Breastfeeding provides the healthiest start on life and a myriad of health benefits for mothers and children (Ip et al, 2007). However, breastfeeding practices worldwide, including in the U.S., continue to lag behind the WHO/UNICEF recommendations of exclusive breastfeeding for six months, and continued breastfeeding with age appropriate complementary feeding for up to two years and beyond (WHO/UNICEF, 2003). There are multiple and unique barriers to continued breastfeeding: pressures on women to resume social, family and economic obligations are common. These pressures often require separation of the mother and child due to work, schooling, or other obligations.
Studies have indicated that the anticipation of returning to work or school is associated with lower rates of breastfeeding initiation (e.g. Noble 2001; Roe et al, 1999). In North Carolina, returning to work or school is one of the most common reasons mothers cite for not initiating breastfeeding and for stopping breastfeeding (NC PRAMS Survey, 2011). While there are many reasons why returning to work is associated with reduced breastfeeding, it is likely that one of the contributing factors is the mothers’ expectations and experiences related to child care.
When mothers place infants in the care of someone other than themselves, they are less likely to breastfeed (Li et al, 2005). Therefore, it is not surprising that enrollment in child care is associated with decreased durations of breastfeeding (Weile et al, 1990). This is compounded by the finding that child-care providers report having inadequate knowledge of breastfeeding and other up-to-date recommendations for feeding infants (Clark et al, 2008).
The Carolina Breastfeeding-Friendly Child Care Initiative promotes widespread implementation of breastfeeding support in child care settings. Please see the following pages for more information:
Carolina Ten Steps to Breastfeeding-Friendly Child Care
Ten Step programs have been successfully used to improve breastfeeding support in hospitals. In the project described in detail below, we developed the initial “Ten Steps for Breastfeeding-Friendly Child Care Centers” which were then updated and revised based on expert review and stakeholder input in a subsequent project funded by the W.K. Kellogg Foundation.
Replication and Scale-up of Breastfeeding-Friendly Child Care
In 2012, with support from the W.K. Kellogg Foundation, CGBI began collaborating with state-level agencies and organizations in NC to replicate the Ten Steps to Breastfeeding-Friendly Child Care for sustainable scale-up throughout NC. Partners include the NC Child Care Health and Safety Resource Center, the NC Infant-Toddler Enhancement Project, Shape NC, the NC Department of Health and Human Services, Wake County Human Services and Wake County Smart Start.
National Collaborative for Advancing Breastfeeding in Child Care (NCABC)
The National Collaborative on Advancing Breastfeeding in Child Care (NCABC) has been established to address promotion, protection and support of breastfeeding in the child-care setting.
Findings from the Infant Feeding Practices Study
The objective of this secondary data analysis, supported by USFDA funding, was to explore whether the type of childcare and its variation over time is associated with later cessation of breastfeeding.
Tools for Action for Breastfeeding and Child Care
The Ten Steps for Breastfeeding Friendly Child Care, and related materials and training on their use, comprise the core intervention in this program.
