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Breastfeeding in Kansas: Who’s doing What Where?

Breastfeeding in Kansas: Who’s doing What Where?. Brenda Bandy, IBCLC Program Director, Business Case for Breastfeeding Kansas Breastfeeding Coalition, Inc. Martha Hagen, MS,RD,LD,IBCLC Breastfeeding Coordinator Nutrition and WIC Services. The NORMAL way to feed a baby!.

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Breastfeeding in Kansas: Who’s doing What Where?

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  1. Breastfeeding in Kansas: Who’s doing What Where? Brenda Bandy, IBCLC Program Director, Business Case for Breastfeeding Kansas Breastfeeding Coalition, Inc. Martha Hagen, MS,RD,LD,IBCLC Breastfeeding Coordinator Nutrition and WIC Services

  2. The NORMAL way to feed a baby!

  3. Where Do We Stand?

  4. Percent of Mothers Who Breastfeed Their Infants at 6 months Kansas and U.S., 2001-2010 Desired Direction = Above Line HP2020 60.6% na na na na HP2020 = Healthy People 2020 na = not available Source: National Immunization Survey (birth year; 2007 and 2008 data are provisional.); Pediatric Nutrition Surveillance System (PedNSS)

  5. Indicators of Breastfeeding Support(CDC 2012 Breastfeeding Report Card)

  6. Breastfeeding Initiation Rates 2008-2010 Brown Republic Marshall Nemaha Rawlins Norton Washington Cheyenne Phillips Jewell Decatur Smith Doniphan Thomas Sherman Graham Pottawatomie Sheridan Atchison Cloud Riley Leavenworth Jackson Mitchell Jefferson Rooks Osborne Clay Ottawa Wyandotte Shawnee Gove Russell Wallace Ellis Lincoln Geary Wabaunsee Trego Douglas Logan Ellsworth Dickinson Johnson Morris Osage Saline Miami Rush Greeley Wichita Scott Ness Lane Lyon Barton Marion Franklin Rice Coffey McPherson Linn Chase Pawnee Finney Hodgeman Kearny Hamilton Anderson Harvey Greenwood Butler Woodson Bourbon Reno Stafford Ford Allen Edwards Pratt Grant Stanton Haskell Neosho Wilson Gray Sedgwick Kingman Kiowa Crawford Elk Cowley Clark Morton Montgomery Stevens Seward Cherokee Labette Chautauqua Meade Barber Sumner Harper Comanche 70%-81.8% < 70% > 81.9% (HP 2020 goal)

  7. Breastfeeding Data Sources • National Immunization Survey • Kansas Birth Certificate Data • Kansas WIC Data • Pediatric Nutrition Surveillance System Data

  8. Surgeon General’s Call to Action to Support Breastfeeding Available at www.surgeongeneral.gov

  9. Call to Action to Support Breastfeeding “Everyone can help make breastfeeding easier.”

  10. Who’s doing What in kansas…and where A look at breastfeeding initiatives and programs across the state of Kansas as they relate to the Surgeon General’s Call to Action to Support Breastfeeding

  11. The “Who” (not the rock band) Kansas Breastfeeding Coalition • Business Case for Breastfeeding (workplace lactation support) • Coming in August – window clings for businesses • High 5 for Mom and Baby (hospital maternity care improvement) Women, Infant & Children (KDHE) • Peer counselors (mother-to-mother support) • Maternal & family education • Community awareness campaigns La Leche League of Kansas • Mother-to-mother support • Continuing education to health care professionals Kansas Public Health Association/County Health Depts. • County-level grants for a variety of breastfeeding interventions

  12. The “Where” A look at the locations of breastfeeding support activities by county in relation to the Surgeon General’s Call to Action to Support Breastfeeding Clearer understanding of breastfeeding in Kansas

