BECOMING AN ADVOCATE

Affecting Public Policy Through Advocacy and Lobbying

You may think that you are too small to make a difference in the scheme of things. Because breastfeeding, childbearing, and childrearing are not economically valued in the US, they lack a voice and have a reduced presence in national health care policy, in the legal system, and in the employment arena. The idea of trying to influence such big issues can be intimidating. You may think that if you have never lobbied for any issue, your efforts will go unnoticed. However, the power of “one” is strong and when one determined individual networks with others championing similar agendas, change happens. This document will provide an overview of a number of methods and ideas for advocating and lobbying for our common special interests of lactation support and services and breastfeeding reform.

What is lobbying?
Know what you want
Do your homework
What’s out there already?
Who are the players?
State Involvement
State hospital licensure regulations
State Legislation
Communicating with your legislators
Determination of Need program
An example of lobbying
Links for Breastfeeding Advocacy

 

What is lobbying?
Lobbying is the art of persuasion. It is an activity protected by the First Amendment to the Constitution: (1791)

“Congress shall make no law … abridging the freedom of speech, or of the press; or the right of the people peaceably to assemble, and to petition the Government for a redress of grievances.”

The word “lobbying” may conjure images in your mind of smoke-filled back rooms and unsavory, behind-the-scenes scheming. The term “lobbyist” however, found its way into our vocabulary in the early 1800s. Historical accounts describe “lobby-agents” variously as the petitioners in the lobby of the New York State Capitol gathered to contact legislators, or favor seekers meeting legislators in the lobby of the Willard Hotel. Caricatures at the time portray plump, cigar-smoking men called “lobbyists” wining and dining lawmakers as they slip money under the table. No wonder the word “lobbying” still invokes sinister undertones of deceit and graft!

Lobbying or advocating a point of view is engaged in by almost all special interest groups in the United States. As individuals and/or groups, we have the right to lobby policy makers which insures that our interests and concerns are heard, as well as competing interests and views, so that legislators have a broad base of information on which to base their decisions. Lobbying attempts to persuade an individual, agency, institution, or organization to support an idea, an issue, a certain course of action, etc. You lobby whenever you work to encourage someone to agree to your way of thinking or to embark on a new project or program. We often call ourselves “advocates” because we speak for those whose voices are often silent – breastfeeding mothers and babies.

As breastfeeding advocates we wish to promote, protect, and support breastfeeding in the US. Our health care system does not have one person in charge of it. Rather, health care responsibilities and funding are distributed across various federal and state agencies. Our tax dollars pay for this policy-making infrastructure. We and our employers pay for health care delivery. We elect federal and state senators and congressmen to represent our health interests for us in the political sector. But somewhere along the way, breastfeeding has become lost as a public health issue. In the minds of many people, breastfeeding is little more than a lifestyle choice. Many barriers to breastfeeding have made the US a bottle-feeding culture. These barriers are often what cause us to say, “I wish someone would do something about that.” Hopefully, that “someone” is you and you will find these suggestions and resources helpful in your breastfeeding advocacy work.

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Know what you want
The first step in lobbying is to ask yourself what your goals are, both personal and professionally. Do you want to work on the state or national level, or both? Do you want to correct an injustice? (women being harassed when breastfeeding in public) Do you want to influence current policy? (encourage increased spending for breastfeeding care and services within the WIC program) Do you wish to help create new legislation? (guarantee nursing or pumping breaks in the workplace) Do you want to work with your state department of public health? (develop breastfeeding performance measures for Title V funding of state maternal child health issues) Do you want to work with state and federal agencies on third party reimbursement issues for breastfeeding care and services? Or, do you want to engage in indirect lobbying such as educational campaigns (World Breastfeeding Week for instance) that are designed to mobilize public opinion and deliver a message to legislators from a large public sector?

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Do your homework
Depending on your goals, you will need to do some research on legislative, regulatory, and policy issues as well as identifying the critical players in the political arena. You also need to see who else is working on the same or similar issues to yours. Do you belong to a professional association with a legislative agenda? If so, where does breastfeeding fit into it? What you are embarking on is termed grassroots lobbying. It derives its strength from numbers—one person working with another, people joining together in groups or task forces, task forces joining each other in coalitions, etc. This weaves an interlocking network that endeavors to fulfill a breastfeeding reform agenda or a plan of action for change.

