CDC-Funded Activities

To enhance statewide support and improve breastfeeding, Alabama sought resources and funding through several CDC breastfeeding initiatives.

Best Fed Beginnings (BFB) was a nationwide quality improvement initiative funded by the CDC and led by the National Institute for Children’s Health Quality in partnership with Baby-Friendly USA and the United States Breastfeeding Committee. The goal of BFB was to help hospitals improve breastfeeding-supportive maternity care practices and increase the number of Baby-Friendly hospitals in the United States. The Baby-Friendly Hospital Initiative was launched by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) in 1991 and is a global effort to protect, promote, and support breastfeeding (WHO & UNICEF, 2009). For hospitals to achieve the Baby-Friendly designation, they must demonstrate that they have implemented the Ten Steps to Successful Breastfeeding (Ten Steps), which are evidence-based practices that are shown to improve maternity care and breastfeeding outcomes, as well as implemented the International Code of Marketing of Breast-milk Substitutes (WHO, 1981; WHO & UNICEF, 2009).

Hospitals in 29 states participated in BFB, including three Alabama hospitals. These hospitals partnered with the ABC to work on Step 10 of the Ten Steps, which is to foster the establishment of breastfeeding support groups and refer mothers to them upon discharge from the hospital or birth center (WHO & UNICEF, 2009). The ABC and the three hospitals provided support groups facilitated by trained staff located near the women they served.

The ABC also developed and implemented a plan for training physicians in the community who interact with mothers discharged from Alabama BFB hospitals. Physicians and staff from BFB hospitals, the ABC, and the Alabama Department of Public Health Training Network collaborated to develop a plan that would address this issue statewide. The decision was to provide web-based training to improve access for health professionals throughout the state. The webinar provided continuing medical education credits and met the 3 hours of physician training required by the Baby-Friendly Hospital Initiative. In addition, the ABC provided materials to physicians, including a list of active International Board Certified Lactation Consultants across Alabama who would consult with them free of charge about patients with lactation problems, copies of Medications and Mother’s Milk for the first 10 participants to complete the continuing medical education evaluation, and copies of From the Surgeon General: Selected Actions for Doctors to Support Breastfeeding (https://www.surgeongeneral.gov/library/calls/breastfeeding/index.html).

Using lessons learned from BFB, the CDC launched the Enhancing Maternity Practices (EMPower) breastfeeding initiative in partnership with Abt Associates, Baby-Friendly USA, the Carolina Global Breastfeeding Institute, and Population Health Improvement Partners. EMPower is a hospital-based quality improvement initiative led by Abt Associates to help hospitals improve breastfeeding-supportive maternity care and achieve the Baby-Friendly designation. EMPower provides participating hospitals with technical assistance, staff training, and quality improvement tools. Hospitals in 24 states are participating in the EMPower initiative, including six Alabama hospitals (Abt Associates, 2017).

The ABC provides breastfeeding support to Alabama communities for projects initiated during the CDC-funded National Association of County and City Health Officials (NACCHO) grant. The project, entitled Reducing Disparities in Breastfeeding Through Peer and Professional Lactation Support, was a grant to increase community support and access to breastfeeding resources. The project increased implementation of evidence-based and innovative peer and professional breastfeeding support programs among predominantly Black and underserved communities by providing awards to community-based organizations and local health departments (NACCHO, 2017). Through funding received by the Birmingham Baby Café, Certified Lactation Counselor training was provided to 25 individuals, including obstetric nurses, medical students, peer counselors, and nutritionists who work with the Special Supplemental Nutrition Program for Women, Infants, and Children, all of whom became certified as lactation consultants. In addition, the grant allowed the ABC to provide breast pumps, taxi vouchers, education materials, and rocking chairs to the Birmingham Baby Café community. Baby Cafés, a free resource for pregnant and breastfeeding moms, are run by trained staff and located throughout the community—for example, in church halls or hospitals—and generally open at least once a week to offer support on all aspects of breastfeeding (Baby Café USA, 2017).

The Baptist Medical Center South in Montgomery, Alabama, was another recipient of a NACCHO grant, creating the Circle of Moms. This group established support groups and a free breast pump loaner program and provided lactation education for healthcare professionals by hosting a Certified Breastfeeding Counselor course. Through continued CDC funding to NACCHO, grantees have made use of the continued technical assistance to sustain their activities.

In addition, the Alabama Department of Public Health obtained support through the CDC-funded Association of State and Territorial Health Officials grant, Building State Health Agency Capacity for Breastfeeding Promotion and Support. The funding was used to develop the Alabama Breastfeeding Initiative, which, in collaboration with the ABC, established a framework to provide guidance and recommendations to hospitals and state and community organizations for increasing the initiation and duration of breastfeeding in Alabama. In particular, it aimed to increase practices supportive of breastfeeding in birthing facilities throughout Alabama. The 26 participating Alabama hospitals were provided evidence-based resources and training that supported implementation of the Ten Steps process and were enabled to engage in a collaboration with a “mentor hospital,” one that had already achieved Baby-Friendly designation. Other activities included a 2-day train-the-trainer event to equip participants with 16 hr of evidence-based breastfeeding education, and training for 30 obstetric nurses statewide to become Certified Lactation Counselors. This funding has helped the Alabama Department of Public Health strengthen its collaboration with partner agencies, health organizations, and hospitals throughout the state.