accompanying the minimum data set that States will collect for the 1992
biennial report. According to a survey of WIC programs in 48 States and 11
American Indian nations and territories conducted by NAWD in early 1991, 31
programs plan to report breastfeeding incidence data and 26 plan to report
breastfeeding duration data to FNS for the 1992 biennial report. In past WIC
program national data collection efforts, the definition of breastfeeding varied
by State, which complicated efforts to collect and compare data. The adoption
of the standard breastfeeding definition required by the WIC Reauthorization
Act, however, should remedy this situation.

The Pregnancy Nutrition Surveillance System (PNSS), supported by the
Division of Nutrition, Center for Chronic Disease Prevention and Health
Promotion, Centers for Disease Control, monitors nutrition-related problems
and behavioral risk factors associated with low birthweight among high-risk
prenatal populations. Simple key indicators of pregnancy nutritional status,
behavioral risk factors, and birth outcome are monitored using clinical data
from a population of low-income, high-risk pregnant women who participate
in publicly funded prenatal nutrition and food assistance programs in
participating States. Breastfeeding data are also collected.

The National Survey of Family Growth, conducted by the Centers for
Disease Control, was conducted in 1973-74, 1976, 1982, and 1988. Interviews
were conducted with a sample of women 15-44 years of age, and information
was collected on fertility, family planning, and breastfeeding practices.

The Pediatric Nutrition Surveillance System (PedNSS), also sponsored by the
Division of Nutrition, Center for Chronic Disease Prevention and Health
Promotion, monitors simple key indicators of nutritional status among low-
income, high-risk infants and children, especially those 0-5 years of age, who
participate in publicly funded health, nutrition, and food assistance programs
in 36 States, the District of Columbia, and the Navajo Nation. The measures
used include anthropometry, birthweight, and hematology. Information is also
collected on infant feeding practices.

The Pregnancy Risk Assessment Monitoring System (PRAMS) is a cooperative
effort between the Centers for Disease Control and the following 7 State Health
Departments: Alaska, District of Columbia, Indiana, Maine, Michigan,
Oklahoma, and West Virginia. The goal of PRAMS is to conduct State-specific,
population-based surveillance of selected maternal behaviors, including infant
feeding practices, that occur during pregnancy and the child’s early infancy.
Data are collected monthly from a sample of mothers (drawn from birth
certificate information) who are contacted by mail and by telephone.

The National Health and Nutrition Examination Survey III (NHANES II) is
being conducted by the Centers for Disease Control from 1988 to 1994.
NHANES III is an interview and examination survey of the civilian
noninstitutionalized population ages 2 months and older. A wide variety of
nutrition information is being collected, including information on
breastfeeding.

The National Maternal and Infant Health Survey (NMIHS) was conducted by
the National Center for Health Statistics, DHHS, from 1988 to 1990. The
purpose of NMIHS is to collect nationally representative data covering natality

51
and fetal and infant mortality. Approximately 60,000 mothers, hospitals, and
providers of prenatal care were contacted via mailed questionnaires and
interviews, which will be linked with vital records. A longitudinal followup of
mothers was conducted in 1990, which involved recontacting mothers and
sometimes their medical providers as well in order to obtain updated health
histories. Mothers were questioned about infant feeding practices and
recommendations they received regarding infant feeding. Hospitals were asked
what the primary method of feeding was while the infant was in the hospital,
and what the infant’s major source of nutrition was up to the fourth month of
life.

The Food and Drug Administration conducted the Survey of Infant Feeding
Patterns in 1989, obtaining detailed information about feeding practices during
the first 12 months of life, including information on transitions between breast
and bottle feeding, introduction of cow’s milk, type and timing of introduction
of solid foods, and important sources of information used for guidance about
infant feeding practices. ;

From 1984 to 1986, the National Institute of Child Health and Human
Development conducted the Prospective Survey of Infant Feeding Practices
Among Primipara among black and white urban primipara living in
Washington, DC, in order to measure the incidence and.duration of
breastfeeding and identify the correlates of incidence and duration of
breastfeeding.

As mentioned in the first chapter, Ross Laboratories conducts a survey
which contacts mothers when their infants are 6 months of age, and asks them
to recall their method of infant feeding in the hospital and during each of the
first 6 months of life. These data contain information on the incidence of
breastfeeding at delivery and at 6 months postpartum for women of various
social, economic, educational, and ethnic backgrounds, The data from this
survey have been used as the basis for setting the parameters of the 1990 and.
the year 2000 breastfeeding objectives for the Nation.

State Data Collection Activities

The 1991 survey of WIC programs in 48 States and 11 American Indian
nations and territories conducted by NAWD found that 46 WIC programs
currently collect breastfeeding incidence data, and 15 more plan to do so in the
future. In addition, 41 programs currently collect breastfeeding duration data,
and 17 more plan to do so in the future. Forty-three of the programs reported
using the standard national definition, and, of the 15 that used other
definitions, 12 plan to change to the national definition in the future. At the
present time, however, it is difficult to compare some of the current and past
data on breastfeeding rates in the WIC program due to the varying definitions
of breastfeeding ‘and calculation formulas used by each State. In many States,
rates reflect the percentage of all postpartum women who are breastfeeding.
Other States measure the rate of breastfeeding using the percentage of women
previously enrolled as pregnant women who return for certification as
breastfeeding mothers. oe

The Iowa WIC program is currently in the process of developing a new data

52
management system. When complete, the system will allow collection of the
following data: breastfeeding incidence; breastfeeding duration; duration of
breastfeeding of infants not currently breastfed; introduction of other milk
besides breastmilk; number of infants being breastfed at their postpartum
visits; and sociodemographic data on the mother.