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What’s out there already?
There are a number of tools or “supplies” to be familiar with no matter where or what breastfeeding lobbying you are engaged in. The US has numerous documents, not only calling for breastfeeding reform, but also describing what needs to be done. Secure copies of these for background purposes, to quote in letters or testimony, for benchmarking and evaluation, or to simply write your congressman and ask why little or nothing has been done to fulfill the various recommendations.

Click here for advocacy resources. Resources for Breastfeeding Advocacy

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Who are the players?
Federal Government
The US government has three independent components – a system designed to provide checks and balances. The legislative branch is Congress. It makes the laws. The executive branch is the president and governmental agencies that carry out the laws. The judicial branch is the Supreme Court that protects the Constitution. Grassroots lobbying can directly affect actions taken in Congress and in governmental agencies. The US Congress has two chambers, the Senate and the House of Representatives. Each chamber has its own set of rules, its own structure, and its own leadership. Each state has two senators representing the entire state and several representatives in the House depending on its population numbers.

The daily business of the Senate and House is carried out through their respective committees. Most of these committees draft and approve legislation. The budget and appropriations committees establish and allocate funds for authorized programs. Congressional committees are the heart of Congress. This is where the real legislative work is accomplished. There are nine standing committees in Congress with primary jurisdiction over health-related legislation.

Senate Committees
Senate Appropriations
Committee on the Budget
Committee on Finance
Committee on Labor & Human Resources

House Committees
House Appropriations
Committee on the Budget
Committee on Education & Labor
Committee on Energy & Commerce
Ways & Means Committee

Find the names of your senators and representatives. Learn what their special interests are and if they serve on any health related committee. Members of Congress and congressional committees have staff that control the flow of information to the lawmakers, advise them on issues, and influence their position on particular pieces of legislation. You can find out who your members of Congress are by calling (202) 225-3121.

Federal Departments and Agencies
Within the Executive branch are the departments of the Federal government. Each department is headed by a secretary who is a member of the president’s cabinet. The US Department of Agriculture (USDA) houses the Women, Infants, and Children (WIC) program. The Department of Health & Human Services (DHHS) has oversight responsibility for most of the other child health programs. Within DHHS is the Maternal & Child Health Bureau (MCHB) who is responsible for building the infrastructure for the delivery of health care services to all mothers and children in the US. This is done primarily through the MCH Services Block Grant, which was originally enacted in 1935, as Title V of the Social Security Act. MCHB also helps states in implementing other relevant legislation and in achieving the Healthy People 2010 objectives for the nation that relate to maternal and child health.

State Involvement
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.

State Legislation
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://lalecheleague.org/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.

Determination of Need program
The Determination of Need Program (DoN) is a tool that breastfeeding advocates may wish to use to help assure the provision of appropriate breastfeeding care and services in hospitals. This program may vary from state to state but the goal of this concept is to promote the availability and accessibility of cost effective quality health care services to the citizens of a state and assist in controlling health care costs. For example, the DoN was established in Massachusetts by the Legislature in 1971 to encourage equitable geographic and socioeconomic access to health care services, to help maintain standards of quality, and to constrain overall health care costs by eliminating duplication of expensive technologies, facilities, and services. DoN receives applications from health care facilities planning substantial capital expenditures or change in services. Citizens of the Commonwealth of Massachusetts can form a ten taxpayer group (TTG) as a party of record to comment and request a public hearing on applications for projects proposed in their community. Once a TTG has requested such a hearing, they can recommend for instance, that appropriate breastfeeding support and services be included as one of the requirements for approval of the facility’s desire to add beds to a maternity unit or nursery. Check with your state department of public health and make your voice heard.

