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 O-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 III) 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 WIe 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 calculatiori formulas used by each State. In many States,
rates reflect the percentage of all postpartum wqmen who are breastfeeding.
Other States measure the rate of bieastheding using the percentage of women
previously enrolled-as pregnant women who return for certification as
breastfeeding mothers.

The Iowa WIG 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
Matema1 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 CIearinghouse on Infant Feeding and Maternal Nutrition.

Bureau of Labor Statistics. (1991, March). Current PopuZation 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, lolst
Congress, 2nd Session, 10.

Department of Health, Education and Welfare. (1979). HeaZthy 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. Roc%Ile, 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 PubIication
No. HRS-D-MC 84-2.1 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. ~HHS
Publication NO. HRS-D-MC 85-2.1 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-l.] 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) 91-50213.1 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), 2803348.

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
Quurterly, 7(l), 13-15.

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

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

Interagency Committee on Nutrition Monitoring. (1989). Nutition 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-S.
Oski, F. A. (1989). "Heating up the bottle battle." 7'he Nation, 249,683-84.
Ryan, A. S., and Martinez, G. A. (1989). "Breast-feeding and the working
mother: A profile." Pediutics, 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. EVERY KOOP FOR THE SUBCOMM~+E
ON NunWION, SENATE CoMMrrr~r oN AGR~~~LTME, NLITRITION, AND FORESTRY
             or4 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 PUPS.
Therefore, infants who could benefit most from the immrmologic 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 he made available
to protect health, nourish, and optimally develop infants in all segments of our
society.

57


       APPENDIX B
SECOND FOLLOWUP REPORT QUESTIONNAIRE

Please answer the following questions about your
   breastfeeding promotion efforts.

1. Name
Title
Address
Telephone number

2. Agency/organization name
Check the box which best describes your agency:
  Cl Federal Health Agency
  El Other Federal Agency
  Cl State Health Agency
  Cl Local Health Agency
  0 Voluntary, Professional, or Nonprofit Organization
  0 Institution of Higher Learning
  Cl Private Practice
  Cl Other; please specify:

3. Does your agency/organization receive Title V support? 0 yes or Cl no
If yes, please describe

4. Has your agency/organization been involved in the past 5 years in
breastfeedlng promotion efforts aimed at achieving the breastfeeding
objectives for the Nation? 0 yes or 0 no
If yes, please continue the questionnaire.

5. Please describe how your breastfeeding promotion efforts are funded.

6. Does your breastfeedlng promotion effort involve collaboration with
other agencies or organizations? Cl yes or O 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
Cl Hospital staff
Cl Public health clinic staff
0 Private practitioners
Cl Other (please specify):

Public education and other breastfeeding promotional efforts
Cl Media campaigns

Cl School-based curricula
Cl Hard-to-reach populations; please specify:
Cl Other (please specify):

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

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

Development of support services in the communi~
0 Telephone hotlines
0 Support groups (professional or peer)
0 Individual counseling of clients and famiies
0 Followup services related to breastfeediig management
0 Client education

Cl Prenatal breastfeeding education
O Inhospital counseling
0 Postdischarge education
0 Other (please specify):

59


&sea& on human lactation and breastkeding
0 Physiological (Le., bn%tmilk composition)
Cl Social/behavioral
El Nutritional
0 Economic

Cl Programmatic (i.e., management, financing, needs assessment, cost-
  benefit analysis, etc., of breastfeeding programs)
O other (please specify):

8. Please provide a basic description of each of your breastfeedlng promotion
efforts (items identifled ln question 7) or attach copies of proposals or
reports which describe your programs.

Please include information on:
o ??????????o?
o Programdesign
o  Length of program
o `Ifipe of staff involved (i.e., physicians, nurses, health educators,
    dietitians)
o Target audience
o Participating agencies

9. Please describe any data you collect on the incidence and duration of
breastfeeding. Please include the defmition(s) of breastfeeding used in
your data collection.