The Maine Breastfeeding Surveillance System, begun in 1983 and automated
in 1986, monitors the incidence of breastfeeding at hospital discharge; using
information collected on standard newborn metabolic disorders screening
forms. Annual reports are generated which show incidence by county, hospital,
size of hospital, individual physician, and physician specialty.

In summary, with the exception of the Ross Laboratories Mothers Survey, all
of the data collection activities described above have very specific target
populations as well as varying methods for collecting data on breastfeeding.
This makes comparison of rates across programs or among different
surveillance systems very difficult. Until a national uniform data collection
system to assess breastfeeding rates of all births is in place, many organizations
working in breastfeeding promotion will continue to utilize the Ross
Laboratories Mothers Survey to compare breastfeeding rates in the general
population to rates in their own study, program, or jurisdiction. It is
encouraging to see the number of breastfeeding incidence and duration data
collection activities reported by respondents. However, to adequately monitor
progress toward the year 2000 breastfeeding objective for the Nation, a
uniform system for collecting data on all mothers and infants in the United
States will need to be put into place.

53
__@——

REFERENCES

American Public Health Association Clearinghouse on Infant Feeding and
Maternal Nutrition. (1989). Government legislation and policies to support
breastfeeding, improve maternal and infant nutrition, and implement a code of
marketing of breastmilk substitutes. Washington, DC: American Public Health
Association Clearinghouse on Infant Feeding and Maternal Nutrition.

Bureau of Labor Statistics. (1991, March). Current Population Survey.
Washington, DC: Bureau of Labor Statistics.

Bureau of National Affairs. (1986). Work and family: A changing dynamic.
Washington, DC: Bureau of National Affairs.

U.S. Congress. (1991, January). “Public Law 101-508: Omnibus Budget
Reconciliation Act of 1990.” Congressional and Administrative News, 101st

Congress, 2nd Session, 10.

Department of Health, Education and Welfare. (1979). Healthy people: The
Surgeon General’s report on health promotion and disease prevention.
Washington, DC: Department of Health, Education and Welfare.

Department of Health and Human Services. (1980). Promoting health,
preventing disease: Objectives for the Nation. Rockville, MD: Department of
Health and Human Services.

Department of Health and Human Services. (1984). Report of the Surgeon
General's Workshop on Breastfeeding and Human Lactation. [DHHS Publication,
No. HRS-D-MC 84-2.] Rockville, MD: Health Resources and Services
Administration.

Department of Health and Human Services. (1985). Followup report: The
Surgeon General’s Workshop on Breastfeeding and Human Lactation. [DHHS
Publication No. HRS-D-MC 85-2.] Rockville, MD: Health Resources and

Services Administration.

Department of Health and Human Services. (1990a). Child health USA ‘90.
[DHHS Publication No. HRS-M-CH 90-1.] Rockville, MD: Health Resources

and Services Administration.

Department of Health and Human Services. (1990b). Healthy people 2000:
National health promotion and disease prevention objectives. [DHHS Publication
No. (DHS) 91-50213.] Washington, DC: U.S. Government Printing Office.

54
Federal Register. (1990). “Special Supplemental Food Program for Women,
Infants, and Children (WIC): Nonfunding mandates of the Child Nutrition
and WIC Reauthorization Act of 1989.” Federal Register, 55(131), 28033—48.

Gielen, A. C., Faden, R. R., O’Campo, P., Brown, H., Paige, D. M. (1991).
“Maternal employment during the early postpartum period: Effects on
initiation and continuation of breast-feeding.” Pediatrics, 87(3), 298-305.

Hewlett, S. A. (1990). “The feminization of the work force.” New Perspectives
Quarterly, 7(1), 13-15.

Huffman, S. L. (1990). Should infant formula be marketed to the public?
Bethesda, MD: Center to Prevent Childhood Malnutrition.

Institute of Medicine. (1991). Nutrition during lactation. Washington, DC:
National Academy Press.

Interagency Committee on Nutrition Monitoring. (1989). Nutrition monitoring
in the United States: The directory of Federal nutrition monitoring activities.
Hyattsville, MD: National Center for Health Statistics.

Moore, J. F., and Jansa, N. (1987). “A survey of policies and practices in
support of breastfeeding mothers in the workplace.” Birth, 14(4), 191-5.

Oski, F. A. (1989). “Heating up the bottle battle.” The Nation, 249, 683-84.

Ryan, A. S., and Martinez, G. A. (1989). “Breast-feeding and the working
mother: A profile.” Pediatrics, 83(4): 524-31.

Siler, J. (1990, 9 April ). “The furor over formula is coming to a boil.” Business
Week, 3153: 52-53.

55
AppeNDIX A
STATEMENT OF SURGEON GENERAL C. EVERETT Koop FOR THE SUBCOMMITTEE
oN NUTRITION, SENATE COMMITTEE ON AGRICULTURE, NUTRITION, AND FORESTRY
ON June 15, 1989

Breastfeeding should be actively promoted in all maternal and child health
programs. Health experts worldwide agree that breastfeeding is the optimal
way to nurture infants and should be practiced whenever possible. I use the
term “nurture” deliberately since it means “to feed and care for during
growth.” Another term for breastfeeding is “nurse” which means “to look after
carefully” as well as “to suckle.” Breastfeeding is, therefore, recommended not
only as a method of feeding but also as a caring relationship.

In fact, lactation is the primary feature that sets us mammals apart from the
rest of the animal kingdom. Human milk, as the unique species-specific source
of infant nutrition, not only allows birth to occur at an early stage of
development, but also requires a time of intense maternal-infant interaction to
facilitate early behavioral development.