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Communicating with your legislators
Many people are reluctant to communicate with their elected representatives. Legislators are often perceived as too busy to read mail and unavailable for meeting with constituents. Contrary to this belief, legislators are very interested in what you have to say. Their staff pays close attention to your communications. Your first contact with an elected official may be through a letter. Your letter might ask that breastfeeding be addressed in some manner, such as in legislation, in health policy regulations, in maternal child health program funding, in worksite policies, etc. The least effective letters are form letters, prepared post cards, and petitions. More effective letters are neatly handwritten or computer generated with a hand written personalized post script. The following are some letter-writing do’s and don’ts.

Do
Properly address your elected officials
• State senator
• The Honorable _____________
• (name of state) Senate
• State House, Room #
• City, State, Zip
• Dear Senator:

• Federal senator
• The Honorable _____________
• United States Senate
• Washington, DC 20510
• Dear Senator:

• State congressional representative
• The Honorable _____________
• (name of state) House of Representatives
• State House, Room #
• City, State Zip
• Dear Representative:

• Federal congressional representative
• The Honorable _____________
• US House of Representatives
• Washington, DC 20515
• Dear Representative :

• Chair of a committee:
• Dear Madam Chairwoman:
• Dear Mr. Chairman

• Speaker of the House
• Dear Mr. Speaker
• Dear Madam Speaker

Don’t
• Misspell their name
• Call them by the wrong title
• Overwhelm them with too much detail, personal history, or rambling narratives
• Use hostile language, pick fights, or threaten them
• Use abbreviations, medical jargon, or gross exaggerations
• Advertise or market yourself or your services

Anatomy of a letter
• State your purpose for writing in the first paragraph of the letter. If your letter pertains to a specific piece of legislation, refer to it by its number as follows:
• * House Bill=H.R.
• * Senate Bill=S.
• Establish your credibility immediately by identifying yourself, your connection to the legislation or problem, and your profession. Include information on the local impact of your concern. Attach pertinent fact sheets, brochures, and short background materials to the letter
• The rule of one—one issue per letter, one page per letter
• Include key issues and documentation
• The outcome of what you are asking for should be addressed as benefits for constituents
• Ask for a specific action
• Offer to be a future resource
• Ask for a written response to your letter
• Always sign your letter and make sure your address and telephone number are included
• Proofread your letter, even if it was composed on a computer. Run the spellchecking program
• Be constructive
• Be persistent

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An example of lobbying
In April 1998, Rep Carolyn Maloney (D-NY) introduced federal legislation into the 105th Congress called the New Mothers’ Breastfeeding Promotion and Protection Act (H.R.3531). Its five major provisions include to:
• • Protect a woman’s right to breastfeed or express milk during the work day
• • Provide a tax credit to encourage employers to facilitate lactation
• • Offer mother’s milk breaks to employed new mothers
• • Develop minimum quality standards for breastpumps
• • Expand WIC’s breastfeeding promotion program (enacted into law 10-31-98)

A second bill was introduced into the House called Right to Breastfeed Act (H.R.4628). This would ensure a woman’s right to breastfeed her child on any portion of Federal property where the woman and her child are otherwise authorized to be. This act was passed into law. Both are important to safeguard breastfeeding in the US. Before being enacted into law however, bills or portions of bills are sent to the appropriate oversight committee to be further refined. Bills also need co-sponsors (other legislators) to accumulate and influence votes of other legislators. Bills such as these need co-sponsors. They are secured when breastfeeding advocates write to their federal members of Congress and ask them to co-sponsor bills. The following letter can be a model for you to use in writing your own representatives.

You may wish to communicate with your senator or representative in person. This can take place in the Member’s district office near your home or in his or her Washington office. When you call, ask for the appointments secretary, informing her of who you are, whom you represent, and the subject you wish to discuss. If the Member is not available, ask to meet with the staff person who handles the relevant issue. Another way to meet your legislator is to invite him or her to attend a breastfeeding coalition meeting, speak at a breastfeeding conference, address your group, etc. Follow-up any meeting with a letter thanking the Member for his or her time, re-stating your position and request, and providing any pertinent materials. This helps establish you as a credible and reliable source of information.

Links to Federal Agencies and Legislative & Agency Resources

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