharmacies will promote commercial infant or related toddler formula by preferential shelf placement or by ads.
  5. All non-locally controlled groceries, food markets, convenience stores and local pharmacies are encouraged to prevent local advertising of formula and to allow display space near infant foods and commodities for provision of breastfeeding literature and support information. This information may not be provided by the formula industry.

Suggested Approaches:

  1. Designating Group may work with local WIC or health care organization to provide breastfeeding materials near infant foods and commodities shelves.
  2. Designating Group will visit locally controlled groceries, food markets, convenience stores, or local pharmacies that sell formula to assess compliance.
  3. CoC or similar, or other influential organization or agency, provides support for this effort.

Current Work:

  • The International Baby Food Action Network, UNICEF, and the World Health Organization have jointly published a report titled “Marketing of breast milk substitutes: national implementation of the international code, status report 2020.” The report provides updated information on the status of implementing the International Code of Marketing of Breast-milk Substitutes (the Code) and subsequent relevant World Health Assembly resolutions in countries. Using a scoring algorithm, the report concludes that in 2018-2020, 44 countries around the world strengthened their protections against inappropriate marketing of breast milk substitutes. 11 other countries passed new Code-related legislation or fill gaps in existing legal measures during this time period. The United States has no legal measures related to the Code. Read the press release.
  • We have emailed all the locally owned grocery stores and pharmacies about providing benefits of breastfeeding rack cards August of 2021
    • To our knowledge none of the locally owned pharmacies sell formula without a prescription.
    • To our knowledge none of the locally grocery stores sell formula.

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

PASS: The Chamber of Commerce has made the information from the health department and Breastfeed Durham websites available to all members.

Rationale: 

Workplace accommodation for breastfeeding workers is included in the Affordable Care Act (ACA) for hourly workers and is needed for breastfeeding to be a successful following return to work. Read more…

Measures:

STEP 10. Education systems, including childcare, K-12, colleges and universities, are encouraged to include breastfeeding-friendly curricula at all levels. 

Pass if all departments of eduction review textbooks to ensure breastfeeding norms or breastfeeding-friendly curricula is introduced at all levels of education: preschool, primary, and higher education.

Rationale: To become the normative behavior, people of all ages should be exposed to breastfeeding as part of all health and family education.

Measures: 

  1. The local School District, or the Department of Education, cooperates in the review of all textbooks to ensure breastfeeding norm.
  2. Breastfeeding-friendly curricula are introduced at all levels of education.

  • Preschool
    • The team approached heads of all 280+ chhildcare programs in durham.
    • Work are working with Durham TA providers.
    • We have put together support materials for childcare providers
    • We have created a local Breastfeeding family childcare designation
    • We have supported the statewide effort for the building blocks for Breastfeeding for the child care, a 10 session training series
    • We have worked with other Durham agencies and confirmed five programs have integrated breastfeeding friendly literature to into their curriculum and are normalizing Breastfeeding.
    • We have a growing list of Breastfeeding will come here child care providers.
  • Primary middle and high school
    • We have reached out to all Durham public school teachers and there have been informed about normalizing breastfeding I have access to tools to support their work in the classroom.
    • Working to support in and safe lactation spaces in all Durham Public School, significant progress is still needed.
    • We are coordinating with with our food equity organizations in Durham to ensure that Breastfeeding is normalized and Durham cooking classes. All Durham school children have access to these programs as well as many Durham parents, especially lower income parents.
      • COVID-19 food security taskforce community partners meeting is supporting breastfeeding (meeting 7.15.2021)
    • Team contuses to approaches head of educational systems and HR coordinators.
  • Universities
    • Durham Tech is working to create a Breastfeeding Friendly Campus environment
    • We have been partnering with Duke students in order to normalize breast-feeding throughout the Duke University system
    • We are still searching for more advocates in the North Carolina Central University system and the Duke University system.
  • Team contuses to approaches head of educational systems and HR coordinators.