Breastfeeding offers many important benefits for mothers, babies, and also
for society. In summary, for mothers it affords protection against hemorrhage
and quicker recovery from childbirth, stronger bonding with the baby, and
relaxation while nursing. For infants, breastfeeding provides optimal nutrition
for normal growth and development, protection against disease, especially ear
infections and gastrointestinal distress; and decreased risk of allergies.
Breastfeeding also has benefits for society through stronger family bonds,
women’s fulfillment of their aspirations for motherhood and increased self-
esteem, and decreased health care costs for infants.

Lactation is an integral stage of the reproductive cycle. The body prepares
for lactation throughout pregnancy, and lactation automatically occurs soon

after the baby is born.
There is abundant evidence that human milk is designed to enhance

optimally the growth, development, and well-being of the infant. A mother’s
milk provides the best protection for her infant against specific infections.
This cannot be duplicated in infant formula.

These benefits are meaningless unless women breastfeed. The rates of
breastfeeding have been slowly declining since 1982, and breastfeeding rates in
lower socioeconomic groups remain much lower than in more affluent groups.
Therefore, infants who could benefit most from the immunologic advantages
of human milk are least likely to receive this protection. -

A decisive way to promote child health in the United States in the next
decade will be to implement effective breastfeeding promotion programs so
that the unique and important benefits of breastfeeding can be made available
to protect health, nourish, and optimally develop infants in all segments of our

society.

57
APPENDIX B
SECOND FOLLOWUP REPORT QUESTIONNAIRE

QUESTIONNAIRE
SECOND FOLLOWUP REPORT:
THE SURGEON GENERAL’S WORKSHOP
ON BREASTFEEDING AND HUMAN LACTATION

Please answer the following questions about your

 

 

 

breastfeeding promotion efforts.
. Name
Title
Address
Telephone number

 

 

. Agency/organization name
Check the box which best describes your agency:
Federal Health Agency

Other Federal Agency

State Health Agency

Local Health Agency
Voluntary, Professional, or Nonprofit Organization

Institution of Higher Learning
Private Practice
Other; please specify:

OOO000gon

. Does your agency/organization receive Title V support? 1] yes or C1 no

 

If yes, please describe

. Has your agency/organization been involved in the past 5 years in
breastfeeding promotion efforts aimed at achieving the breastfeeding
objectives for the Nation? C1 yes or C. no

If yes, please continue the questionnaire.
. Please describe how your breastfeeding promotion efforts are funded.

. Does your breastfeeding promotion effort involve collaboration with

other agencies or organizations? (J yes or 1] no
If yes, please list all agencies and organizations involved

58
7. Check all activities included in your breastfeeding promotion efforts.

Professional education in human lactation and breastfeeding
(1 Hospital staff
1 Public health clinic staff
(1 Private practitioners
[Other (please specify):

Public education and other breastfeeding promotional efforts
QO Media campaigns
O School-based curricula
{1 Hard-to-reach populations; please specify:
[1 Other (please specify):

Strengthening of support for breastfeeding in the health care system
0 Promoting coordinated breastfeeding policies and practices in the
continuum of maternal and infant health
DO Establishing hospital-community liaisons
[1 Training peer counselors
(1 Other (please specify):

Building support for breastfeeding in the workplace
C1] Employee education
(J Employer education
C Encouraging provision of facilities for pumping and
storing breastmilk
C Provision of facilities in your own agency/organization to
allow employees to pump and store breastmilk
O Day care policies and practices
(J Maternity leave polices and practices
C) Other (please specify):
O Establishing workplace polices and practices

Development of support services in the community
Telephone hotlines

Support groups (professional or peer)

Individual counseling of clients and families

Followup services related to breastfeeding management
Client education

CO Prenatal breastfeeding education

[1 Inhospital counseling

LC Postdischarge education

(] Other (please specify):

Oooda

59
8.

10.

11.

12.

13.

14.

Research on human lactation and breastfeeding
Physiological (i.e., breastmilk composition)
Social/behavioral

Nutritional

Economic
Programmatic (i.e., management, financing, needs assessment, cost-

benefit analysis, etc., of breastfeeding programs)
Other (please specify):
Please provide a basic description of each of your breastfeeding promotion
efforts (items identified in question 7) or attach copies of proposals or
reports which describe your programs.

OO0o0a

C

Please include information on:
e Program title
e Program design

e Length of program
e Type of staff involved (i.e., physicians, nurses, health educators,

dietitians)
e Target audience
* Participating agencies
Please describe any data you collect on the incidence and duration of
breastfeeding. Please include the definition(s) of breastfeeding used in
your data collection.

Please describe (or provide copies of) the results of any evaluation of your
breastfeeding promotion efforts.

Describe the key or essential elements that made these breastfeeding
promotion efforts work.

Please list any materials generated as a result of these efforts (manuals,
policy guidelines, education materials, videotapes, training curricula,
conference proceedings, final reports, etc.) Please include information on
each publication’s availability and price, as well as a contact address and
phone number. If possible, please enclose a copy of each of these
materials for NCEMCH’s Reference Collection.

In your experience, what barriers keep women from beginning to
breastfeed? How can these barriers be overcome?

In your experience, what barriers keep women from continuing to
breastfeed? How can these barriers be overcome?
15. What suggestions or ideas do you have for future
breastfeeding promotion efforts?
¢ At the national level:
¢ At the State level:
° At the agency/local level:

Please return this questionnaire to:
Breastfeeding Project
National Center for Education in Maternal and Child Health
38th and R Streets, N.W.
Washington, DC 20057

61
APPENDIX C
List OF QUESTIONNAIRE RESPONDENTS

The following is a list of alt
scope and Federal agencies are
organization name.
by state name.