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

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

12. Please list any materials generated as a result of these efforts (manuals,
policy guidelines, education materials, videotapes, training curricula,
conference proceedings, fhxal 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.

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

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

60


15. What suggestions or ideas do you have for future
breastfeeding promotion efforts?
     o  At the national level:
     o  At the State level:
     o  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


     &PE!`4DlX c
LIST OF QUESTIONNAIRE RESPONDENTS

The ~liowing is a list of all questionm&e responcientr. Organizations of a national
scope and Federal agencies are listed first, in alphabetical order by agency or
orgrmization name. State and local organizations are then listed, in alphabetical order
b,VStade?liWlt?.

NATIONAL oJIGmnATloNs AND FEDERAL
AlxNcuu

American Academy of Pediatrics
Joe M. Sanders, Jr., M.D.
Associate Executive Director
141 Northwest Point Boulevard
EIk Grove ViIIage, IL 60009-0927
(800) 433-9016

American Conege of Obstetricians and
Gynecologistr
Shirley A. Shelton
Associate Director, CIinicaI Practice
409 12th street, S.W.
Washington, DC 20024
(202) 863-2502

AmericanDietetic Association
Cheryl Co&n, MS., R.D.
Administrator, Alliance Program
216 West Jackson Boulevard, Suite 700
Chicago, IL 60606-6995
(312) 899-0040, Rxt. 4778

AInelk!an HospitaI Association
Bruce McPherson
Group Vice President
840 North Lake Shore Drive
Chicago, IL 60611
(312) 2806000

American Public Health Association
Clearinghouse on Infant Feeding and
Matemzd Nutrition
1015 15th Street, N.W.
Washington, DC 20005
(202) 789-5600

Center to Prevent Childhood
MdllUtdtiOll
Barbara L. Bershon, PhD.
U.S. Projects Manager
7200 Wisconsin Avenue, Suite 204
Bethesda, MD 20814
(301) 9865777

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) 3341917

Food and Nutrition
Information Center,
National Agricultural Library
U.S. Department of Agricukure
10301 Baltimore Boulevard, Room 304
BeItsviIIe, MD 20705-235 1
(301) 5045719

Food and Nutrition Service
Supplerr~eutal 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, He&by Babies
National Coalition, Subcommittee on
Breastfeeding Promotion
Brenda Lisi

3101 Park Center Drive, Room 609
Alexandria, VA 22302
(703) 305-2554

lndian Health Service
U.S. Department of Health and Human
services
Yvonne Jackson, Ph.D., R.D.
Chief, Nutrition and Dietetics Section
5600 Fishers Lane
Rockville, MD 28057
(301) 443-1114

62


Institute for Reproductive HeaIth
Georgetown University Medical Center
Department of Obstetrics and Gynecology,
3 PHC
3800 Reservoir Road, N.W.
Washington, DC 20057
(202) 687-1392

La Lecbe League International
Betty Wagner
Fxecutive Director
9616 Minneapolis Avenue
P.O. Box 1209
Franklin Park, IL 60131-8209
(708) 455-7730

Matemal and Child Health Bureau
Health Resources and Service
Admihtration
U.S. Department of Health and Human
SMViCeS
M. Elizabeth Brannon, MS., R.D.
Director, MCH Training
Parklawn Building, Room 9-12
5600 Fishers Lane
Rockvilie, MD 20857
(301) 443-2190

National Association of WTC Direcl
Kathy A. Dugas
Chair, Breastfeeding Promotion
committee
c/o Mississippi WIG Program
2423 North State Street
Underwood Annex Room R214
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
StVViCS
Paul J. Placek, Ph.D.
Chief, Followback Survey Branch
Division of Vital Statistics
6525 Belaest Road
Presidential Building, Room 840
Hyattsville, MD 28782
(301) 4367464

United States Agency for Internatonal
DeveIopment
Sue Anthony
Office of Nutrition Servfces
SA-18, Room 413
Washington, DC 20523-1808
(703) 875-4035

