Coordination, Goals and Monitoring

Breastfeeding Committee

The National Breastfeeding Committee (NSK) in Germany was established by the federal government in 1994 to promote breastfeeding nationally.  The NSK currently functions as an advisory arm to the federal government and issues evidence-based breastfeeding recommendations.

Reference:

  1. National Breastfeeding Committee

Brazil has a National Breastfeeding Committee, created by law (Portaria 111, January 19, 2012). This Committee is consulted by the Ministry of Health about breastfeeding promotion and protection issues. This committee includes representation from government, universities, and civil organizations.

Reference:

  1. ORDINANCE NO. 111, OF 19 JANUARY 2012 Redefine the National Committee for Breastfeeding (CNAM).

In May 2011, the US Federal Interagency Breastfeeding Work Group was created, comprising representatives from 16 government agencies, including the Office of Personnel Management (OPM), Department of Labor, US Department of Agriculture (USDA), Department of Defense and most of the operating divisions within the Department of Health and Human Services (DHHS). The group has a central coordination role and meets monthly to share information and ensure inter-agency collaboration around breastfeeding activities and to facilitate coordination among these federal agencies in their shared responsibilities related to the promotion and support of breastfeeding and related efforts to promote, protect, and support breastfeeding. The Federal Interagency Breastfeeding Workgroup primarily shares and disseminates information on related activities within individual agencies. The Workgroup plays a coordination role, but each agency is autonomous and for this reason, there is no work plan. As federal agencies, they work to promote, recommend, and institutionalize evidence based practices, many of which are policy or environmental supports.

Below is a sample agenda for the work group:

  • It’s Only Natural. Mother’s Love.  Mother’s Milk. -   Office on Women’s Health public education campaign targeted to African American women.
  • Loving Support -  a USDA program to improve training for managers and peer counselors in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).
  • Breastfeeding in Military Treatment Facilities 
  • Breastfeeding issues in disasters 
  • Videos on application of Nursing Breaks Law 
  • National Breastfeeding Research Consortium
  • Systematic Review of Health Outcomes of Breastfeeding
  • Updating the Business Case for Breastfeeding - federal program to educate employers about the value of supporting breastfeeding employees in the workplace.

The United States Breastfeeding Committee is a coalition of non-governmental bodies that works closely with federal agencies, i.e. those in the Federal Interagency Breastfeeding Work Group, and is the lead national organization that promotes and supports breastfeeding activities across the country. In 2014, the USBC set out a new strategic framework with the overall Mission “To drive collaborative efforts for policy and practices that create a landscape of breastfeeding support across the United States.”  The coalition has four main goals:

  • Be the national collective voice for breastfeeding
  • Ensure organizational vitality
  • Engage stakeholders in a Collective Impact model, and
  • Create and model a culture of inclusion, diversity, and equity.

All 50 states, the District of Columbia, U.S. territories, and Indian Tribal Organizations have breastfeeding coalitions.  Each area of the country has an elected Coalitions Regional Representative (CRR) and Alternate Regional Representative (ARR).  These individuals serve as “ambassadors or liaisons, fostering communication between the USBC and the coalitions in their regions”.  Responsibilities include:

  • Attending bi-annual USBC membership meetings;
  • Collaborating with the USBC to identify, assess, and prioritize coalition actions;
  • Communicating state/regional concerns or issues; and
  • Supporting and promoting USBC events. 

Regional teleconferences are convened bi-monthly and information is disseminated regularly through listserve.

References:

  1. Anstey, E. H., MacGowan, C. A., & Allen, J. A. (2016). Five-Year Progress Update on the Surgeon General's Call to Action to Support Breastfeeding, 2011.Journal of Women's Health, 25(8), 768-776.
  2. [Personal conversation with Nutrition Branch, Centers for Disease Control and Prevention (CDC), U.S. Department of Health & Human Services] (2016).
  3. Grummer-Strawn, L. (2013). Making Breastfeeding a Public Health Priority in the United States.  Paper presented at the World Health Organization seminar Geneva, Switzerland.
  4. Centers for Disease Control and Prevention, Division of Nutrition, Physical Activity, and Obesity. (2013). News and Updates from the CDC. Paper presented at the Breastfeeding Coalitions Webinar, Webinar.
  5. United States Breastfeeding Committee. (2014). USBC Strategic Framework. 
  6. United States Breastfeeding Committee. (2016).  Coalitions: Regions & Regional Representatives.  

