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Summary of the Surgeon General’s Call to Action to Support Breastfeeding

On January 20, 2011, Surgeon General Regina M. Benjamin issued a “The Surgeon General’s Call to Action to Support Breastfeeding,” outlining steps that can be taken to remove many of the challenges faced by women who want to breastfeed their babies. The Surgeon General identified 20 evidence-based actions that are needed, including establishing worksite policies and programs that are supportive to employees who are breastfeeding, implementing maternity care practices in hospitals and birthing facilities that do not sabotage breastfeeding, reducing marketing of infant formula products, and ensuring access to services provided by International Board Certified Lactation Consultants (IBCLCs). The Call to Action asks six segments of society to step forward and take responsibility for removing breastfeeding barriers within each of their respective spheres of influence.The twenty action steps within the six categories have numerous suggested implementation strategies.

Mothers and their Families: recognizes the need for mothers to be informed by their health care providers of the importance of breastfeeding, and that health care providers support mothers in their efforts to breastfeed.
Communities: asks for community-based support for breastfeeding mothers from public health programs, including the provision of peer counseling support, and around the clock breastfeeding support from community organizations. Manufacturers of infant formula should be held accountable for marketing their products within the guidelines of the International Code of Marketing of Breastmilk Substitutes and health care providers should not serve as advertisers of infant formula.
Health Care: requests that hospitals accelerate their efforts to achieve the Baby-Friendly designation, ensure access to skilled, professional lactation care services following hospital discharge, provide training in lactation care in undergraduate and graduate educational programs for health professionals, encourage insurers to reimburse for services provided by IBCLCs, and increase availability of banked donor milk.
Employment: calls for paid maternity leave, the establishment of lactation support programs by employers, and the adoption of child care standards that support breastfeeding mothers.
Research and Surveillance: identifies the need for new research regarding the most effective ways to increase breastfeeding rates among populations with low rates, conduct analyses of the cost effectiveness of breastfeeding, and provide a better evidence base for making clinical decisions in challenging situations.
Public Health Infrastructure: urges the creation of a federal interagency work group on breastfeeding, and increasing the capacity of the United States Breastfeeding Committee and affiliated state coalitions.

The Call to Action represents a significant tool for use in validation of the importance of both breastfeeding and the role that the IBCLC plays in assuring that all mothers and infants receive the level of lactation care and services that they need. The document can be used in numerous ways to improve access to evidence-based care in the hospital, to provide post discharge lactation care in the community, and in settings where mothers experience the most difficult challenges to breastfeeding, such as the workplace. The Call to Action functions as a guide or roadmap for those wishing to make changes, as it places the responsibility for breastfeeding improvement on all the segments of society that interact with mothers or who have an influence on how lactation support is provided. It provides suggestions on how best to reduce barriers, and challenges health care providers, institutions, organizations, agencies, the Government, employers, and insurers to all do their part to see that mothers and infants receive the support to which they are entitled.

Action 11 specifically recommends, “Ensure access to services provided by International Board Certified Lactation Consultants.” It goes on to ask that IBCLCs be designated as “covered providers” and that reimbursement should be provided independent of licensure. Adherence to these recommendations will go a long way in reducing disparities and providing access to care that can be financially out of reach for mothers when insurers refuse reimbursement for lactation care and services provided by IBCLCs. Use this document to your advantage, whether you work in a hospital, clinic, agency, or private practice. There is so much room for improvement that we should make sure that we have all of the tools at our disposal in our work to help mother and babies breastfeed. To obtain copies of the Call to Action see:


MarshaWalker, RN, IBCLC

Marsha Walker has worked with breastfeeding mothers since 1976, first as a volunteer counselor with Nursing Mothers Counsel in California and eventually as the Director of the Breastfeeding Support Program at Harvard Pilgrim Health, a large HMO in Massachusetts. Much of her time is currently spent advocating for breastfeeding on the state and federal levels. She is the executive director of the National Alliance for Breastfeeding Advocacy (NABA) which is the organization that monitors the Code in the US. Marsha also sits on the Board of Directors Baby Friendly USA, Massachusetts Breastfeeding Coalition, and Best for Babes. She represent USLCA to the US Department of Agriculture’s Breastfeeding Promotion Consortium and represent NABA to the US Breastfeeding Committee.

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