title: The business case for breastfeeding: a successful regional implementation, evaluation, and follow-up.
abstract: BACKGROUND
  Breastfeeding benefits the health of babies and mothers, but returning to work is a significant barrier for mothers wishing to continue breastfeeding for the recommended 12 months. A resource training kit, The Business Case for Breastfeeding (BC4BF), developed by the Health Resources and Services Administration, U.S. Department of Health and Human Services, was implemented in Southeastern Virginia to assist businesses in developing lactation support programs (LSPs) and eliminating breastfeeding barriers.
  
  
  METHODS
  The primary goals of the 1-year project were to educate 20 businesses about breastfeeding support in the workplace, engage 10 businesses to implement the BC4BF, and assess sustainability via documented policy and environmental changes and integration of the LSP into the business infrastructure. The Transtheoretical Model of Behavior Change was adapted to assess stage of organizational change. A Centers for Disease Control and Prevention tool for measuring community-level policy, systems, and environmental change was adapted to assess worksite policy and environmental changes.
  
  
  RESULTS
  Over 20 businesses were educated about the BC4BF. Seventeen engaged in the project. Fourteen significantly increased their stage of change, development of LSPs, written policies, and physical and social environment changes (p≤0.001). A brief follow-up study revealed that all 14 employers maintained their programs 8 months after the program ended, with increased stages of change, policy enforcement, and physical environment (p≤0.05).
  
  
  CONCLUSIONS
  The BC4BF provided an effective approach to assisting employers in establishing and maintaining LSPs in the workplace across several cities.
authors.affiliation: Department of Pediatrics, Division of Community Health and Research, Consortium for Infant and Child Health, Eastern Virginia Medical School, Norfolk, VA 23507, USA.
authors.forename: Cheza C
authors.initials: CC
authors.lastname: Garvin
authors.forename: Natasha K
authors.initials: NK
authors.lastname: Sriraman
authors.forename: Amy
authors.initials: A
authors.lastname: Paulson
authors.forename: Elise
authors.initials: E
authors.lastname: Wallace
authors.forename: Charley E
authors.initials: CE
authors.lastname: Martin
authors.forename: Liz
authors.initials: L
authors.lastname: Marshall
mesh_terms: D000293:Adolescent; D000328:Adult; D001942:Breast Feeding / Q000523:psychology*; D006801:Humans; D016134:Organizational Policy; D010043:Outcome and Process Assessment, Health Care; D016730:Program Development; D062707:Return to Work; D014481:United States; D014768:Virginia; D017132:Workplace / Q000331:legislation & jurisprudence* / Q000458:organization & administration*; D055815:Young Adult