NATIONAL ORGANIZATIONS AND FEDERAL
AGENCIES

American Academy of Pediatrics
Joe M. Sanders, Jr., M.D.

Associate Executive Director

141 Northwest Point Boulevard
Elk Grove Village, IL 60009-0927
(800) 433-9016

American College of Obstetricians and
Gynecologists

Shirley A. Shelton

Associate Director, Clinical Practice

409 12th Street, S.W.

Washington, DC 20024

(202) 863-2502

American Dietetic Association
Chery] Corbin, M.S., R.D.
Administrator, Alliance Program

216 West Jackson Boulevard, Suite 700
Chicago, IL 60606-6995

(312) 899-0040, Ext. 4778

American Hospital Association
Bruce McPherson

Group Vice President

840 North Lake Shore Drive
Chicago, IL, 60611

(312) 280-6000

American Public Health Association
Clearinghouse on Infant Feeding and
Maternal Nutrition

1015 15th Street, N.W.

Washington, DC 20005

(202) 789-5600

Center to Prevent Childhood
Malnutrition

Barbara L. Bershon, Ph.D.

U.S. Projects Manager

7200 Wisconsin Avenue, Suite 204
Bethesda, MD 20814

(301) 986-5777

questionnaire respondents. Organizations of a national
listed first, in alphabetical order by agency or
State and local organizations are then listed, in alphabetical order

Food and Nutrition Board
(Institute of Medicine)

Carol West Suitor

Study Director

2101 Constitution Avenue, N.W.
IOM 2137, Room 301
Washington, DC 20418

(202) 334-1917

Food and Nutrition

Information Center,

National Agricultural Library

U.S. Department of Agriculture
10301 Baltimore Boulevard, Room 304
Beltsville, MD 20705-2351

(301) 504-5719

Food and Nutrition Service
Supplemental Food Programs Division
U.S. Department of Agriculture
Ronald J. Vogel

Director

3101 Park Center Drive, Suite 1017
Alexandria, VA 22302

(703) 305-2746

Healthy Mothers, Healthy Babies
National Coalition, Subcommittee on
Breastfeeding Promotion

Brenda Lisi

Chair

3101 Park Center Drive, Room 609
Alexandria, VA 22302

(703) 305-2554

Indian Health Service

U.S. Department of Health and Human
Services

Yvonne Jackson, Ph.D., R.D.

Chief, Nutrition and Dietetics Section
§600 Fishers Lane

Rockville, MD 28057

(301) 443-1114

62
Institute for Reproductive Health
Georgetown University Medical Center
Department of Obstetrics and Gynecology,
3 PHC

3800 Reservoir Road, N.W.

Washington, DC 20057

(202) 687-1392

La Leche League International
Betty Wagner

Executive Director

9616 Minneapolis Avenue

P.O. Box 1209

Franklin Park, IL 60131-8209
(708) 455-7730

Maternal and Child Health Bureau
Health Resources and Service
Administration

U.S. Department of Health and Human
Services

M. Elizabeth Brannon, M.S., R.D.
Director, MCH Training

Parklawn Building, Room 9-12

5600 Fishers Lane

Rockville, MD 20857

(301) 443-2190

National Association of WIC Directors
Kathy A. Dugas

Chair, Breastfeeding Promotion
Committee

c/o Mississippi WIC Program

2423 North State Street

Underwood Annex Room #214

Jackson, MS 39215

(601) 960-7842

National Center for Education in
Maternal and Child Health
Carolyn Sharbaugh, M.S., R.D.
Director, Nutrition Programs

38th and R Streets, N.W.
Washington, DC 20057

(202) 625-8400

National Center for Health Statistics
U.S. Department of Health and Human
Services

Paul J. Placek, Ph.D.

Chief, Followback Survey Branch
Division of Vital Statistics

6525 Belcrest Road

Presidential Building, Room 840
Hyattsville, MD 20782

(301) 436-7464

United States Agency for International
Development

Sue Anthony

Office of Nutrition Services

SA-18, Room 413

Washington, DC 20523-1808

(703) 875-4035

STATE AND LOCAL AGENCIES AND
ORGANIZATIONS

Alabama

Miriam J. Gaines

Nutrition Services Administrator
Alabama Department of Public Health
434 Monroe Street

Montgomery, AL 36130

(205) 242-5673

Arizona

Sheryl Lee, M.P.H., RD.

Chief, Office of Nutrition Services
Arizona Department of Health Services
1740 West Adams

Phoenix, AZ 85007

(602) 542-1886

Becky Melland-Buckley, M.S., R.D.
Division Director

Pima County Health Department
WIC Program

Community Nutrition Division
1121 North El Dorado Place, E200
Tucson, AZ 85713

(602) 296-6207

Susan Trombley, R.N.C., I.B.C.L.C.
Lactation Coordinator

University Medical Center
Department of Nursing—OB/GYN
1501 North Campbell

Tucson, AZ 85724

(602) 694-5712

Arkansas

Carole Garner

Director, Nutrition Services
Arkansas Department of Health
4815 West Markham, Slot 21
Little Rock, AR 72205-3867
(S01) 661-2324

63
California

Beverly Clark

WIC Project Director

Alameda County Health Care Services

Agency

499 Sth Street, Room. 304
Oakland, CA 94607
(415) 268-2548

Kathryn G. Dewey
Associate Professor

ent of Nutrition
University of California at Davis
Davis, CA 95616
(916) 752-1992

Ofelia Dirige

Associate Professor

Division of Maternal and Child Health
Graduate School of Public Health

San Diego State University

6505 Alvarado Road, #205

San Diego, CA 92120

(619) 594-2795

Joyce M. Houston

Public Health Nutritionist

Humboldt County Health Department
§29 I Street

Eureka, CA 95501

(707) 445-6205

Audrey Naylor, M.D.
President and Codirector
Wellstart

P.O. Box 87549

San Diego, CA 92138
(619) 295-5192

Sandra Apgar Steffes, R.N., MSS.