  13. Action 1:Give mothers the support they need to breastfeed their babies. • 88% of hospitals in Kansas included breastfeeding in their prenatal patient education (“Maternity Practices in Infant Nutrition and Care Survey” (mPINC), Centers for Disease Control and Prevention, 2011) • Kansas Public Health Association (KPHA) grant funding made possible: • Breast pump/aids in 12 counties • Breastfeeding prenatal classes in 6 counties • Spanish breastfeeding materials in two counties • High School education in Johnson County

  14. Action 1: Counties providing maternal support through KPHA grants Brown Republic Marshall Nemaha Rawlins Norton Washington Cheyenne Phillips Jewell Decatur Smith Doniphan Thomas Sherman Graham Pottawatomie Sheridan Atchison Cloud Riley Leavenworth Jackson Mitchell Jefferson Rooks Osborne Clay Ottawa Wyandotte Shawnee Gove Russell Wallace Ellis Lincoln Geary Wabaunsee Trego Douglas Logan Ellsworth Dickinson Johnson Morris Osage Saline Miami Rush Greeley Wichita Scott Ness Lane Lyon Barton Marion Franklin Rice Coffey McPherson Linn Chase Pawnee Finney Hodgeman Kearny Hamilton Anderson Harvey Greenwood Butler Woodson Bourbon Reno Stafford Ford Allen Edwards Pratt Grant Stanton Haskell Neosho Wilson Gray Sedgwick Kingman Kiowa Crawford Elk Cowley Clark Morton Montgomery Stevens Seward Cherokee Labette Chautauqua Meade Barber Sumner Harper Comanche

  15. Action 3:Strengthen programs that provide mother-to-mother support and peer counseling. • La Leche League of Kansas has 56 volunteers providing mother-to-mother support in 20 counties. 1.92 LLL Leaders/1000 live births (LBs) compared to 0.95/1000 LBs nationally • 39 WIC Peer Counselors in 47 counties. • 13 breastfeeding support groups established with KPHA grants run by county health departments.

  16. Action 3: La Leche League Brown Republic Marshall Nemaha Rawlins Norton Washington Cheyenne Phillips Jewell Decatur Smith Doniphan Thomas Sherman Graham Pottawatomie Sheridan Atchison Cloud Riley Leavenworth Jackson Mitchell Jefferson Rooks Osborne Clay Ottawa Wyandotte Shawnee Gove Russell Wallace Ellis Lincoln Geary Wabaunsee Trego Douglas Logan Ellsworth Dickinson Johnson Morris Osage Saline Miami Rush Greeley Wichita Scott Ness Lane Lyon Barton Marion Franklin Rice Coffey McPherson Linn Chase Pawnee Finney Hodgeman Kearny Hamilton Anderson Harvey Greenwood Butler Woodson Bourbon Reno Stafford Ford Allen Edwards Pratt Grant Stanton Haskell Neosho Wilson Gray Sedgwick Kingman Kiowa Crawford Elk Cowley Clark Morton Montgomery Stevens Seward Cherokee Labette Chautauqua Meade Barber Sumner Harper Comanche

  17. Action 3: WIC Peer Counselors Brown Republic Marshall Nemaha Rawlins Norton Washington Cheyenne Phillips Jewell Decatur Smith Doniphan Thomas Sherman Graham Pottawatomie Sheridan Atchison Cloud Riley Leavenworth Jackson Mitchell Jefferson Rooks Osborne Clay Ottawa Wyandotte Shawnee Gove Russell Geary Wallace Ellis Lincoln Wabaunsee Trego Douglas Logan Ellsworth Dickinson Johnson Morris Osage Saline Miami Rush Greeley Wichita Scott Ness Lane Lyon Barton Marion Franklin Rice Coffey McPherson Linn Chase Pawnee Finney Hodgeman Kearny Hamilton Anderson Harvey Greenwood Butler Woodson Bourbon Reno Stafford Ford Allen Edwards Pratt Grant Stanton Haskell Neosho Wilson Gray Sedgwick Kingman Kiowa Crawford Elk Cowley Clark Morton Montgomery Stevens Seward Cherokee Labette Chautauqua Meade Barber Sumner Harper Comanche

