AFFECTING PUBLIC POLICY THROUGH ADVOCACY AND LOBBYING
Much of the money that goes to the states for various programs that provide perinatal care, high risk infant identification, services to newborns with special needs, etc., comes from the Federal government through the process known as the Title V Block Grant. These MCH programs are connected to the health department in each state. The Block Grant process has always contained provisions for consumer input through public hearings and public comment periods. In response to Congressional passage of regulations related to government performance improvement, MCHB proposed 18 areas, or performance measures for which states would be responsible. States must report data related to each measure and to show improvement in the numbers each year. One of the performance measures asks states to report yearly on the per cent of women breastfeeding at hospital discharge. States that currently do not collect this data will be required to do so for the first time. This may be the first step in reducing the reliance on formula companies for this data. Furthermore, each state must develop 7-10 other measures to be part of their application for funding. It is possible for anyone to propose a measure, including for example, one that would complement the national breastfeeding measure. You might ask for data collection and improvement on the per cent of discharged women known to have access to lactation support and services through the hospital, the primary care site, or in the community.
You may wish to review the draft application before it is submitted, conduct discussions with the state health department, attend public hearings, and provide written comments. Topics to discuss might include prenatal and postpartum barriers to breastfeeding that women encounter in your state, including hospital protocols that may need to be evaluated to effect performance improvement. Title V funds received by the health department could be used for resources to inform pregnant women of lactation support and services in the community, for low income women to receive additional lactation services post discharge, or for mothers whose babies have special needs (cleft lip/palate, Downs) to receive extended lactation services. When you review your state’s application for Title V funding consider asking for the following:
• Include breastfeeding in all objectives that relate to infant morbidity and mortality, maternal, reproductive and breast health, immunizations, low birth weight babies, and adolescent programs
• Collect statistics that state infant feeding method (exclusive breastfeeding, partial breastfeeding, formula-fed) at the following times:
* At hospital discharge
* At all routine immunization visits
* At all infant hospitalizations
* At all deaths up to 24 months of age
* At all emergency room visits
• All health personnel in contact with pregnant and new mothers receive professional breastfeeding management education
If you provide written testimony, cite the appropriate references from journals and provide a full copy of the articles. Follow up by requesting a summary of the testimony. If your points were not included, consider contacting your local state legislator and ask for a meeting to discuss your concerns.
State hospital licensure regulations
All states have hospital licensure regulations within their respective department of public health. Most have a requirement for a perinatal advisory committee to function in a multidisciplinary capacity to advise the public health department on issues related to maternal and newborn services. See if you can become part of this committee or at least attend its meetings and offer verbal or written comments regarding the inclusion of breastfeeding care and service language in the state regulations. You may wish to ask that your state perinatal regulations contain language that forbids formula-containing discharge packs from being given to breastfeeding mothers by hospitals at discharge.
Most states have little if any provision for breastfeeding in their health laws, civil laws, criminal laws, family laws or employment laws. Mothers in every state in the US have the right to breastfeed in public with or without legislation. States have been enacting legislation not because it is illegal to breastfeed in public but because it can be embarrassing or difficult to do so. Current regulations codify that breastfeeding is not indecent, lewd, sexual, or otherwise criminal and that women have the right to nurse anywhere in public. Many states have enacted such laws, with a few exempting nursing mothers from jury duty, and some giving incentives to private employers who promote breastfeeding. Updated information on state legislation can be found on La Leche League’s web page at http://www.llli.org/Law/LawBills.html.
Check to see if your state has enacted or is working on legislation that protects a woman’s right to breastfeed in public. Call the office of your state legislator and ask to speak with the staff person in charge of health issues. Introduce yourself and describe what you are looking for. Explain that you wish to be sent copies of any pending or enacted legislation that includes breastfeeding in public, in the worksite, in health legislation, in criminal law, in civil law, and in family law. See if your representative is on any of the government committees whose jurisdiction covers these areas. This is the first step in educating your congressional representative about the importance of breastfeeding. You may wish to write a letter regarding your disappointment that no regulations exist in your state to protect breastfeeding mothers. If your state has some form of breastfeeding legislation, see if it can be expanded to other areas of state laws and policies. You may wish to work towards a statewide model breastfeeding policy, similar to the one described by Waggett and Waggett. Developing a working relationship with your state legislator’s office establishes you as a credible and accessible source of specialized information. You are also a voter, which means that your representative will listen to you as a constituent too.