STATE AND LOCAL AGENCIES AND
OR-TIONS

Mtrlam J. Gaines
Nutrition Services Administrator
Alabama Department of Public Health
434 Monroe S@eet
Montgomery, AL 36130
(205) 242-5673

Arizona
Sheryl Lee, M.P.H., R.D.
Chief, Office of Nutrition services
Arizona Department of Health Services
1740 West Adams
Phoenix, AZ 85007
(602) 5421886

Becky Melland-Buckley, M.S., R.D.
Division Director
Pima County Health Department
WIG Program
Community Nutrition Division
1121 North RI Dorado Place, R200
Tucson, AZ 85713
(602) 296-6207

Susan Trombley, RN.C., LB.C.LC.
Lactation Coordinator
University Medical Center
Deparhnent of Nursing-OB/GYN
1501 North Campbell
Tucson, AZ 85724
(602) 694-5712

Arkansas
Carole Gamer
Director, Nutrition Services
Arkansas Department of Health
4815 West Markham, Slot 21
LittIe Rock, AR 722053867
(501) 6612324

63


wIC Project Director
~arneda County Health Care Services

499 5th Street, Room 304
Oakland, CA 94607
(415) 2682548

KathrynG.Dewey
Associate Professor
z;;;f ~tlition
      califomia at Davis
Davis, CA 95616
(916) 752-1992

Of&a Dhige

Associate Frokssor
Division of Maternai and child Health
Graduate School of public Health

San Diego State University
6505 AIvarado Road, W205
San Diego, CA 92120
(619) 5942795

Joyce M. Houston
public Health Nutritionist
Humboldt County Health Department
529 I street
Eureka, CA 95501
(707) 445-6205

Audrey Naylor, M.D.
president and Codhector
Wellstart
P.O. Box 87549
San Diego, CA 92138
(619) 295-5192

Sandra Apgar Steffes, RN., MS.
Course Coordinator, Lactation programs
Univerrity of CaIifornia at Los Angeles
Fxtension/HeaIth Sciences
loo995 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 CircIe
Colorado Springs, CO 80910
(719) 6306440

Chris Hunt

perinataI Frogram Manager
Katy Baer
WIG Program Manager
Valley-Wide Health Services, Inc
204 Carson Avenue
Alanma, CO 81101
(719) 589-5161

Lynn Wand
Director of Community Nutrition
Denver Department of He&h and
Hospitals
Nutrition Frogram
777 Bannock street
Denver, CO 80204
(303) 893-7197

Pam Leite
Fresbyterian-St. Luke's Medical Center
Lactation program
501East19tbAvenue
Denver, CO 80203
(303) 869-1881

Joan McGill, M.D., RD.
Chief Nutritionist
Colorado Department of Health
Nutrition Services
4210 East 1 lth Avenue
Denver, CO 80220
(303) 331-8380

Jose E. Ortega
Administrator
La CIinica de1 VaIIe, Inc.
P.O. Box 870
Rocky Ford, CO 81067
(719) 2547626

Barbara Skinder
F%inatal Coordinator
Pueblo Community Health Center
230 Colorado Avenue
pueblo, CO 81004
(719) 5438711

COMeCtiCUt
Ruth Gitchell, MS., RD.
Nutrition Consuhant
CoMecticut Department of Health
SC?lViCeS
150 Washington Street
Hartford, CT 06106
(203) 566-1159

64


District of Columbia
Vergie Hughes, RN., I.B.C.L.C.
Nursing Coordinator
Georgetown University Hospital
3800 Reservoir Road, N.W.
Washington, DC 20007
(202) 7846455

LiIia 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
h-thy Nena
Health Education Supervisor
Kosrae Department of Health Services
P.O. Box 127
Kosrae, FSM 96944
(691) 370-3199