  18. Action 3: Breastfeeding Support Groups at County Health Departments (KPHA grants) Brown Republic Marshall Nemaha Rawlins Norton Washington Cheyenne Phillips Jewell Decatur Smith Doniphan Thomas Sherman Graham Pottawatomie Sheridan Atchison Cloud Riley Leavenworth Jackson Mitchell Jefferson Rooks Osborne Clay Ottawa Wyandotte Shawnee Gove Russell Wallace Ellis Lincoln Geary Wabaunsee Trego Douglas Logan Ellsworth Dickinson Johnson Morris Osage Saline Miami Rush Greeley Wichita Scott Ness Lane Lyon Barton Marion Franklin Rice Coffey McPherson Linn Chase Pawnee Finney Hodgeman Kearny Hamilton Anderson Harvey Greenwood Butler Woodson Bourbon Reno Stafford Ford Allen Edwards Pratt Grant Stanton Haskell Neosho Wilson Gray Sedgwick Kingman Kiowa Crawford Elk Cowley Clark Morton Montgomery Stevens Seward Cherokee Labette Chautauqua Meade Barber Sumner Harper Comanche

  19. Action 3: Mother-to-Mother Support Composite Brown Republic Marshall Nemaha Rawlins Norton Washington Cheyenne Phillips Jewell Decatur Smith Doniphan Thomas Sherman Graham Pottawatomie Sheridan Atchison Cloud Riley Leavenworth Jackson Mitchell Jefferson Osborne Rooks Clay Ottawa Wyandotte Shawnee Gove Russell Wallace Ellis Lincoln Geary Wabaunsee Trego Douglas Logan Ellsworth Dickinson Johnson Morris Osage Saline Miami Rush Greeley Wichita Scott Ness Lane Lyon Barton Marion Franklin Rice Coffey McPherson Linn Chase Pawnee Finney Hodgeman Kearny Hamilton Anderson Harvey Greenwood Butler Woodson Bourbon Reno Stafford Ford Allen Edwards Pratt Grant Stanton Haskell Neosho Wilson Gray Sedgwick Kingman Kiowa Crawford Elk Cowley Clark Morton Montgomery Stevens Seward Cherokee Labette Chautauqua Meade Barber Sumner Harper Comanche

  20. Action 4: Use community-based organizations to promote and support breastfeeding. • KPHA grants funded: • 24/7 warm helpline in two counties • Breastfeeding events in three counties • Healthy Start home visitors continue to serve breastfeeding mothers • Parents As Teachers educators receive specific training on breastfeeding • Formation of African-American peer support project in KC • Coming soon…“Breastfeeding Welcome Here” window-clings for businesses from the KBC

  21. Action 4: Community-based organizations to support breastfeeding – KPHA grants Brown Republic Marshall Nemaha Rawlins Norton Washington Cheyenne Phillips Jewell Decatur Smith Doniphan Thomas Sherman Graham Pottawatomie Sheridan Atchison Cloud Riley Leavenworth Jackson Mitchell Jefferson Rooks Osborne Clay Ottawa Wyandotte Shawnee Gove Russell Wallace Ellis Lincoln Geary Wabaunsee Trego Douglas Logan Ellsworth Dickinson Johnson Morris Osage Saline Miami Rush Greeley Wichita Scott Ness Lane Lyon Barton Marion Franklin Rice Coffey McPherson Linn Chase Pawnee Finney Hodgeman Kearny Hamilton Anderson Harvey Greenwood Butler Woodson Bourbon Reno Stafford Ford Allen Edwards Pratt Grant Stanton Haskell Neosho Wilson Gray Sedgwick Kingman Kiowa Crawford Elk Cowley Clark Morton Montgomery Stevens Seward Cherokee Labette Chautauqua Meade Barber Sumner Harper Comanche

  22. Action 5: Create a national [local] campaign to promote breastfeeding KPHA grants funded media campaigns in five counties.