Course Coordinator, Lactation Programs
University of California at Los Angeles
Extension/Health Sciences

100995 Le Conte Avenue, Room 614
Los Angeles, CA 90024

(213) 825-9187

Colorado

Stephanie Buffetti, R.N., B.S.N.
Fund Development Manager
Community Health Centers, Inc.
2828 International Circle
Colorado Springs, CO 80910
(719) 630-6440

Chris Hunt

Perinatal Program Manager

Katy Baer

WIC Program: Manager
Valley-Wide Health Services, Inc.
204 Carson Avenue

Alamosa, CO 81101

(719) 589-5161

Lynn Ireland

Director of Community Nutrition
Denver Department of Health and
Hospitals

Nutrition Program

777 Bannock Street

Denver, CO 80204

(303) 893-7197

Pam Leite

Presbyterian-St. Luke's Medical Center
Lactation Program

501 East 19th Avenue

Denver, CO 80203

(303) 869-1881

Joan McGill, M.D., RD.

Chief Nutritionist

Colorado Department of Health
Nutrition Services

4210 East 11th Avenue

Denver, CO 80220

(303) 331-8380

Jose E. Ortega
Administrator

La Clinica del Vaile, Inc.
P.O. Box 870

Rocky Ford, CO 81067
(719) 254-7626

Barbara Skinder

Perinatal Coordinator

Pueblo Community Health Center
230 Colorado Avenue

Pueblo, CO 81004

(719) 543-8711

Connecticut

Ruth Gitchell, M.S., R.D.

Nutrition Consultant

Connecticut Department of Health
Services

150 Washington Street

Hartford, CT 06106

(203) 566-1159
District of Columbia

Vergie Hughes, R.N., I.B.C.L.C.
Nursing Coordinator
Georgetown University Hospital
3800 Reservoir Road, N.W.
Washington, DC 20007

(202) 784-6455

Lilia E. Parekh, R.D.

WIC Coordinator

Children’s Hospital

Children’s National Medical Center
2220 11th Street, N.W.
Washington, DC 20009

(202) 745-5597

Federated States of Micronesia
Arthy Nena

Health Education Supervisor

Kosrae Department of Health Services
P.O. Box 127

Kosrae, FSM 96944

(691) 370-3199

Florida

Carol Bryant

Executive Director

Best Start

3500 East Fletcher, Suite 106
Tampa, FL 33609

(813) 974-4867

Deborah Eibeck, M.S., R.D.

Chief, WIC and Nutrition Services
Florida Department of Health

and Rehabilitative Services

1317 Winewood Boulevard
Building 1, Room 200
Tallahassee, FL 32399-0700

(904) 488-8985

Judy Perkin

Program Director

CC Dietetics, University of Florida
Box J-184 JHMHC

Gainesville, FL 32610

(904) 392-4078

Georgia

Beth S. Everett, M.P.H., R.D.
Chief Nutritionist

Maternal and Infant Care Project
Grady Memorial Hospital

80 Butler Street

Atlanta, GA 30335

(404) 589-4932

Hawaii

Loretta J. Fuddy, A.C.S.W., M.P.H.
Acting Program Administrator
Maternal and Child Health Branch
Hawaii Department of Heaith
741-A Sunset Avenue

Honolulu, HI 96816

(808) 737-8229

Gigliola Baruffi, M.D., M.P.H.

Project Director

Infant Feeding and Growth
U.S.-Related Pacific Islands
University of Hawaii School of Public
Health

1960 East-West Road

Honolulu, HI 96822

(808) 956-8832

Melissa Nikaido

Nutrition Education Coordinator
WIC Program

Ala Moana Health Center

591 Ala Moana Boulevard, Suite 233
Honolulu, HI 96813

(808) 548-6559, 548-5300

Hlinois

_ Robyn Gabel

Director

Illinois Maternal and Child Health
Coalition

3411 West Diversey, Suite 5
Chicago, IL 60647

(312) 384-8828

Stephen E. Saunders, M.D., M.P.H.
Chief, Division of Family Health
Illinois Department of Public Health
535 West Jefferson

Springfield, IL 62761

(217) 782-2736

Aquiles J. Solnero, M.D.
Professor

University of Illinois
School of Public Health
2035 West Taylor
Chicago, IL 60612
(312) 281-1871

Merryjo Ware, M.P.H., R.D.
Nutrition Services Coordinator
Illinois Department of Public Health
Division of Health Assessment and
Screening

100 West Randolph

Chicago, IL 60601

(312) 814-5126
Indiana

Indiana WIC Program
Indiana State Board of Health
1330 West Michigan Street
P.O. Box 1964

Indianapolis, IN 46206

(317) 633-0849

Nancy B. Meade

Nutrition Consultant

Indiana State Board of Health
Maternal and Child Health Division
1330 West Michigan Street

P.O. Box 1964

Indianapolis, IN 46206-1964

(317) 633-0656

Iowa

Connie Betterley, M.S., R.D.

Chief, Bureau of Nutrition and
Health Promotion

Brenda Dobson

WIC Nutrition Services Coordinator
Iowa Department of Public Health
3rd Floor, Lucas Building

Des Moines, IA 50319-0075

(515) 281-7097, 281-7769

Kansas

Sarah McCamman

Director of Training in Nutrition
Children’s Rehabilitation Unit
University Affiliated Programs
University of Kansas

39th and Rainbow Boulevard
Kansas City, KS 66103

(913) 588-5745

Kentucky

Patricia Nicol, M.D., M.P.H.