Florida
Carol Bryant

Hawaii
Loretta J. Fuddy, A.C.S.W., M.P.H.
Acting program Administrator
Maternal and Child Health Branch
Hawaii Department of Health
741-A Sunset Avenue
Honolulu, HI 96816
(808) 737-8229

GigIiola Baruffi, M.D., M.P.H.
Project Director
Infant Feeding and Growth
U.S.-Related PachIc Islands
University of Hawaii School of Public
Health
1960 East-West Road
Honolulu, HI 96822
(808) 9568832

MeIissa Nikaido
Nutrition Education Coordinator
WIG Program
Ala Moana Health Center
591 Ala Moana Boulevard, Suite 233
Honolulu, HI 96813
(808) 548~6559,548-5300

Executive Director
Best Start
3500 East Fletcher, Suite 106
Tampa, FL 33609
(813) 9744867

lIIbOiS
Robyn Gabel
Director
IIIinois Maternal and Child Health
Coalition

Deborah Eibeck, M.S., R.D.
Chief, WIC and Nutrition Services
Florida Department of Health

   3411 West Diversey, Suite 5
   Chicago, IL 60647
- (312) 3848828

and Rehabihtative Services
1317 Winewood Boulevard
Building 1, Room 200
Tallahassee, FL 32399-0700
(904) 488-8985

Judy Perkin

Program Diiector
CC Dietetics, University of FIorida
Box J-184 JHMHC
Gainesville, FL 32610
(904) 3924078 .

Georgia

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

Stephen E. Saunders, M.D., M.P.H.
Chief, Division of Family Health
IIIinois Department of Public Health
535 West Jefferson
Springfield, IL 62761
(217) 782-2736

AquiIes J. Solnero, M.D.
Professor
University of IlIinois
School of Public Health
2035 West Taylor
Chicago, IL 60612
(312) 281-1871

Chief Nutritionist
Maternal and Infant Care Project       Merryjo Ware, M.P.H., R.D.
                       Nutrition Services Coordinator
Grady Memorial Hospital
80 Butler Street             IIIinois Department of Public Health
                        Division of Health Assessment and
Atlanta, GA 30335
(404) 589-4932               Screening
                    100 West Randolph
                    Chicago, IL 60601
                     (312) 814-5126

65


Indiana

Indiana WIG Program
hdiana State Roard of Health
1330 west Michigan street
P-0. Box 1964
Indianapolis, IN 46206
(317) 633-0849

Nancy B. Meade
Nutrition Consdtant
lndiana State Board of Health
Maternal and Child Health JXvision
1330 West Michigan Street
P.O. Box 1964
Indianapolis, IN 462061964
(3 17) 6330656

IOWil
Connie Betterley, MS., R.D.
Chief, Bureau of Nutrition and
Health Promotion
Brenda Dobson
WIG Nutrition Services Coordinator
Iowa Department of Public Health
3rd Flooi, Lucas Building
Des Moines. IA 503190075
(515) 281-7097,281-7769

iiEEf-
Director of Training in Nutrition
Children's Rehabilitation Unit
University Affiliated Programs
university of Kansas
39th and Rainbow Boulevard
Kansas City, KS 66103
(913) 5885745

Kermlcky
Patricia Nlcol, M.D., M.P.H.
Director, Division of Maternal and Child
Health
Cabinet fox Human Resources
Kentucky Department of Health Services
275 F&t Main street
Rankfort, KY 406210001
(502) 564-4830

Louisiana
Betty Oseid, M.D.
Depmment of Pediatrics
l.mMana State University Medical Center
1542 Tulane Avenue
New Orleans, LA 70112
(504) 568-6123

Maine
Judythe GatcheR
Nutrition Consultant
me Department of Human Services
Division of Maternal and Child Health
15 1 Capitol Street, State House Station #l 1
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, MS., R.D.
State WIG Nutrition Coordinator
Ruth Palombo, MS., RD.
Director, Office of Nutrition
Massachusetts Department of Public
Health
150 Tremont Street, Third Floor
Boston, MA 02111
(617) 727-6876

