By Naomi Bromberg Bar-Yam, PhD
In time for World Breastfeeding Week/National Breastfeeding Month, the U.S. Breastfeeding Committee (USBC) has released Nourishing Thriving Communities: A National Breastfeeding Plan for the United States. It lays out a broad vision for strengthening breastfeeding and human milk feeding in the U.S. through healthcare, workplaces, communities, public policy, workforce development, research, and changes in the larger infant-feeding environment—in other words, throughout our society.
For those of us who have worked in breastfeeding for many years, there is little here that is new. We know that families need skilled and culturally responsive lactation care, and that workplaces, healthcare systems, insurance coverage, paid leave, community resources, marketing practices, and economic circumstances all affect whether people can meet their breastfeeding goals. We have been working on these issues for decades.
So what does a new National Breastfeeding Plan add?
Breastfeeding Is Not Just an Individual Responsibility
Perhaps the Plan’s most important contribution is the way it frames the problem.
Breastfeeding is still too often seen as an individual responsibility. We educate parents about its benefits, encourage them to breastfeed, teach them how to overcome difficulties, and refer them for help when problems arise. But individual determination only goes so far.
The Plan uses the term “constrained choice” to describe decisions that appear voluntary but are limited by many social factors. Its Policy, Systems, and Environmental framework deliberately moves our attention upstream, toward the conditions that make breastfeeding possible, or extraordinarily difficult. A parent cannot individually create paid family leave. A NICU parent cannot change an insurance policy to cover the breast pump they need. A worker cannot single-handedly create a supportive workplace. Families cannot individually redesign healthcare systems. These are societal problems requiring societal solutions.
That is not a new idea. But there is value in putting it at the center of a national plan and stating clearly that the responsibility for breastfeeding lie beyond the person doing the breastfeeding.
Communities Must Help Lead the Work
The Plan also emphasizes something that is easy to say, harder to achieve: communities themselves must be part of determining what change looks like.
It distinguishes community engagement from community self-determination. Engagement can mean inviting people to participate in programs or asking for their opinions. Self-determination means communities identifying their own priorities and having meaningful influence over the decisions and resources affecting their lives. That challenges all of us who consider ourselves advocates and experts.
However knowledgeable and well intentioned we may be, we cannot decide what communities need and bring them our solutions. We can and should ask families to tell their stories in support of legislation we are pursuing on their behalf. We must also ask families and communities what problems they encounter, what changes they need, and how we can support them.
From 100,000 Feet to the Ground
Like many national strategic plans, this one operates largely at 100,000 feet. It gives us a destination and many possible paths, but relatively little practical guidance for getting there.
In the introduction, USBC asks readers to consider how they and their organizations can contribute to the Plan and what tools, resources, or support would help them take action.
Those are useful questions for Massachusetts Breastfeeding Coalition. Much of our work already fits within this larger framework. DRIVE creates pathways into lactation support for people from marginalized communities. Our advocacy for insurance coverage of multi-user, double electric breast pumps for NICU families addresses a systemic barrier for parents separated from their hospitalized babies. Our workplace initiative looks at the policies, practices, and physical environments that make breastfeeding possible after returning to work. These are not isolated projects. They address different parts of the ecosystem the Plan describes.
The Plan gives us an opportunity to look at them together, identify what is missing, and ask who else needs to be involved in determining an executing on our priorities.
Making the Plan a Living Roadmap
There is another question worth asking: what happens to the Plan itself now?
USBC is not starting from scratch. It already serves as a national convener and backbone institution, connecting national organizations, state and local breastfeeding coalitions, community groups, and federal partners. Its Constellation work groups bring organizations together around specific issues. It provides policy information, state reports, educational opportunities, advocacy resources, and a national conference and convening.
Now it is time to connect USBC’s existing infrastructure explicitly to the new Plan by:
- Listing organizations already working on aspects of the plan;
- Posting and disseminating:
- examples of successful programs or policies;
- implementation tools;
- funding opportunities;
- relevant state and federal legislation;
- measures of progress;
- and ways to connect with others doing similar work.
For state and local coalitions, the Plan could help answer not only Where should we go? but also What can we realistically do here? Who should be at the table? Who has tried this elsewhere? What worked? And what resources can help us? USBC already has many of the pieces. The challenge is to use them to make the National Breastfeeding Plan a living framework for collective action.
A roadmap has value because it helps us see where we are going and how our separate journeys connect. But a roadmap sitting on a shelf doesn’t get us there.
The National Breastfeeding Plan places responsibility where it belongs, on all of us who shape the conditions in which families feed and care for their children. And it reminds us advocates and experts that communities are not simply people we serve or voices we invite into our work. They must be partners in deciding what the work should be.
Together, we can turn the roadmap into the journey.
Naomi Bromberg Bar-Yam, PhD, has been working in maternal and child health for over 35 years as an educator, researcher, advocate, and writer. In addition to serving on the board of Massachusetts Breastfeeding Coalition, she is past president of the Human Milk Banking Association of North America (HMBANA) and is the founding director emerita of Mothers’ Milk Bank Northeast, which provides safe donor milk to hospitals and families throughout the northeastern US. Learn more about her on her LactSpeak profile.
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