Durham’s birth outcomes are improving — and they are improving because the community has spent the last 8 years building a coordinated, countywide system to support human milk feeding and maternal health.
The Ten Steps to a Breastfeeding Family Friendly Community form the backbone of that work. This framework, created by the Carolina Global Breastfeeding Institute and adapted locally, guides communities in building environments where breastfeeding, chestfeeding, and human milk feeding are fully supported.
This is systems change — and Durham is proving it works.
1. Leadership & Accountability (Step 1)
Durham is one of the few North Carolina communities with:
- A public human milk feeding strategic plan
- Multiple proclamations affirming breastfeeding support
- A cross-sector leadership structure involving the Health Department, BFFC, NCBC, doulas, IBCLCs, and grassroots parent leaders
These commitments create durable policy direction and stability across political and budget cycles.
2. A Welcoming Public Environment (Step 2)
More than 250 “Breastfeeding Welcome Here” signs and clings signal community-wide acceptance.
This reduces stigma, supports consistent feeding, and ensures parents can nurse anywhere without fear — a small but powerful protection against early weaning.
3. Health System Leadership (Step 3)
Durham partners directly with:
- Primary care providers
- WIC
- Birth center and midwifery groups
This alignment ensures consistent, evidence-based guidance. Providers understand where to send families for support, and community resources reinforce the recommendations families receive in clinic.
4. High-Quality Prenatal Education (Step 4)
Prenatal education efforts reach thousands of families annually through:
- Community events
- Walking groups and baby cafés
- CBO outreach
- CHWs, doulas, and peer counselors
These touchpoints increase early lactation confidence and reduce medically unnecessary formula supplementation.
5. Skilled Lactation Support (Step 5)
Durham has a disproportionately high number of:
- IBCLCs
- Peer supporters
- Bilingual lactation providers
- Free or low-cost lactation clinics
- Culturally grounded community groups like Lactancia Latina
This strong workforce reduces feeding-related complications that often escalate into hospitalization, preterm birth cascades, or maternal stress.
6. Annual Gaps-in-Care Assessment (Step 6)
This step — unique to Durham — ensures constant system improvement.
Each year the coalition reviews:
- Where families fall through the cracks
- Where providers need help
- Where disparities persist
- Which systems require new investment
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This continuous improvement approach is rare in public health, but in Durham it is routine — and effective.
7. Workplace Support (Step 7)
Dozens of Durham businesses are now breastfeeding-friendly and equipped with policies, signage, and spaces.
Workplace support helps parents maintain milk supply during a critical period and prevents early cessation.
8. Childcare Center Engagement (Step 8)
More than 80 childcare centers have received training or materials through Breastfeed Durham.
This ensures:
- Proper milk handling
- Infant feeding cues
- Safe pace-feeding
- A supportive environment for working parents
Childcare is often where breastfeeding ends — but in Durham, it’s where it is protected.
9. Community Support Systems (Step 9)
Durham’s community network includes:
- Doulas
- CHWs
- Peer counselors
- Parent groups
- Milk sharing networks
- Walking groups
- Emergency-prepared infant feeding kits
This broad web of support reduces isolation and fills gaps outside clinic walls.
10. Emergency Preparedness for Infant Feeding (Step 10)
Durham is one of the only communities in the country equipped with:
- SAFE Team partnerships
- Infant feeding sanitation kits
- CHW/doula protocols
- Hospital collaboration during disasters
As seen during Hurricane Helene, this saves lives.
The Ten Steps are not just about breastfeeding — they are about protecting infants when systems fail.
Why This Matters
When the Ten Steps are implemented together, they:
- Reduce preterm birth
- Reduce infant mortality
- Improve chronic disease prevention
- Protect maternal mental health
- Reduce health system utilization
- Increase equity and resilience
Durham is showing the rest of North Carolina what happens when a community invests in coordinated, structural, evidence-based maternal and infant health.
This is what public health looks like when it works.