Director, Division of Maternal and Child
Health

Cabinet for Human Resources

Kentucky Department of Health Services
275 East Main Street

Frankfort, KY 40621-0001

(502) 564-4830

Louisi
Betty Oseid, M.D.

Department of Pediatrics

Louisiana State University Medical Center
1542 Tulane Avenue

New Orleans, LA 70112

(S04) 568-6123

Maine
Judythe Gatchell

Nutrition Consultant

Maine Department of Human Services
Division of Maternal and Child Health
151 Capitol Street, State House Station #11
Augusta, ME 04333
(207) 289-3311

Maryland

Mary T. Goodwin

Chief Nutritionist

Montgomery County Health Department
100 Maryland Avenue

Rockville, MD 20850

(301) 217-1701

Ruth Faden, Ph.D.

Project Director

Determinants of Infant Feeding:
Breast vs. Bottle

Johns Hopkins School of Hygiene and
Public Health

615 North Wolfe Street

Baltimore, MD 21205

(301) 955-6498

Massachusetts

Jan Kallio, M.S., R.D.

State WIC Nutrition Coordinator
Ruth Palombo, M.5., R.D.

Director, Office of Nutrition
Massachusetts Department of Public
Health

150 Tremont Street, Third Floor
Boston, MA 02111

(617) 727-6876

Mi

Susan L. Hoshield, R.N.C., B.S.N.
Regional Perinatal Coordinator
Northem Michigan Hospitals
416 Connable Street

Petoskey, MI 49770

(616) 348-4819

Alwin K. Peterson
Acting Director, WIC Division
Michigan Department of Public Health
3423 North Logan, Box 30195
Lansing, MI 48909

(517) 335-8979

66
Minnesota

Mary Johnson

Nutrition Consultant

WIC Program

Minnesota Department of Health
717 Delaware Street, S.E.

P.O. Box 9441

Minneapolis, MN 55440

(612) 623-5400

Mississippi

Agnes Hinton, R.D., M.S.

Director, Nutrition Services

Mississippi State Department of Health
P.O. Box 1700

Jackson, MS 39215-1700

(601) 960-7476

Missouri

Bradley E. Applebaum

Regional Medical Consultant
U.S. Public Health Service

601 East 12th Street, Room 501
Kansas City, MO 64106

(816) 426-2924

Lorna Wilson

Director

Division of Maternal, Child,
and Family Health

Missouri Department of Health
1730 East Elm Street

Jefferson City, MO 65101
(314) 751-6174

Montana

Rita J. Bradley, R.D.

Community Nutrition Resource Center
(formerly Renewable Technologies)
P.O. Box 4511

Butte, MT 59702

(406) 723-6387

June Luptak, R.D.

Deering Community Health Center
123 South 27th Street

Billings, MT 59101

(406) 256-6821

Maria Stephens

Executive Director

Montana Migrant Council, Inc.
1148 First Avenue North
Billings, MT 59101

(406) 248-3149

Nebraska

Sue Medinger

Director, Nutrition Division
Nebraska Department of Health
P.O. Box 95007

Lincoln, NE 68509

(402) 471-2781

Nevada

Beverly Donahue

Nutrition Education Coordinator
Nevada WIC Program

505 East King Street, Room 205
Carson City, NV 89511

(702) 687-4797

New Hampshire

Lisa Ferriero

WIC Nutrition Consultant

Bureau of WIC Nutrition Services
New Hampshire Division of

Public Health Services

6 Hazen Drive, Health and Welfare
Building

Concord, NH 03301

(603) 271-4546

Chris Shannon

Nutrition Consultant

Bureau of Maternal and Child Health
New Hampshire Division of

Public Health Services

6 Hazen Drive

Concord, NH 03301-6527

(603) 271-4541

New Jersey

Geraldine Franklin, M.S., R.D.

Public Health Consultant (Nutritionist)
Sandra Ottenberg, R.N.C., B.S.N.
Health Care Service Evaluator

New Jersey Department of Health
Division of Community Health Services

CN 364

‘Trenton, NJ 08625-0364

(201) 292-9560, 292-5616

New Mexico

Victoria Parrill

MCH Nutritionist

Sharon Porter

WIC Nutrition Education Coordinator
New Mexico Health and Environment
Department

Public Health Division

Santa Fe, NM 87503

(S05) 827-2355, 827-2486
New York

Cutberto Garza

Director and Professor

Division of Nutritional Sciences
Cornell University

127 Savage Hall

Ithaca, NY 14853

(607) 255-2228

Barbara H. J. Gordon, Ph.D.
Associate Professor/Program Director
City University of New York Hunter
College

Nutrition and Food Science Program
425 East 25th Street

New York, NY 10010

(212) 481-7570

Ruth A. Lawrence, M.D.

Project Director

University of Rochester

School of Medicine and Dentistry
Department of Pediatrics, Box 777
601 Elmwood Avenue

Rochester, NY 14642

(716) 275-0088, 275-4354

Sally Ann Lederman
Associate Professor

Clinical Public Health and Nutrition
Columbia University School of Public
Health

Center for Population and Family Health
60 Haven Avenue

New York, NY 10032

(212) 305-6960

Elisabeth Luder, Ph.D.

