Report Card – Breastfeed Orange NC Ten Steps

Updated during National Breastfeeding Month 2022! Thank you to all for your support! We continue to build awareness and grow support!

Eight adults and one child behind banner with text: Celebrating World Breastfeeding Week & National Breastfeeding Month.
2022 WBW and NBM Celebrations at Carrboro and Kidzu/Chapel Hill Farmers’ Markets!!

Step 1. The community’s elected or appointed leadership has a written statement supporting breastfeeding that is routinely communicated to all.

Rationale​: Good policies and procedures should provide insight on what management believes is important, clarify obligations and their purpose, and be consistent and last beyond the term of a particular executive. A policy/proclamation is generally formulated by top management as an integral part of organization strategy that will guide decision making and leave some room for managerial discretion.


  1. The written and signed policy/proclamation includes actions to support the following nine steps. Yes
  2. The written and signed policy/proclamation is shared via all local media outlets, including newspapers, radio and television as well as social media, as available, and the majority have done so in the last year. Yes
  3. Local print and other media have hosted a discussion of this issue with breastfeeding experts and/or La Leche League or similar at least bi-annually. Not Yet
  4. A copy of the Ten Steps designation and the local policy/proclamation is widely distributed at least annually, possibly during World Breastfeeding Week (In US, National Breastfeeding Month) Yes

PASS if at least 3 of the 4 are in place.

How are we doing? Our governments are resolved to become breastfeeding friendly! Status: PASS

STEP 2. The community as a whole provides a welcoming atmosphere for chest/breastfeeding families.

Rationale​: This step builds upon State and Federal laws that dictate that breastfeeding, chestfeeding, and human milk feeding may be carried out wherever the parent is lawfully allowed to be. The maintenance of milk supply is only possible when infants are fed on cue and frequently day and night. Parents know that they need to nurse when the infant indicates, and chest/breastfeeding must not be relegated to places where adults would not consume food, such as toilet areas.


  1. “Breastfeeding Welcome Here” signage is posted next to the welcome signs to the community or in similar prominent positions (e.g., city operated parks, swimming pools, senior centers). In progress
  2. A “Breastfeeding Welcome Here” seal/logo is posted on community/city websites and/or social media or similar, and/or flyers are available at the Visitors Bureau. In progress
  3. The Federal law or similar is enacted in this locale (e.g., North Carolina Law is enforced). Yes

PASS i, ii, if documented; PASS iii, if law or similar is in place and supported by local law enforcement.

How are we doing? Our first responders support the protections for nursing families! Looking forward to adding the Welcome signage throughout the community! Status: 1 and 2 – In Progress; 3 – PASS

STEP 3. Optimal chest/breastfeeding1 is supported by health leadership.

Rationale​: This international definition is included in the Policy Statement/Proclamation and disseminated at appropriate times, such as World Breastfeeding Week or National Breastfeeding Month, to all health entities. 1​Early and exclusive breastfeeding for up to 6 months and continued breastfeeding with appropriately-timed introduction of complementary foods are encouraged for at least 2 years and for as long as the mother and child desire. (


This definition of optimal infant feeding, or that proposed by the World Health Organization, American Academy of Family Practitioners, or American Academy of Pediatricians, is disseminated and confirmed with healthcare and community leadership, with discussion and corrections as needed.

PASS if the local health authority accepts this definition.

How are we doing? Our health leadership supports optimal infant feeding! Status: PASS

STEP 4. During pregnancy, all families in the community are informed about the benefits of chest/breastfeeding, as well as about the risks of unnecessary formula use, and where to access support as needed​.

Rationale​: Chest/breastfeeding education and support allows families to make informed decisions regarding infant feeding practices. This step is supportive of the ​International Code of Marketing of Breast-milk Substitutes,​ that calls for unbiased information in the hands of the public, especially concerning the risks of formula use for maternal and child health outcomes. Distribution should include attention to equity – ensuring that those populations who are more vulnerable receive special inputs.


Non-commercial materials on this issue are distributed, in hard copy and/or online, through community and faith-based organizations, produced or approved by the chest/breastfeeding authority or Designating Group, reflective of the population and culturally appropriate. Distribution may be via health sector, local chest/breastfeeding support groups, or chest/breastfeeding coalition.  

PASS if there is documentation that information has been widely distributed.

How are we doing? Our health department and community groups provide resources and support. Status: PASS

STEP 5. Health care in the community is breastfeeding-friendly.

Rationale​: Health care within the community must be breastfeeding-friendly, if a community is to support optimal infant feeding. Research confirms that comprehensive lactation support in prenatal, maternity and postnatal care results in improved chest/breastfeeding success.


  1. All maternity care centers are either designated Baby-Friendly (BFHI) or designated as fully qualified chest/breastfeeding friendly by a State-level equivalent designation. This designation must include at least the following: Healthcare personnel involved in the care of families with babies are trained in the skills necessary to support optimal chest/breastfeeding.
  2. All clinics have been informed about a breastfeeding-friendly designation (check with your state breastfeeding coalition), and at least 50% of offices/clinics have applied for the designation, OR, offices/clinics provide documentation concerning the prenatal chest/breastfeeding support, such as educational tools, or practice behaviors, that they employ with all patients, regardless of race or ethnicity.