  23. Barton County Marketing Project • Included: • Billboards • Newspaper ads • Radio spots

  24. Action 5: Create a national [local] campaign to promote breastfeeding Brown Republic Marshall Nemaha Rawlins Norton Washington Cheyenne Phillips Jewell Decatur Smith Doniphan Thomas Sherman Graham Pottawatomie Sheridan Atchison Cloud Riley Leavenworth Jackson Mitchell Jefferson Rooks Osborne Clay Ottawa Wyandotte Shawnee Gove Russell Wallace Ellis Lincoln Geary Wabaunsee Trego Douglas Logan Ellsworth Dickinson Johnson Morris Osage Saline Miami Rush Greeley Wichita Scott Ness Lane Lyon Barton Marion Franklin Rice Coffey McPherson Linn Chase Pawnee Finney Hodgeman Kearny Hamilton Anderson Harvey Greenwood Butler Woodson Bourbon Reno Stafford Ford Allen Edwards Pratt Grant Stanton Haskell Neosho Wilson Gray Sedgwick Kingman Kiowa Crawford Elk Cowley Clark Morton Montgomery Stevens Seward Cherokee Labette Chautauqua Meade Barber Sumner Harper Comanche

  25. Action 7. Ensure that maternity care practices around the United States are fully supportive of breastfeeding. 26% of birthing facilities in KS reported not giving out discharge packs containing infant formula samples and marketing products to breastfeeding patients. (2009 mPINC survey, CDC) NO “Baby Friendly” designated hospitals in Kansas. Wesley in Wichita selected for “Best Fed Beginnings” project. KPHA grants funded: • Breastfeeding discharge bags in 5counties. • Hospital policy improvement in 2 counties.

  26. Action 7. Maternity care improvement through KPHA grants (discharge bags & hospital policies) Brown Republic Marshall Nemaha Rawlins Norton Washington Cheyenne Phillips Jewell Decatur Smith Doniphan Thomas Sherman Graham Pottawatomie Sheridan Atchison Cloud Riley Leavenworth Jackson Mitchell Jefferson Rooks Osborne Clay Ottawa Wyandotte Shawnee Gove Russell Wallace Ellis Lincoln Geary Wabaunsee Trego Douglas Logan Ellsworth Dickinson Johnson Morris Osage Saline Miami Rush Greeley Wichita Scott Ness Lane Lyon Barton Marion Franklin Rice Coffey McPherson Linn Chase Pawnee Finney Hodgeman Kearny Hamilton Anderson Harvey Greenwood Butler Woodson Bourbon Reno Stafford Ford Allen Edwards Pratt Grant Stanton Haskell Neosho Wilson Gray Sedgwick Kingman Kiowa Crawford Elk Cowley Clark Morton Montgomery Stevens Seward Cherokee Labette Chautauqua Meade Barber Sumner Harper Comanche

  27. Action 8: Develop systems to guarantee continuity of skilled support for lactation between hospitals and health care settings in the community. KPHA grants funded: • Resource directories & referral systems in 8 counties. • Post-discharge follow-up visits to mothers in 7 counties. • Walk-in breastfeeding clinics in 5 counties.

  28. Action 8: Continuity of Care from KPHA funding Brown Republic Marshall Nemaha Rawlins Norton Washington Cheyenne Phillips Jewell Decatur Smith Doniphan Thomas Sherman Graham Pottawatomie Sheridan Atchison Cloud Riley Leavenworth Jackson Mitchell Jefferson Rooks Osborne Clay Ottawa Wyandotte Shawnee Gove Russell Wallace Ellis Lincoln Geary Wabaunsee Trego Douglas Logan Ellsworth Dickinson Johnson Morris Osage Saline Miami Rush Greeley Wichita Scott Ness Lane Lyon Barton Marion Franklin Rice Coffey McPherson Linn Chase Pawnee Finney Hodgeman Kearny Hamilton Anderson Harvey Greenwood Butler Woodson Bourbon Reno Stafford Ford Allen Edwards Pratt Grant Stanton Haskell Neosho Wilson Gray Sedgwick Kingman Kiowa Crawford Elk Cowley Clark Morton Montgomery Stevens Seward Cherokee Labette Chautauqua Meade Barber Sumner Harper Comanche

  29. Action 9. Provide education and training in breastfeeding for all health professionals who care for women and children. KPHA grants funded: • 56 people from 12 counties to attend 3 day “Certified Breastfeeding Educator” (CBE) trainings • Education for health care professionals (HCPs) in 16 counties 250 HCPs from across Kansas attended La Leche League of KS Continuing Education Program in March 2012, funded in part by the Kansas Health Foundation. Save the Date – March 8, 2013 for next LLL of KS CE Program featuring Dr. Tina Smillie.