Michigan

Susan L. Hoshield, R.N.C., B.S.N.
Regional Perinatal Coordinator
Northern 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
(5 17) 335-8979

66


h4imlesota
Mary Johnson
Nutrition Consultant
wlc Program
Minnesota Department of Health
717 Delaware Street, S.E.
P.O. Box 9441
Minneapolis, MN 55440
(612) 623-5400

h4ississippi
Agnes Hinton, R.D., MS.
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) 4262924

Loma Wilson
Director
Division of Maternal, Child,
and Family Health
Missouri Department of Health
1730 East Elm Street
Jefferson City, MO 65101
(314) 7516174

Montana
Rita J. Bradley, RD.
Community Nutrition Resource Center
(formerly Renewable Ttiologies)
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
Biilings, MT 59101
(406) 2483149

Nebraska
Sue Medinger
Director, Nutrition Division
Nebraska Department of Health
P.O. Box 95007
Lincoln,NE 68509
(402) 471-2781

Nevada
Beverly Donahue
Nutrition F&cation Coordinator
Nevada WIG Program
505 East King Street, Room 205
Carson City, NV 89511
(702) 687-4797

New Hampshire
Lisa Ferriero
WIG Nutrition Consultant
Bureau of WIG Nutrition Services
New Hampshire Division of
Public Health Services
6 Hazen Drive, Health and Welfare
Bllilding
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 J-Y
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 086250364
(201) 292-9560,292-5616

New Mexico
Victoria Panill
MCH Nutritionist
Sharon Porter
WIG Nutrition Education Coordinator
New Mexico Health and Environment
Department
Public Health Division
Santa Fe, NM 87503
(SOS) 8272355, 827-2486

67


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 Diior
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) 3056960

Elisabeth Luder, Ph.D.
Associate Director
Pedfatric Puhnonary 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

68

Wilma E. Waithe
MCI-I Nutrition Coordinator
New York State Department of Health
Bureau of Nutrition
Room 859
E.S.P. Coming Tower Building
Albany, NY 12237
(518) 4748459

North Carolina
Janice Somers Lebeuf, M.P.H.
Nutrition Consultant
WIG Section
Division of Maternal and Child Health
North Carolina Department of
Environmental Health and Natural
Resources
P.O. Box 27687
Raleigh, NC 2761 l-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 87400
Chapel Hill, NC 27599
(919) 966-5979

North Dakota
Jean Tracy
Nutritionist
North Dakota Health Department
Bismark, ND 58505
(701) 2242493

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


olcIahoma
AnneRoberts

State Coordinator
Oklahoma Healthy Mothers,
Healthy Babies

c/o Oklahoma Institute for Child
Advocacy
4030 North Lincoln, #208
Oklahoma City, OK 73152
(405) 4248014

Carok Waldvogel
MCH Consultant
Oklahoma State Department Of Health
100 Northeast 10th Street, P.O. Box 53551
Oklahoma City, OK 73152
(405) 271-6617

Mary Kay DiL.oreto, MS., R.D.
Nutrition Consultant
Oregon Department of Human Resources
Health Division
P.O. Box 231

Portland, OR 97207
(503) 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 r
(503) 4948382

Pennsylvania

Evelyn S. Bouden, M.D.
Director
Division of Maternal and Child Health
Pennsylvania Department of Health
Room 725, H 61 W Building
P-0. Box 90

Harrisburg, PA 17108
(717) 787-7443

Biiye June Eichelberger, RD., M.P.H.
State Nutrition Director
Pennsylvania Department of Health
P.O. Box 90
Room 1003, Health and Welfare Building
Hanisburg, PA 17108
(717) 787-6967

National Child Nutrition Project
Philadelphia, PA
Contact the National Center fix Education in
Maternal and Child Health, Wrdngton,
DC, for more infinmation. See page 63.

