Category Archives: breastfeeding

Dakota County Public Health Builds on Breastfeeding Program to Create Rapid Referral System

By Harumi Reis-Reilly, MS, LDN, CHES, IBCLC, Lead Program Analyst, NACCHO, and Katie Galloway, MBA, RD, LD, IBCLC, Dakota County WIC Program

Dakota County Public Health Department (DCPHD) in Minnesota, a 2017 NACCHO Model Practice awardee, built upon their comprehensive breastfeeding program and implemented a rapid referral system to expand access to critical lactation care to low-income families. Through the Reducing Breastfeeding Disparities through Peer and Professional Support grant, DCPHD increased participation by 68% in prenatal breastfeeding classes and more than doubled their rapid-response lactation visits.

DCPHD provides many services to the large underserved members of its community, especially pregnant women and new mothers. For example, in 2010, about 33% of babies born were to low-income women on Minnesota’s Medicaid Program. Dakota County WIC participants started breastfeeding at high rates (85%) in 2013, however only 38% of them were still breastfeeding at six months. While breastfeeding initiation among African

Americans in the Dakota County WIC program are among the highest in Minnesota, there are concerning inequities related to the exclusively breastfeeding rates. For instance, according to the WIC database, African American clients are more than four times less likely to exclusively breastfeed than white, non-Hispanic women.

One of the reasons for low exclusivity breastfeeding rates among African American moms was the limited availability of affordable lactation support services in Dakota County. Hospitals and medical providers outsource prenatal and postpartum breastfeeding classes and support services to for-profit businesses, whose fees pose a financial barrier that prevents low-income families from receiving appropriate breastfeeding education and support. Due to staffing limitations and inadequate lactation training for public health professionals, there are few affordable breastfeeding services available in the area.

Although DCPHD’s family health nursing staff regularly promoted breastfeeding, only 8% of its staff had have completed advanced breastfeeding training. While all DCPHD WIC staff was trained at the Certified Lactation Counselor (CLC) level, staff and clinic scheduling constraints made it difficult to provide adequate support.

Prior to NACCHO funding, DCPHD led the Breastfeeding-Friendly Health Department initiative, designed to improve the breastfeeding environment and increase organizational capacity to support breastfeeding. This initiative was piloted in ten local health departments (LHD) in the state. Pilot sites implemented the ten-step protocol, including supportive policies and use of champions as outlined in the Breastfeeding-Friendly Health Department Toolkit. This program has been successful and is now recognized as a Model Practice, receiving the 2017 NACCHO Award due to its contribution to the overall improvement of public health through effective evidence-based practice methods. Watch their presentation here: Link to Dakota Presentation.

In 2015, with funds from NACCHO and the Centers for Disease Control and Prevention (CDC), DCPHD enhanced its comprehensive breastfeeding program by implementing a new component: the rapid response system. This initiative provided advanced lactation support by trained public health nurses within 24 hours of referral. The program addressed critical gaps in breastfeeding support services for African American, low-income, and underserved communities in Dakota County.

DCPHD works cooperatively with the Dakota County WIC program to support prenatal breastfeeding classes, since most DCPHD clients who are pregnant women and new mothers are also WIC participants. DCPHD also worked with Dakota County’s 360 Communities, a faith-based organization, and the Community Action Program to provide breastfeeding education training to home visitors with the goal of increasing the provision of lactation education among nursing mothers.

DCPHD was able to meet the identified community needs of access to immediate, critical support through the implementation of the rapid-response to lactation referrals. DCPHD increased organizational capacity by training 60 staff members on basic and advanced lactation management. This increased number of available trained lactation support providers led to greater availability of free-of-charge breastfeeding classes throughout the community, and a 68% increase in participation in classes. In addition, the rapid referral system more than doubled the number of rapid-response lactation visits (from 2.8 to 6.9 visits/month) during the grant period.

In addition to training public health nurses who visit clients, DCPHD was also able to build on the capabilities of additional home visitors, enabling them to provide basic lactation support and make appropriate referrals to sustain breastfeeding.

Since Dakota County already had a foundation of supportive policies and systems in their Breastfeeding-Friendly Health Department before NACCHO’s grant, they were able to build upon this supportive environment and quickly implement additional components to its program. The key factors in their success were the supportive leadership within the organization, the previously built foundation of implemented policies and systems, and prior key partnerships with WIC and a home visiting agency.

