Dear Colleague Letter: Call to Action - Successful Breastfeeding Outcomes, April 3, 2017

April 3, 2017

Dear Colleagues:

Despite strong evidence that exclusive breastfeeding saves lives, improves health outcomes for mothers and their children, and decreases health-care costs, the rates of exclusive breastfeeding in New York State (NYS) are low. In 2014, 87% of NYS mothers initiated breastfeeding, but only 43% of mothers were exclusively breastfeeding their newborns at hospital discharge, significantly below the Healthy People 2020 goal of at least 70%. Nearly half of all healthy breastfed infants received infant formula during their hospital stays. Formula supplementation of breastfed infants in NYS continues to be among the highest in the country, which if unnecessary, can have a negative effect on successful breastfeeding outcomes.

Supporting women's breastfeeding goals is a major public health priority. Lactation services should be available before and after the birth so a safe, supportive environment is created for women who want and are able to breastfeed. For successful breastfeeding, supportive efforts must be coordinated across multiple settings and among different providers to close any care gaps and provide seamless, high-quality continuous care and support.

I call on all New York State health care providers to:

  • Discuss the benefits of breastfeeding and the impacts of not breastfeeding with prenatal patients and their partners to help them make informed feeding decisions.
  • Discuss breastfeeding at prenatal visits so patients feel prepared prior to delivery. Create a birth plan together that identifies their breastfeeding goals. While there are few contraindications to breastfeeding, it's important that women's decisions to not breastfeed because of medical, psychological or personal reasons be respected.
  • Work with your affiliated hospitals and their prenatal and newborn clinics and offices to ensure that their policies and procedures are consistent with the recently amended NYS Perinatal Services regulations (Section 405.21), effective January 16, 2017. Support implementation of evidence-based practices associated with breastfeeding success, including early skin-to-skin bonding and keeping mother and baby together. Make sure qualified staff are available 24 hours per day, 7 days per week to provide lactation support as part of routine care.
  • Advocate and help support your hospital's efforts to become designated as a Baby-Friendly Hospital, which means they have implemented the World Health Organization's Ten Steps to Successful Breastfeeding and the International Code of Marketing of Breast-milk Substitutes." Visit: Designated Baby-Friendly facilities in NYS can be found here:
  • After hospital discharge, ensure newborn infants have a timely follow-up visit (within 3 to 5 days of birth and within 48 to 72 hours after hospital discharge) to assess feeding and jaundice. Breastfed infants should receive a formal breastfeeding evaluation, including qualified lactation support and counseling to address any feeding problems. See:
  • Be a breastfeeding champion at your practice, and support your practice becoming designated as a NYS Breastfeeding Friendly Practice. See:
  • Coordinate with local health departments and other organizations to advocate for community-based breastfeeding support. Refer your patients in need of child care to child care centers and day care homes that have achieved the NYS Breastfeeding Friendly designation. See:
  • Refer income-eligible pregnant or postpartum women to the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) for breastfeeding education and lactation support, provided by nutritionists, breastfeeding professionals and peer counselors. Lactation support includes a breast pump assessment, breast pumps and supplies for mothers who need them. Visit:
  • Inform women about their right to breastfeed at their places of employment or child care centers, and to take reasonable unpaid break time or use paid break or meal time to express or pump breast milk at work. Visit: and
  • Also, begin informing your working patients and families about the NYS Paid Family Leave program, which will provide employees with wage replacement to help them bond with a newborn infant or newly-adopted or foster child, starting on January 1, 2018.

We need to change the conversation around breastfeeding to make sure education and support are available to all women, regardless of their background or life situations. As leaders in public health, we must take action to make exclusive breastfeeding for the first six months of life the norm, not the exception. I challenge you to be an agent of change.

If you have any questions or would like more information, please contact the New York State Department of Health at:


Howard A. Zucker, M.D., J.D.
Commissioner of Health