  30. Action 9: Education for HCP’s from KPHA funding Brown Republic Marshall Nemaha Rawlins Norton Washington Cheyenne Phillips Jewell Decatur Smith Doniphan Thomas Sherman Graham Pottawatomie Sheridan Atchison Cloud Riley Leavenworth Jackson Mitchell Jefferson Rooks Osborne Clay Ottawa Wyandotte Shawnee Gove Russell Wallace Ellis Lincoln Geary Wabaunsee Trego Douglas Logan Ellsworth Dickinson Johnson Morris Osage Saline Miami Rush Greeley Wichita Scott Ness Lane Lyon Barton Marion Franklin Rice Coffey McPherson Linn Chase Pawnee Finney Hodgeman Kearny Hamilton Anderson Harvey Greenwood Butler Woodson Bourbon Reno Stafford Ford Allen Edwards Pratt Grant Stanton Haskell Neosho Wilson Gray Sedgwick Kingman Kiowa Crawford Elk Cowley Clark Morton Montgomery Stevens Seward Cherokee Labette Chautauqua Meade Barber Sumner Harper Comanche

  31. Action 11. Ensure access to services provided by International Board Certified Lactation Consultants (IBCLCs). • Currently 135 IBCLC’s in KS 3.4 IBCLC’s in KS/1000 live births compared to 3.24/1000 LBs nationally • 9 new IBCLC’s from KPHA grant funding

  32. Action 11: IBCLC’s in Kansas Brown Republic Marshall Nemaha Rawlins Norton Washington Cheyenne Phillips Jewell Decatur Smith Doniphan Thomas Sherman Graham Pottawatomie Sheridan Atchison Cloud Riley Leavenworth Jackson Mitchell Jefferson Rooks Osborne Clay Ottawa Wyandotte Shawnee Gove Russell Wallace Ellis Lincoln Geary Wabaunsee Trego Douglas Logan Ellsworth Dickinson Johnson Morris Osage Saline Miami Rush Greeley Wichita Scott Ness Lane Lyon Barton Marion Franklin Rice Coffey McPherson Linn Chase Pawnee Finney Hodgeman Kearny Hamilton Anderson Harvey Greenwood Butler Woodson Bourbon Reno Stafford Ford Allen Edwards Pratt Grant Stanton Haskell Neosho Wilson Gray Sedgwick Kingman Kiowa Crawford Elk Cowley Clark Morton Montgomery Stevens Seward Cherokee Labette Chautauqua Meade Barber Sumner Harper Comanche

  33. Action 14. Ensure that employers establish and maintain comprehensive, high-quality lactation support programs for their employees. • The Kansas Business Case for Breastfeeding has trained over 160 people to help businesses create a workplace lactation support program in 13 counties. • Employer assistance in 9 counties provided with funding from KPHA grants.

  34. Action 14: Business Case for Breastfeeding trainings Brown Republic Marshall Nemaha Rawlins Norton Washington Cheyenne Phillips Jewell Decatur Smith Doniphan Thomas Sherman Graham Pottawatomie Sheridan Atchison Cloud Riley Leavenworth Jackson Mitchell Jefferson Rooks Osborne Clay Ottawa Wyandotte Shawnee Gove Russell Wallace Ellis Lincoln Geary Wabaunsee Trego Douglas Logan Ellsworth Dickinson Osage Johnson Morris Saline Miami Rush Greeley Wichita Scott Ness Lane Lyon Barton Marion Franklin Rice Coffey McPherson Linn Chase Pawnee Finney Hodgeman Kearny Hamilton Anderson Harvey Greenwood Butler Woodson Bourbon Reno Stafford Ford Allen Edwards Pratt Grant Stanton Haskell Neosho Wilson Gray Sedgwick Kingman Kiowa Crawford Elk Cowley Clark Morton Montgomery Stevens Seward Cherokee Labette Chautauqua Meade Barber Sumner Harper Comanche