PASS if these rates or higher are documented

How are we doing? We are building a strong healthcare community! Status: 1 – Pass; 2 – In Progress

STEP 6: Non-health system chest/breastfeeding support groups and services are fully available in the community, including International Board Certified Lactation Consultants (IBCLCs), peer-to-peer lactation support providers, and other skilled breastfeeding support.

Rationale​: Chest/breastfeeding support must extend beyond the clinic. Therefore, there must be active community support for referral and independent action by chest/breastfeeding families to find the support they need. Once these are established, all clinics and hospitals should be called upon to provide active referral. Active collaboration between health care providers and community lactation support entities is needed to support this Step.


  1. Confirmation that such services are active or being created that would serve the community, with attention to meeting the needs of various racial/ethnic groups.
  2. At least one in person or virtual meeting has been held and at least one communication to the public on this mutual effort are documented annually.

PASS if Designating Group receives documentation of the measures

How are we doing? Our community has many dedicated lactation support groups and individuals! Check out the calendar for organizations providing support and information. Status: PASS

STEP 7. The businesses and social organizations in the community welcome chest/breastfeeding families.

Rationale​: For a community to support chest/breastfeeding, there is a need to provide locations where families are comfortable chest/breastfeeding.


i. At least 50% of the Chamber of Commerce (CoC) member organizations, economic development organizations, and non-member organizations have signed a form that they welcome nursing families in their place of business and display welcome signs or a “Breastfeeding Welcome” logo (e.g. window cling). These may be provided by the BFFC Team. (Breastfeed Orange NC has clings to share!)

PASS if window clings (or similar) are posted and/or availability of materials in at least 50% of businesses are documented.

How are we doing? Our businesses and organizations are stepping up to show their support! Thank you!! Status: In Progress

STEP 8. Local businesses and healthcare clinics/offices follow the principles of the International Code of Marketing of Breast-Milk Substitutes.

Rationale​: The International Code of Marketing of Breast-milk Substitutes​ (“Code of Marketing”/“WHO Code”) affirms that “the encouragement and protection of breast-feeding is an important part of the health, nutrition and other social measures required to promote healthy growth and development of infants and young children.” It strives to protect, promote, and support chest/breastfeeding for the health and well-being of infants, especially during the vulnerable early months of life. Lactation education and support allows families to make informed decisions regarding infant feeding practices. While ​realizing that manufacturers and distributors of breast-milk substitutes have a role to play in relation to infant feeding, the Code of Marketing recognizes that the inappropriate and unnecessary marketing and distribution of breastmilk/human milk substitutes by healthcare facilities and businesses can impact infant feeding practices of families.


  1. Parents will receive chest/breastfeeding education and support from the healthcare facilities.
  2. Healthcare facilities will not promote commercial infant or related toddler formula through ads or free samples; and when supplementation is medically-indicated, will make every effort to access provide expressed milk from parent or donor human milk before infant formula.
  3. Businesses that sell or promote commercial infant formula agree to offer pamphlets on the benefits of chest/breastfeeding in the aisle or area where formula is sold; information is provided by a lactation-support entity that receives no support from any part of the infant formula industry.
  4. No locally controlled groceries, food markets, convenience stores or pharmacies will promote commercial infant or related toddler formula by preferential shelf placement or by ads.
  5. All non-locally controlled groceries, food markets, convenience stores and local pharmacies are encouraged to prevent local advertising of formula and to allow display space near infant foods and commodities for provision of chest/breastfeeding literature and support information. This information may not be provided by the formula in​dustry.

PASS when no locally controlled businesses have advertised infant formula or related toddler formulas by verification with such businesses, and when at least 50% of food stores agree to provide chest/breastfeeding-supportive materials near formula shelf placement.

How are we doing? We are building awareness of the impact that advertising of breast-milk substitutes has on breast/chestfeeding success. Status: In Progress

STEP 9. The World Alliance for Breastfeeding Action (WABA) maternity care and employment or, in the US, The US Business Case for Breastfeeding is promulgated by the government and the Chamber of Commerce (CoC) or equivalent.

Rationale​: Workplace accommodation for lactating workers is included in the Affordable Care Act (ACA) for hourly workers and is needed for chest/breastfeeding to be successful following return to work.


i. The current state of the laws concerning mandated business support for chest/breastfeeding, and the materials available to support the law, are made available to all CoC members, similar business groups, and other businesses at least annually. (ACA materials from Dept. of Labor provided by local breastfeeding organizations or health department:​ ).
ii. The US Business Case for Breastfeeding or WABA maternity care and employment-related materials are promulgated by the Chamber of Commerce or similar organization. (Materials are available at: and/or

PASS if CoC, community-based organizations, and/or local chest/breastfeeding organizations provide documentation that the health department has made the information and updated websites available.

How are we doing? We are reaching out to the business community about the importance and benefits of support in the workplace for lactating employees. Good for children, good for families, good for businesses!! Status: In Progress

Step 10. Education systems, including childcare, K-12, colleges and universities, are encouraged to include chest/breastfeeding-friendly curricula at all levels.

Rationale​: To become the normative behavior, people of all ages should be exposed to chest/breastfeeding as part of all health and family education.


  1. The local School District, or the Department of Education, provides books and/or images that illustrate chest/breastfeeding as the norm.
  2. Breast/chestfeeding-friendly curricula are introduced at all levels of education.

PASS if yes to one.

How are we doing? Our education systems, from childcare to post-secondary education, are providing support to students! Status: In Progress