ESPHL PROJECT HIGHLIGHTS

WASHINGTON
July 2014

Team Members:
John Wiesman *
Randi Becker
Christopher Blake
Kathleen Buchli
Eileen Cody
Kelly Cooper
Jason McGill
Jennifer McNamara
Janis Snoey
* Team Leader

For additional information, contact:

Jennifer McNamara
Deputy Assistant Secretary
Prevention and Health Division
Washington State Department of Health
jennifer.mcnamara@doh.wa.gov
States policies shape where we live, learn, work, and play, and impact the publics health. While there is evidence
for what works to improve populations health outcomes, many states lack robust partnerships capable of
mobilizing stakeholders, re-examining existing legal models, and innovating through statue and regulation. The
Excellence in State Public Health Law (ESPHL) program sought to strengthen the relationships among health
policy decision-makers in and among selected states and to increase the ability of these states to understand how
policy could improve the publics health. States determined their own priorities, and ESPHL did not predetermine states outcomes.

Breastfeeding is a primary prevention public health strategy,

positively impacting the health of both babies and mothers. In
Washington State, most mothers (about 88%) report
breastfeeding their baby at some point. However, only 20% of
mothers report following the recommendation from the
American Academy of Pediatrics to exclusively breastfeed until
their baby is six months old.

Ten Steps to Successful

Breastfeeding:
1.

Research has shown that mothers are more likely to initiate and
continue breastfeeding when hospital maternity practices and
policies support breastfeeding. The goal established by the
Washington State Excellence in State Public Health Law (ESPHL)*
team was for every birthing hospital in Washington to establish
and implement maternity care practices that reflect the BabyFriendly Ten Steps to Successful Breastfeeding, as developed by
the World Health Organization. Key strategies were to
implement a voluntary recognition program for hospitals called
Washington Steps Up for Breastfeeding Success!; increase the
visibility of breastfeeding as an important public health strategy
related to other priorities such as childhood obesity prevention;
and explore the possibility of policies that would further these
goals.
A baby-friendly or breastfeeding-friendly hospital sounds like an
oxymoron to those who arent intimately involved with
maternity care practices in birthing hospitals. How could a
hospital not be baby or breastfeeding-friendly? For several on
Washingtons ESPHL team, the problem was a revelation. For all
on the team, the solution was unifying; we could support
hospitals to become breastfeeding-friendly by helping them
implement the Ten Steps to Successful Breastfeeding. Another
motivating factor was the link between breastfeeding and
childhood obesity.
The Maternity Practices in Infant Nutrition and Care in
Washington Survey (mPINC) from the Centers for Disease
Control and Prevention (CDC) is a survey of all birthing hospitals
in Washington about their maternity care practices. Questions
are grouped into seven sections by dimensions of care (such as
feeding of infants, breastfeeding assistance, and staff training)
and each section is scored based on the percent of hospitals
reporting ideal responses to the questions. Washingtons score
in 2011 was 77 out of 100 (9th best in the country). By crosswalking the mPINC with the Ten Steps to Successful
Breastfeeding we were able to see which steps hospitals in
*

Have a written
breastfeeding policy that is
routinely communicated to
all healthcare staff.
2. Train all healthcare staff in
skills necessary to
implement this policy.
3. Inform all pregnant women
about the benefits and
management of
breastfeeding.
4. Help all mothers initiate
breastfeeding within one
hour of birth.
5. Show mothers how to
breastfeed and how to
maintain lactation even if
they should be separated
from their infants.
6. Give newborns no food or
drink other than breast
milk, unless medically
indicated.
7. Practice rooming-in;
allowing mothers and
infants to remain together
24 hours a day.
8. Encourage breastfeeding
on demand.
9. Give no artificial teats or
pacifiers.
10. Foster the establishment of
breastfeeding support
groups and refer mothers
to them upon discharge
from the hospital.

ESPHL, a program of the Aspen Institute Justice & Society Program, was made possible by a grant from the Robert
Wood Johnson Foundation.

Washington were having trouble with.

We quickly found a strong partnership with the Washington State Hospital Association (WSHA). WSHA is
a membership organization representing community hospitals and other health-related organizations.
They are a well-respected organization with a finger on the pulse of their members needs and interests.
We also continued our partnership with WithinReach, a community-based organization serving families
and children in Washington. Breastfeeding is a priority of WithinReach and they participate in the
Department of Healths Breastfeeding Workgroup. We used our technical assistance funding from the
ESPHL program to contract with WithinReach to convene staff members from various hospitals in two
community meetings. These meetings helped determine what would motivate hospitals to participate in
Breastfeeding-Friendly Washington and make decisions about visual marketing.

In our department, we have a

strategy around how we do our
work, which basically says, through
collaborations and partnerships,
we leverage knowledge, resources,
and relationships to create
healthier choices and communities.
Being able to very quickly build
relationships with our state elected
officials and their staffers, around
supporting breastfeeding-friendly
hospitals, was remarkable.
-

Dr. John Wiesman,

Secretary of Health,
Washington State
Department of Health

Through convening stakeholders and talking with

prospective parents, the ESPHL team identified a three-tier
designation system (bronze, silver, and gold) and designed a
visual recognition symbol for the marketing materials to
promote that system. We are working on creating a
presence on the Department of Healths website to educate
parents and providers about breastfeeding, and we are also
setting up an online application system for hospitals to
apply for recognition.
We plan to identify ways to share the mPINC data analysis
and continue to mine it for strategies to support hospitals in
becoming breastfeeding friendly. We are also working on
identifying the number of hospitals that would fall into each
of the three recognition tiers so we can identify metrics for
the Breastfeeding-Friendly Washington program. We hope
to encourage hospitals to use it as a leveraging point for
achieving the Baby-Friendly accreditation.
What we learn through the hospital recognition program
will help us identify and quantify the need for additional
resources if and when we expand to recognize provider
offices, employers, and day care centers that take steps to
support breastfeeding.

Our ESPHL project has helped elevate the importance of breastfeeding in Washington State, specifically
the need for breastfeeding-friendly environments. This concept has strong policymaker support and is
now a key component in Governor Jay Inslees Healthiest Next Generation initiative to support healthy
weight in children.