  35. Action 14: Employer Assistance/Outreach from KPHA funding Brown Republic Marshall Nemaha Rawlins Norton Washington Cheyenne Phillips Jewell Decatur Smith Doniphan Thomas Sherman Graham Pottawatomie Sheridan Atchison Cloud Riley Leavenworth Jackson Mitchell Jefferson Rooks Osborne Clay Ottawa Wyandotte Shawnee Gove Russell Wallace Ellis Lincoln Geary Wabaunsee Trego Douglas Logan Ellsworth Dickinson Johnson Morris Osage Saline Miami Rush Greeley Wichita Scott Ness Lane Lyon Barton Marion Franklin Rice Coffey McPherson Linn Chase Pawnee Finney Hodgeman Kearny Hamilton Anderson Harvey Greenwood Butler Woodson Bourbon Reno Stafford Ford Allen Edwards Pratt Grant Stanton Haskell Neosho Wilson Gray Sedgwick Kingman Kiowa Crawford Elk Cowley Clark Morton Montgomery Stevens Seward Cherokee Labette Chautauqua Meade Barber Sumner Harper Comanche

  36. Action 14: Composite of Employer Support for Breastfeeding Brown Republic Marshall Nemaha Rawlins Norton Washington Cheyenne Phillips Jewell Decatur Smith Doniphan Thomas Sherman Graham Pottawatomie Sheridan Atchison Cloud Riley Leavenworth Jackson Mitchell Jefferson Osborne Rooks Clay Ottawa Wyandotte Shawnee Gove Russell Wallace Ellis Lincoln Geary Wabaunsee Trego Douglas Logan Ellsworth Dickinson Johnson Morris Osage Saline Miami Rush Greeley Wichita Scott Ness Lane Lyon Barton Marion Franklin Rice Coffey McPherson Linn Chase Pawnee Finney Hodgeman Kearny Hamilton Anderson Harvey Greenwood Butler Woodson Bourbon Reno Stafford Ford Allen Edwards Pratt Grant Stanton Haskell Neosho Wilson Gray Sedgwick Kingman Kiowa Crawford Elk Cowley Clark Morton Montgomery Stevens Seward Cherokee Labette Chautauqua Meade Barber Sumner Harper Comanche

  37. Action 15: Expand the use of programs in the workplace that allow lactating mothers to have direct access to their babies. 14 State agencies in Kansas allow approximately 6850 employees to bring their babies to work. Over 270 babies have been brought to work to date. Source -Babies in the Workplace website – www.babiesatwork.org

  38. Action 16: Ensure that all child care providers accommodate the needs of breastfeeding mothers and infants. In Johnson County -Training for childcare providers covering the latest breastfeeding guidelines from “Caring for Our Children: National Health and Safety Performance Standards” 3rd edition, 2011 Working with Child Care Aware to provide training. Now available through KS-TRAIN

  39. Action 19:Develop a national [local] monitoring system to improve the tracking of breastfeeding rates as well as the policies and environmental factors that affect breastfeeding. Monitoring breastfeeding rates in 4 counties from KPHA grant funding. Currently breastfeeding rates come from: • Kansas birth certificate data (2 years behind) • Kansas WIC population (by county, timely) • National Immunization Survey (3 years behind)

