New awards from The Duke Endowment to Carolina Global Breastfeeding Institute will support breastfeeding across the Carolinas

June 12, 2019

ENRICH Carolinas, a project that supports hospitals in improving maternity care practices for mothers and babies, will be expanded across North and South Carolina thanks to awards from The Duke Endowment totaling $5 million. Run by the Carolina Global Breastfeeding Institute (CGBI), housed in the UNC Gillings School of Global Public Health, ENRICH Carolinas provides technical assistance and training for hospitals, prenatal clinics and childcare facilities on how to create a friendlier and safer environment for all infants that supports breastfeeding.

The funding will allow the project, now in 19 counties, to expand and include support for all hospitals that provide maternity care at no cost to the facility, resulting in lifelong improved health for babies and their mothers for generations to come. This expansion will ensure that no matter where a family delivers in the Carolinas, they will get quality care that supports optimal health outcomes for the birthing parent and their baby within an environment that enables breastfeeding — with a focus on informed decision-making and respect for parental choice.

Members of the ENRICH project team smile together in Armfield Atrium. Catherine Sullivan, director of the Carolina Global Breastfeeding Institute, is second from the right.

Members of the ENRICH project team smile together in Armfield Atrium. Catherine Sullivan, director of the Carolina Global Breastfeeding Institute, is second from the right.

“Our vision is to make sure that every family is provided the support that they need to achieve their feeding goals,” said Catherine Sullivan, CGBI’s director, ENRICH Carolina’s principal investigator, and an assistant professor of maternal and child health at the Gillings School. “This project has the potential to impact 178,000 births every year in the Carolinas.”

Once the best care practices are fully implemented in a hospital, a facility can apply for a prestigious designation called Baby-Friendly. ENRICH Carolinas’ goal is to reach every baby born in the Carolinas, aiming to have 100% of the maternity care hospitals and birthing centers in North and South Carolina working to implement the best practices by its fifth year (either through the Baby-Friendly designation or a similar quality improvement program). If accomplished, North and South Carolina would become the first states to achieve that status.

“The hospitals are the anchor,” said Sullivan. “That’s where it all starts.”

To be designated Baby-Friendly by Baby-Friendly USA, a hospital must adhere to the World Health Organization’s Ten Steps to Successful Breastfeeding. These steps include discussing the importance of breastfeeding with pregnant women and their families, supporting skin-to-skin contact, and enabling mothers and their infants to remain together and to practice rooming-in 24 hours a day. In a Baby-Friendly hospital, education on the safe preparation and feeding of formula is provided to mothers who have made an informed decision to use formula.

The project also represents a major step toward eliminating racial and ethnic disparities for outcomes related to breastfeeding-friendly practices. According to the Centers for Disease Control and Prevention (CDC), African-American infants are 21% less likely to ever have been breastfed than white infants. The CDC also reports that African-American mothers experience maternal mortality at three to four times the rate of white women. Differences in the care provided based on race and ethnicity have been well documented.

“Our project teams are going to go through racial equity training so they can then provide appropriate guidance to the institutions they are serving,” Sullivan said.

Breastfeeding offers many benefits to both mothers and children, according to the World Health Organization. Breast milk protects infants against infectious and chronic diseases and reduces infant mortality due to common childhood illnesses. In birthing mothers, breastfeeding reduces the risk of breast and ovarian cancer and contributes to their metabolic health and well-being. Based on these benefits, breastfeeding is considered the optimal means of feeding for the first six months of life.

Currently, 16% of North Carolina’s hospitals are designated as Baby-Friendly, while 45% have received the related state designation administered by the N.C. Division of Public Health. In South Carolina, which doesn’t have a state-run recognition program, 31% of maternity care hospitals are designated Baby-Friendly.

Families, however, also need information and support before coming to the hospital to deliver their baby and after going home and returning to life, school or work. CGBI offers a wide range of educational and support programs aimed at these time points, and ENRICH Carolinas brings them together in one project.

“We’re calling it the enhanced baby bundle,” Sullivan said. She added that studies have shown prenatal education on breastfeeding and a supportive environment throughout the pregnancy and postpartum periods sifnificantly improve breastfeeding rates.

Contact the Gillings School of Global Public Health communications team at

Recent News