Associate Director

Pediatric Pulmonary Center
Mount Sinai School of Medicine
New York, NY 10029

(212) 241-7788

Christine M. Olson

Associate Professor

Cornell Cooperative Extension
Division of Nutrition Sciences
Room 376, MVR Hall

Ithaca, NY 14853

(607) 255-2142

Wilma E. Waithe

MCH Nutrition Coordinator

New York State Department of Health
Bureau of Nutrition

Room 859

E.S.P. Corning Tower Building
Albany, NY 12237

(518) 474-8459

North Carolina

Janice Somers Lebeuf, M.P.H.
Nutrition Consultant

WIC Section

Division of Maternal and Child Health
North Carolina Department of
Environmental Health and Natural
Resources

P.O. Box 27687

Raleigh, NC 27611-7687

(919) 733-2973

Elizabeth Watkins, D.Sc.

Professor

University of North Carolina

School of Public Health

Department of Maternal and Child Health
315 Pittsboro Street

CB #7400

Chapel Hill, NC 27599

(919) 966-5979

North Dakota

Jean Tracy

Nutritionist

North Dakota Health Department
Bismark, ND $8505

(701) 224-2493

Ohio

Lindsey K. Grossman, Ph.D.

Project Director

Breastfeeding Promotion in a Low-Income
Urban Population

Ohio State University

Research Foundation

1314 Kinnear Road

Columbus, OH 43210

(614) 293-8034

Ruth Shrock

Administrative Staff Nutrition Consultant
Division of Maternal and Child Health
Ohio Department of Health

246 North High Street

Columbus, OH 43215

(614) 466-8932

68
Oklahoma

Anne Roberts

State Coordinator

Oklahoma Healthy Mothers,
Healthy Babies

c/o Oklahoma Institute for Child
Advocacy

4030 North Lincoln, #208
Oklahoma City, OK 73152
(405) 424-8014

Carole Waldvogel

MCH Consultant

Oklahoma State Department Of Health
100 Northeast 10th Street, P.O. Box 53551
Oklahoma City, OK 73152

(405) 271-6617

Oregon

Mary Kay DiLoreto, M.S., R.D.

Nutrition Consultant

Oregon Department of Human Resources
Health Division

P.O. Box 231

Portland, OR 97207

(S03) 229-5691

Pam Hellings, R.N., Ph.D., C.P.N.P.
Associate Professor, Family Nursing
Oregon Health Sciences University—EJSN
3181 Southwest Sam Jackson Park Road
Portland, OR 97201-3098 .

(503) 494-8382

Pennsylvania

Evelyn S. Bouden, M.D.

Director

Division of Maternal and Child Health
Pennsylvania Department of Health
Room 725, H & W Building

P.O. Box 90

Harrisburg, PA 17108

(717) 787-7443

Billye June Eichelberger, R.D., M.P.H.
State Nutrition Director
Pennsylvania Department of Health
P.O. Box 90

Room 1003, Health and Welfare Building
Harrisburg, PA 17108

(717) 787-6967

National Child Nutrition
Philadelphia, PA

Contact the National Center for Education in
Maternal and Child Health, Washington,
DC, for more information. See page 63.

Project

69

Rhode Island
Cathleen McElligott, M.S., R.D.
State WIC Nutrition Coordinator
Rhode Island Department of Health
Three Capitol Hill

Providence, RI 02908

(401) 277-3940

South Carolina

Robert H. Buchanan, Jr.

Project Director, Statewide Action Plan to
Promote Breastfeeding

South Carolina Department of Health and
Environmental Control

Division of Children’s Health

2600 Bull Street

Columbia, SC 29201

(803) 734-4610

South Dakota

Linda Marchand

District Nutrition Supervisor

South Dakota Department of Health
Nutzrition Services

725 North LaCrosse

Rapid City, SD 57701

(605) 394-2526

Randi Oviatt, R.N.
Community Health Nurse

South Dakota Department of Health
1306 North Main

Spearfish, SD 57783

(605) 347-4587

Nancy Spyker

State Nutritionist

South Dakota Department of Health
Nutritional Services

717 Fifth Street

Spearfish, SD 57783

(605) 642-6391

Tennessee

Betsy Haughton

Associate Professor, Nutrition and Food
Sciences

College of Human Ecology

University of Tennessee

Knoxville, TN 37996-1900

(615) 974-5445
Minda Lazarov, M.S., R.D.
Director, Breastfeeding Promotion
and Support Programs

Maternal and Child Health Section
Tennessee Department of Health
and Environment

C2-233 Cordell Hull Building
Nashville, TN 37247-5225

(615) 741-7218

Texas

M. T. DiFerrante, M.P.H., R.D., L.D.
Chief of Nutrition Services

City of Houston Department of Health
and Human Services

8000 North Stadium Drive

Houston, TX 77054

(713) 794-9292

Judy Hopkinson, Ph.D.

Research Assistant Professor
Children’s Nutrition Research Center
1100 Bates

Houston, TX 77030

(713) 798-7008

Barbara Keir

Director, Public Health Nutrition
Texas Department of Health
Community and Rural Health
1100 West 49th Street

Austin, TX 78756-3199

($12) 458-7785

David K. Rassin, Ph.D.

Professor, Department of Pediatrics
Child Health Center, C3T16
University of Texas Medical Branch
Galveston, TX 77550

(409) 761-1139

Utah

Agnes Greenhall

Perinatal Care Coordinator

Salt Lake Community Health Centers
c/o Redwood Community Health Center
3060 Lester Street

West Valley City, UT 84119

(801) 973-9483

Marianne Michaels, M.S.