For more information, contact: Katie Galloway, MBA, RD, LD, IBCLC; Dakota County WIC Program;

Leveraging Existing Resources to Achieve Breastfeeding Equity

By Emily Bernard, IBCLC, NACCHO Consultant; Barb Hawkins Palmer, KCHD, Executive Director of Healthy Kent; Bonita Agee, Strong Beginnings, Education Coordinator; Teresa Branson, KCHD, Deputy Administrative Health Officer; and Chelsey Saari, KCHD, Project Director for Population Health & Accreditation Coordinator


Recognizing there was significant racial inequity in breastfeeding among African American mothers, the Kent County Health Department (KCHD), in Grand Rapids, Michigan, deemed the disparity unacceptable and convened a group of stakeholders to discuss this issue and ways to address it. Only 53% of African American mothers initiated breastfeeding, compared to 79% for white clients. Although there is a WIC program operated by KCHD and various additional maternal and infant health support services in the community, stakeholders determined that mothers would benefit more from receiving one-on-one breastfeeding-specific care. Using the well-documented success of peer mentor models, and with funds from NACCHO, KCHD formed a committee who worked in collaboration with the Healthy Kent Breastfeeding Coalition and the EMPower Hospital (Mercy Health Saint Mary’s), to create the Mothers Helping Mothers Breastfeed project, peer mentor home visiting program, in an effort to close the breastfeeding continuity of care gap for African American women. Continue reading

Story From the Field: Children’s Home Society of Florida

By Shannon Currie, MSL, Community School Director, Children’s Home Society of Florida and Harumi Reis-Reilly, MS, LDN, IBCLC, Lead Program Analyst, Breastfeeding Project, Safe, Healthy and Resilient Communities, NACCHO

Meeting Teen Moms Where They Are: An Innovative School-based Breastfeeding Program

Children’s Home Society and Commonsense Childbirth engaged the community of Pine Hills from community-based partnerships designed to demonstrate improvement in breastfeeding practices for registered participants in the early post-partum period, at 6 months and 12 months, as compared to 2013 statistical data collected from the Florida Department of Health. Children’s Home Society (CHS) of Florida provided Wellness Coaches to deliver peer lactation support and education through direct referral and online support through the Peer and Online Lactation Support (POLS) portal. Continue reading

Laying the Infrastructure for Breastfeeding Partnerships in Lee County

By Emily Bernard, IBCLC, NACCHO consultant in collaboration with Carol Lawrence, PhD, MS, BSN, RNC-OB and Lori Riddle, Lori H. Riddle, RD, LD/N, CLC  Florida DOH and Lee Health


The Florida Department of Health in Lee County (DOH Lee) worked alongside three hospitals during NACCHO’s Reducing Breastfeeding Disparities through Peer and Professional Support project. DOH Lee’s project was designed to improve the county’s environment to support breastfeeding for black families through the establishment of a strategically developed coalition, as well as through the provision of advanced training of agency and hospital staff, other than nurses, to improve breastfeeding support within the hospital and the community. DOH Lee helped to implement the EMPower Breastfeeding Project by providing prenatal education and postpartum support to low-income, black families delivering in these enrolled hospitals. Continue reading

Shifting Internal Policies and Systems to Create Breastfeeding Continuity of Care

By Carmen Vergara, RN, MPH (ESPERANZA HEALTH CENTERS) and Harumi Reis-Reilly, MS, CNS, CHES, IBCLC (NACCHO)  

Esperanza Health Centers, a former grantee of NACCHO’s Breastfeeding Initiative, is a Federally Qualified Health Center (FQHC) on the Southwest side of Chicago. The main population served is predominately low-income and Latino, and families in Esperanza’s service area experience significant economic, educational, and health inequities. Over 70% of area residents live 200% below the poverty level. Esperanza’s main services are adult primary care, pediatrics, prenatal care, and behavioral health. Additional public health services include programs related to children’s weight management, diabetes management, and physical activity. Continue reading

Removing Barriers to Breastfeeding in Niagara County

istock_000000346530_mediumBy Elaine Roman, MA, BSN, RN, IBCLC, ANLC Director, Division of Public Health Planning and Emergency Preparedness, Public Information Officer & Elise Pignatora, MS, CLC Public Health Resource & SNS Support Officer, Niagara County Department of Health

For the past three years, Niagara County (NY) Medical Reserve Corps (MRC) has received the MRC Challenge Award from the National Association of County and City Health Officials (NACCHO) for their breastfeeding initiative, “Energizing Partnerships to Advance Support Networks for Breastfeeding Mothers.” Director of the Division of Public Health Planning in the Niagara County Department of Health Elaine Roman, MA, BSN, RN, IBCLC, ANLC and Public Health Resource and SNS Support Officer Elise Pignatora, MS, CLC led the lactation initiative. The Niagara County Department of Health’s inspiration for this intervention to the 215,000 population community came from the 2011 Surgeon General’s Call to Action to Support Breastfeeding.  “We also looked at the Healthy People 2020 numbers and realized our county was not performing the way we would like it to be in regards to initiation, duration, and exclusivity of breastfeeding in our county,” Roman said. Continue reading