The IYCF Alliance in Bangladesh grew from the development of National Communication Framework and Plan for Infant and Young Child Feeding in Bangladesh. (Reference #2) Workshops coordinated by the International Food Policy Research Institute, who sit within the Ministry of Health (MOH), were convened with the specific intention of coordinating activities around IYCF programs. The Alliance includes the Government of Bangladesh and key NGOs working in the region - National Nutrition Services, NICEF, CARE, Alive & Thrive, BRAC, Save the Children and many other government departments, NGOs and professional organizations. The Alliance acts as a platform for these organizations to share experiences, agree on key messages and harmonize these, publish research, publicize events and monitor programmes to drive improvements in infant and child nutrition.

Objectives of the National IYCF Alliance:

  • A forum for guiding and monitoring programmes and communications related to improving IYCF.
  • Share, review and learn from data and evidence.
  • Track progress of the targets and goals embedded in IYCF plans.
  • Develop and maintain coordination and mapping of activities of partner organizations, to ensure efficient and effective use of resources.
  • Harmonize IYCF messages across all activities and communications.
  • Guide BFHI, Breastmilk Substitutes Code, curricula, and any other IYCF activities.

 
The Alliance met quarterly, set annual priorities, and standardized performance management measures and reported on these biannually. A map of all the IYCF activities in the country was maintained to ensure effective coordination of programming. (See Reference #3, Annex 2 for the National IYCF Alliance of Bangladesh Terms of Reference)

References:

  1. McFadden, A., Kenney-Muir, N., Whitford, H., Renfrew, M.J. (2015).  Breastfeeding: Policy Matters. Identifying strategies to effectively influence political committment to breastfeeding: a review of six country case studies.
  2. Institute of Public Health Nutrition, Bangladesh. (2010).  National Communication Framework and Plan for Infant and Young Child Feeding in Bangladesh.
  3. Bangladesh Breastfeeding Foundation. (2015).  Bangladesh- WBTi Report.

In 2013, the rate of women dying in childbirth had risen to an alarming level in Kenya.  Unsure of the causes (i.e. was it cultural or could policy changes influence a change), Kenya’s Ministry of Health turned to their health information system. The data identified the root causes: more than a third of women were giving birth at home and many of them were not accessing health facilities because of distance and financial costs. As a result of these findings, in June 2013, President Uhuru Kenyatta declared maternity services free in all public health facilities in Kenya, subsequently removing the cost barrier to women and their families. The investments Kenya has made in strengthening their data collection tools such as household surveys, health management information systems and civil registration and vital statistics have helped them to use their data to inform policy decisions. Whilst this example is not specific to breastfeeding, it does offer a relevant illustration on using data effectively to inform decision making.

Reference:

  1. World Health Organization. (2016). Kenya takes steps to save mothers’ lives, showing why better data matters.

PRAMS, the Pregnancy Risk Assessment Monitoring System, is a surveillance project of the Centers for Disease Control and Prevention (CDC) and state health departments. PRAMS collects state-specific, population-based data on maternal attitudes and experiences before, during, and shortly after pregnancy. PRAMS surveillance currently covers about 78% of all U.S. births and the data are used by researchers to investigate emerging issues in the field of reproductive health and by state and local governments to plan and review programs and policies aimed at reducing health problems among mothers and babies.
In 1999, the state of Oregon PRAMS data showed that whilst 90 % of mothers initiated breastfeeding, the continuation rates dropped significantly by the time the infant was 3-4 months old. 37% of mothers stopped because they had to go back to work and faced barriers in continuing to breastfeed, such as inflexible working times and a lack of a private, clean space to express or breastfeed.
The Oregon Public Health Division studied the PRAMS data to try and understand how to increase breastfeeding rates. They initiated partnerships with state building managers to identify and refurbish space that enabled employees to breastfeed or express at work. In 2007, they presented the findings to the state legislature and the Oregon House Bill 2372, known as “Rest Periods for Expression of Breast Milk,” was adopted into law. The Bill required large employers (with more than 25 employees) to provide time and space for breastfeeding. Following the creation of this law, the Oregon Senator, Ron Wyden, successfully advocated for inclusion of some parts of the law to be included in the national Patient Protection and Affordable Care Act, 2010.

Following the adoption of the state law, the Oregon Bureau of Labor and Industries drafted state implementation guidelines. The regulations require employers of 25 or more employees to give women at least a 30-minute break period every 4 hours and a private area, other than a public restroom, to express milk. As a result of this law, PRAMS data showed an increase in the proportion of women who exclusively breastfed for at least 9 weeks from 9.3% in 2007 to 12.2% in 2008.

Reference:

  1. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (CDC), National Center for Chronic Disease Prevention and Health Promotion, Division of Reproductive Health. Data to Action Success Story: Oregon. Atlanta, GA
India

Sima Naik discusses breastfeeding and the importance of good nutrition in the first 1000 days with Rebati Naik, Accredited Social Health Activist (ASHA), in Badamahuladhia village, Odisha, India.© 2014 John Nicholson, SPRING Project, Courtesy of Photoshare