Rhode Island
Cathleen Mdligott, MS., RD.
State WIG Nutritton Coordinator
Rhode Island Department of Health
Three Capitol Hill
Providence, RI 02908
(401) 277-3940

south carolhla
Robert H. Buchanan, Jr.
Project Director, Statewide Action Plan to
Promote Breastfeeding
South Carolina Department of Health and
Environxnental 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
Nut&ion Services
725 North LaCrosse
Rapid City, SD 57701
(605) 394-2526

Randi Oviatt, RN.
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

TeMeSSee
Betsy Haughton
Associate professor, Nutrition and Food
Sciences
College of Human Ecology
University of Tennessee
Knoxville, TN 379961900
(615) 9745445

69


Minda Iaaw, MS., RD.
Director, Breas&edmg Promotion
and Support Programs
Maternal and Child Health Section
Tennessee Department of Health
and Environment
CZ-233 Cordell Hull Building
Nashvlile, TN 372475225
(615) 741-7218

TuraS
M. T. DiFkrante, M.P.H., R.D., LD.
Chief of Nutrition Services
City of Houston Department of Health
and Human Services
8000 North Stadium Drive
Houston, TX 77054
(713) 7949292

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 787563199
(512) 458-7785

David K Rassm, Ph.D.
Professor, Department of Pediatrics
Child Health Center, C3T16
University of Texas Medical Branch
Galveston, TX 77550
(409) 761-1139

E Greenhall
Perinatal Care Coordinator
Salt Lake Communi~ Health Centers
C/O Redwood Community Health Center
3060 Lester street
West Valley City, UT 84119
(801) 973-9483

Marianne Michael.% MS.
Breastfeeding Promotion Coordinator
Utah Department of Health, WIG 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 Socfal Services
Division of Parent/Child Health Services
MS: LC-1lA

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-l 730

West Virginia
Denise Ferris
Director
West Virginia WIG Program
Bureau of Public Health
West Virginia Department of Health
and Human Resources
1411 Virginia Street, Past
P.O. Box 69004
Charleston, WV 25301
(304) 348-0030

70


Wyoming
Deborah Barnes and Margie Sewell
Laramie County WIG 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


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. 5. Agency for international Development
Alabama

Alabama Department of Public Health

.

.
-

.

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

16
28, 35,39
15,47
15
8,15, 21, 30, 39,40,4S, SO
19, 20, 40
4a,49
10, 11,20,22, 35, 37, 39.40
8,11,15, 19,24,28, 29, 35,42,46
14, 28, 31,51
! 16


Arizona

Arizona Department of Health Service-
Pima Countv Health

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

University of California at Los Angeles Extensior
Wellstart

t:  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 Me&-al rnnta

Children's National

Best Start

Florida Department of Health and Rehabilitative Canri*ar         . - I
University of Florida

1

ii, 16, 22, 28, 30, 36,44


Y

Georgia
Grady Memorial Hnsnital
        .._ ..-. .-. _ ._-.
       -

Hawaii
Hawaii Department of Health,
Maternal and Child Health Branch
Hawaii WIC Proaram

University
Illinois

of Hawaii School I of Public Health                  .
                                         -
-

Illinois 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

.


.

01 ' Illinois School of Public Health                   .
-

Indiana

Indiana State Board of Health,
Maternal and Child Health Division
Indiana State Board of Health,
WIC Program
Iowa
Iowa Department of Public Health/Iowa WIC Program

.



.

22,23,29,40,41,42

.


Kansas

Unit              .

University of Kansas Children's Rehabilitation
Kentuky
Kentucky Department of Health Services
Louisiana

Louisiana State University Medical Center
Maine

Maine Department of Human Services

.- . .

Marylana

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 Miqrant Council, Inc.
Nebraska
Nebraska Department of Health

Nevada
Nevada WIC Program

34


11,22

13.53

45
13,29

20

40

14,20, 34


2540


2440


31


20,40