  40. Action 19: Collecting breastfeeding rates Brown Republic Marshall Nemaha Rawlins Norton Washington Cheyenne Phillips Jewell Decatur Smith Doniphan Thomas Sherman Graham Pottawatomie Sheridan Atchison Cloud Riley Leavenworth Jackson Mitchell Jefferson Rooks Osborne Clay Ottawa Wyandotte Shawnee Gove Russell Wallace Ellis Lincoln Geary Wabaunsee Trego Douglas Logan Ellsworth Dickinson Johnson Morris Osage Saline Miami Rush Greeley Wichita Scott Ness Lane Lyon Barton Marion Franklin Rice Coffey McPherson Linn Chase Pawnee Finney Hodgeman Kearny Hamilton Anderson Harvey Greenwood Butler Woodson Bourbon Reno Stafford Ford Allen Edwards Pratt Grant Stanton Haskell Neosho Wilson Gray Sedgwick Kingman Kiowa Crawford Elk Cowley Clark Morton Montgomery Stevens Seward Cherokee Labette Chautauqua Meade Barber Sumner Harper Comanche

  41. Action 20:Improve national leadership on the promotion and support of breastfeeding. Specifically, “to increase the capacity of…affiliated state coalitions to support breastfeeding.” • 9 county/regional breastfeeding coalitions in Kansas (4 from funding from KPHA grants) • Listing of local coalitions - www.ksbreastfeeding.org/contactus/localcoalitions.aspx. • “Starting a Community Conversation” Summit on Coalition Building Nov. 9th, at Wesley Medical Center, Wichita – FREE!!

  42. Action 20: Local Breastfeeding Coalitions Brown Republic Marshall Nemaha Rawlins Norton Washington Cheyenne Phillips Jewell Decatur Smith Doniphan Thomas Sherman Graham Pottawatomie Sheridan Atchison Cloud Riley Leavenworth Jackson Mitchell Jefferson Rooks Osborne Clay Ottawa Wyandotte Shawnee Gove Russell Wallace Ellis Lincoln Geary Wabaunsee Trego Douglas Logan Ellsworth Dickinson Johnson Morris Osage Saline Miami Rush Greeley Wichita Scott Ness Lane Lyon Barton Marion Franklin Rice Coffey McPherson Linn Chase Pawnee Finney Hodgeman Kearny Hamilton Anderson Harvey Greenwood Butler Woodson Bourbon Reno Stafford Ford Allen Edwards Pratt Grant Stanton Haskell Neosho Wilson Gray Sedgwick Kingman Kiowa Crawford Elk Cowley Clark Morton Montgomery Stevens Seward Cherokee Labette Chautauqua Meade Barber Sumner Harper Comanche

  43. Composite of all Actions Brown Republic Marshall Nemaha Rawlins Norton Washington Cheyenne Phillips Jewell Decatur Smith Doniphan Thomas Sherman Graham Pottawatomie Sheridan Atchison Cloud Riley Leavenworth Jackson Mitchell Jefferson Osborne Rooks Clay Ottawa Wyandotte Shawnee Gove Russell Wallace Ellis Lincoln Geary Wabaunsee Trego Douglas Logan Ellsworth Dickinson Johnson Morris Osage Saline Miami Rush Greeley Wichita Scott Ness Lane Lyon Barton Marion Franklin Rice Coffey McPherson Linn Chase Pawnee Finney Hodgeman Kearny Hamilton Anderson Harvey Greenwood Butler Woodson Bourbon Reno Stafford Ford Allen Edwards Pratt Grant Stanton Haskell Neosho Wilson Gray Sedgwick Kingman Kiowa Crawford Elk Cowley Clark Morton Montgomery Stevens Seward Cherokee Labette Chautauqua Meade Barber Sumner Harper Comanche

  44. A BIG thank you to the United Methodist Health Ministry Fund! For contributing so generously to: • Kansas Public Health Association breastfeeding grants • Kansas Business Case for Breastfeeding • High 5 for Mom & Baby program

  45. Resources • Kansas Breastfeeding Coalition, Inc. • www.ksbreastfeeding.org • Business Case for Breastfeeding • www.kansasbusinesscase.com • High 5 for Mom & Baby • www.kansashigh5.org • La Leche League of Kansas • www.kansasLLL.org

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