Breastfeeding Promotion Coordinator
Utah Department of Health, WIC Program
262 West 300 North

Provo, UT 84601

(801) 373-5339

Esther Satterfield

Executive Director

Weber Community Health Center, Inc.
670 28th Street

Ogden, UT 84403

(801) 393-5355

Vermont

Penny Rieley

WIC Nutrition Coordinator

Vermont Department of Health—Local
Health

1193 North Avenue

P.O. Box 70

Burlington, VT 05402

(802) 863-7333

Washington

Maxine D. Hayes, M.D., M.P.H.

MCH Director

Washington Department of Health

and Social Services

Division of Parent/Child Health Services
MS: LC-11A

Olympia, WA 98504

(206) 753-7021

Jane Mitchell Rees, M.S., R.D.

Director, Nutrition Services and Education
Division of Adolescent Medicine
University of Washington, CDMRC WJ-10
Seattle, WA 98195

(206) 685-1266

Bonnie Worthington-Roberts
Professor, Nutrition Sciences
Child Development and

Mental Retardation Center
University of Washington, DL-10
Seattle, WA 98195

(206) 543-1730

West Virginia
Denise Ferris

Director

West Virginia WIC Program
Bureau of Public Health
West Virginia Department of Health
and Human Resources

1411 Virginia Street, East
P.O. Box 69004

Charleston, WV 25301
(304) 348-0030

70
Wyoming

Deborah Barnes and Margie Sewell
Laramie County WIC Program
1122 Logan Avenue

Cheyenne, WY 82001

(307) 638-1630

Lois Pine, R.N., M.S.

Education Coordinator
Wyoming Department of Health
Family Health Services
Hathaway Building, Fourth floor
Cheyenne, WY 82002

71
GL

APPENDIX D
RESPONDENTS REPORTING BREASTFEEDING PROMOTION ACTIVITIES

RESPONDENTS

Federal Agencies and National Organizations
American Academy of Pediatrics
American College of Obstetricians and Gynecologists
American Dietetic Association
American Hospital Association
APHA Clearinghouse on Infant Feeding and Maternal Nutrition
Center to Prevent Childhood Malnutrition
Food and Nutrition Board, Institute of Medicine
Food and Nutrition Information Center, USDA
Food and Nutrition Service, USDA
Indian Health Service, DHHS
Institute for Reproductive Health
La Leche League International
Maternal and Child Health Bureau, DHHS
National Association of WIC Directors
National Center for Education in Maternal and Child Health
National Center for Health Statistics, DHHS
Subcommittee on Breastfeeding Promotion,

Healthy Mothers, Healthy Babies Coalition
U. S. Agency for international Development
Alabama
Alabama Department of Public Health

  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
    

Paces Wuere Cirep

9, 13, 21, 24, 40
10
14, 23

16

28, 35, 39

45, 47

15

8, 15, 21, 30, 39, 40, 45, 50
19, 20, 40

48, 49

10, 11, 20, 22, 35, 37, 39, 40
8,11, 15, 19, 24, 28, 29, 35, 42, 46
14, 28, 31,51

16

51

12, 28, 38,41
ee 9, 16,27, 48
€Z

 

Arizona

Arizona Department of Health Services

Pima County Health Department WIC Program
University Medical Center

Arkansas

Arkansas Department of Health

California

Alameda County Health Care Services Agency
Humboldt County Health Department
San Diego State University School of Public Health
University of California at Davis

University of California at Los Angeles Extension
Weilstart

Colorado

Colorado Department of Health

Community Health Centers, inc.

Denver Department of Health and Hospitals

La Clinica del Valle, Inc.

Pueblo Community Health Center
Presbyterian-St. Lukes's Medical Center
Valley-Wide Health Services, Inc.

Connecticut

Connecticut Department of Health Services
District of Columbia

Children’s National Medical Center
Georgetown University Hospital

Federated States of Micronesia

Kosrae Department of Health Services

Florida

Best Start

Florida Department of Health and Rehabilitative Services
University of Florida

 
 
 
 
 
 
 
 

 
 

E30, 38, 39
40

17, 28, 30, 36

 
 
 
 
 
 

29
| 44

10
9, 19, 29, 40

 
    
  
 
 
 
 

13, 22, 24, 35
40
40

20
10

 
     
 

11, 16, 22, 28, 30, 36, 44
29, 31, 40
¥L

Georgia
Grady Memorial Hospital
Hawaii
Hawaii Department of Heaith,
Maternal and Child Health Branch
Hawaii WIC Program
University of Hawaii School of Public Health
illinois
ilinois Department of Public Health,
’ Division of Family Health
illinois Department of Public Health,
Division of Health Assessment and Screening
Illinois Maternal and Child Health Coalition
University of Illinois School of Public Health
indiana
Indiana State Board of Health,
Maternal and Child Health Division
Indiana State Board of Health,
WIC Program
jowa
lowa Department of Public Health/lowa WIC Program

     
  

Paces Were Citep

10, 11, 40

 

 

22, 23, 29, 40, 41, 42

 
SZ

 

Kansas

University of Kansas Children’s Rehabilitation Unit
Kentuky

Kentucky Department of Health Services
Louisiana

Louisiana State University Medical Center

Maine

Maine Department of Human Services

Maryland

Johns Hopkins School of Hygiene and Public Health
Montgomery County Health Department
Massachusetts

Massachusetts Department of Public Health

 

Michigan
Michigan Department of Public Health
Northern Michigan Hospitals

 

Minnesota
Minnesota Department of Health

 

Mississippi
Mississippi Department of Health

 

Missouri
Missouri Department of Health

 

Montana

Community Nutrition Resource Center
Deering Community Health Center
Montana Migrant Council, inc.

 

Nebraska
Nebraska Department of Health

 

Nevada
Nevada WIC Program

34

11, 22

45
13, 29

 

20

40

 

 

14, 20, 34

25, 40

20, 40

31

20, 40