Module Components

• Overview
• Learning Activities

Nurs 810 - Evidence-Based Policy Development

Module 7: Theories of Policy Development

Learning Activities

1. Review the following example of an application of the Kingdon model to policy change related to breastfeeding in the United States:
   
   In March 2010 The Joint Commission’s (TJC) Pregnancy and Related Conditions core measure set was retired and replaced with a new Perinatal Care core measure set. One of the 5 Perinatal Core measures specified was exclusive breast milk feeding upon discharge. Although TJC only required hospitals to choose a minimum of 4 out of the 11 core measure sets, those who elected to choose the perinatal core measures would have to collect data related to exclusive breastfeeding on discharge, and to ultimately improve quality of care related to infant feeding.
   
   In response to TJC’s new core measure on exclusive breast milk feeding, the United States Breastfeeding Committee (USBC), an independent nonprofit coalition of 41 nationally influential professional, educational, and governmental organizations, published guidelines and a toolkit to aid hospitals and maternity facilities in accurate collection of the data needed.
   
   In January 2011, there was more support for breastfeeding at the federal level, when the Surgeon General released a “Call to Action to Support Breastfeeding.” She called on health care providers, employers, insurers, policymakers, researchers and the community to take 20 action steps to support mothers in reaching their personal breastfeeding goals and to remove obstacles toward breastfeeding.
   During the same period as the above initiatives, policy advocates were also pushing businesses to do their part by setting up a private non-bathroom place for women to express breast milk, and allowing them break time to do it. These amenities were now required by law under Section 4207 of the Patient Protection and Affordable Care Act at businesses with at least 50 employees.
   
   Although policy change was occurring that supported breastfeeding in the workplace, if women couldn’t afford the need supplies to express milk in the workplace, the barriers against breastfeeding would persist. In response to this need, political forces came together to enact legislation for Preventive Services for Women under the Patient Protection and Affordable Care Act. These services called for insurance companies to cover the costs of comprehensive lactation support and counseling from trained providers, as well as breastfeeding equipment for pregnant and postpartum women. This coverage would include the cost of purchasing or renting breast pumps and breastfeeding related supplies.
   
   Despite all of these policy changes to support breastfeeding, hospitals were still engaged in practices that provided barriers to supporting mothers in breastfeeding. One controversial practice was giving out free formula from manufacturers to new mothers on discharge, which has been found to be associated with lower rates of breastfeeding after discharge.
   
   Another political change occurred in Maryland in November 2102, when the Maryland Department of Health and Mental Hygiene (DHMH) unveiled the new Maryland Hospital Breastfeeding Policy Recommendations. These recommendations called for Maryland hospitals to voluntarily become “Maryland Best Practices Hospitals,” by attaining Baby Friendly certification through the Baby Friendly Hospital Initiative (BFHI).  Some of these initiatives support giving newborns no food or drink other than breast milk (unless medically indicated), offering breastfeeding infants no pacifiers or artificial nipples, and encouraging mothers to practice “rooming-in" (a practice that allows mothers and infants to remain together 24 hours a day). In response to these recommendations, Dr. Jim Rost, Medical Director of the Neonatal Intensive Care Unit and Pediatrics at Shady Grove Adventist Hospital announced at a press conference a new policy at an organizational level to encourage breastfeeding. Click here to watch and listen to a brief video of this press conference.
   
   The above scenarios are examples of where problems, solutions and political streams, as described by the Kingdon model, have coupled at various times to create windows of opportunity for changes in breastfeeding policies at organizational, state and federal levels.