Healthy Start Act The Healthy Start Act began as a grass roots effort by a group of concerned tribal members who later became known as the

Navajo Nation Breastfeeding Coalition (NNBC).

To understand the significance of the Healthy Start Act, it is important to understand some of the challenges that are experienced by Navajo communities.

•  The Navajo Nation is the largest US reservation. It is located in the Four Corners region of the US, where the corners of Arizona, Colorado, Utah, and New Mexico meet. Navajo Nation occupies portions of Arizona, New Mexico, and Utah. The reservation is approximately 27,000 square miles; about the size of West Virginia.

•  According to the 2000 U.S. Census:

• The population of the Navajo Nation is 180,462, with a median age of 24.0 years. (1)

• Among Navajo families, 42.9% live below poverty level, with an average annual per capita income of $7,269

• In 2003, the Navajo Nation reported an unemployment rate of 42%. (2)

• Like many other American Indian/Alaska Natives (AI/AN), Navajos experience many health disparities:

• High rates of diabetes reflected in the Navajo Area IHS age-adjusted diabetes mellitus death rate in 1996-1998. It was three times greater than U.S. all race rate of 13.5 per 100,000. (3, 5)

• The trend in the prevalence of overweight (>95th percentile) among children aged 2-5 years of age in the Navajo Nation PedNSS data has almost doubled from 9.4% in 1987 to 17.3% in 2007. (4) The upward trend in overweight and obesity suggests future increases in diabetes. 

The Story:

• In 2000, the Fort Defiance Breastfeeding Task Force began working to return breastfeeding to the norm for infant feeding

• In the past few years, it has expanded its membership to individuals living in other Navajo Agencies (Western, Central, Shiprock, and Eastern) and the Navajo WIC program. This expansion of membership formed the Navajo Nation Breastfeeding Coalition (NNBC).

•  In early 2007, the NNBC developed a logic model and work plan to improve breastfeeding duration and exclusivity rates.

• Later in 2007, Navajo Nation WIC administered a survey among WIC participants that showed many mothers reported they stopped breastfeeding due to employment.

• It was apparent that policy change would support working mothers to continue breastfeeding and work.

The Goal:

Secure legislation requiring accommodation of breastfeeding employees on Navajo Nation.

  The Plan:

1. The Navajo Nation Breastfeeding Coalition gained partnerships with CDC, I.H.S., WIC and Elder Sites – working with breastfeeding peer counselors, dietitians, nurses, health promotion/disease prevention coordinators, physicians, and the tribal Community Health Representatives .

2. The NNBC initiated a business case for breastfeeding campaign to educate families, community business, health professionals, and tribal leaders. The talking points were:

• Navajo elders have taught that mother’s milk is the traditional food for Navajo babies. Elders have emphasized the importance of bonding between mother and child and Navajo mothers’ opportunities to teach about traditional values in regards to living in harmony with the world and kinship responsibilities.

• Not breastfeeding increases an infant’s risk of health problems that plague Navajo families, including diabetes, obesity, ear infections, respiratory infections, and diarrhea. (7, 8)

• Breastfeeding can reduce some of the health disparities. Many families are living below the federal poverty level. Not breastfeeding puts more mothers and babies at risk for illnesses with complications. Costly illness places more burdens on the IHS health care dollars. Fewer health care dollars left over for other health care needs, like drug abuse prevention, immunization programs, dental programs and community health.

• Supporting working Navajo mothers is good business as more Navajo mothers are in the work force:

• About ½ of Navajo women in childbearing years are part of the work force. (1)

• Businesses that accommodate breastfeeding have fewer health claims due to less illness among the breastfed children and reduced absenteeism due to care for ill children.

• There is lower health care cost (an average of $400 per baby over the first year).

• There is improved employee productivity with increased loyalty and morale with an earlier return from maternity leave.

• Organizations create a family-friendly image in the community and improve their ability to attract and retain valuable employees. (9-14)

• Accommodating breastfeeding employees is good for the worksite and not difficult or expensive to implement.

3. NNBC representatives spoke at 94 of the 110 Chapter Houses, gaining their approval for the Worksite Breastfeeding Resolution:

.

 

For further information:Roberta Duncan, rmduncan2003@yahoo.comOra Nez, nativekeebler@hotmail.comAmanda Singer, asinger_07@yahoo.comLorraine Whitehair, lwhitehair@cdc.govSamantha Interpreter, samantha.interpreter@ihs.gov Sue Murphy, Suzan.Murphy@ihs.govWith appreciation for printing assistance, H Baheshone

Navajo Nation Breastfeeding CoalitionCDC, I.H.S., WIC, Tribal Health

W. Daychild

Percent of Chapters with Workplace Breastfeeding Resolutions, Navajo Nation 2008

Navajo Tribal Council Fort Defiance BF Task Force Members

2008 Navajo Nation Healthy Start Act

Amanda Singer, OraNez, Roberta Duncan

Oct 22, 7:34 PM EDT

New Navajo law provides breast-feeding rights

 

By FELICIA FONSECA Associated Press Writer

 

FLAGSTAFF, Ariz. (AP) -- Navajo lawmakers have approved a measure that would require employers on the reservation to provide a place for working mothers to breast feed.

 

The Tribal Council voted 64-0 in favor of the bill Wednesday as it wrapped up its fall session in the tribal capital of Window Rock.

 

Under the Navajo Nation Healthy Start Act, mothers would be allowed unpaid time during work hours to breast feed their children or use a breast pump. Roberta Duncan, a member of a breast-feeding task force that pushed for the tribal law, says many women cite work as a barrier to starting and continuing to breast feed their children. She said many women feel they can't ask their supervisors to breast feed and fear resistance from co-workers.

"It's very hard on them emotionally," Duncan said. "It's like they're asking for something they have no right to ask for."

 

Businesses would have 90 days to send a written plan to the Office of Navajo Labor Relations detailing the ways in which they'll comply with the law. Navajo President Joe Shirley Jr. has 10 days to sign or veto the measure once it reaches his desk. Duncan said businesses she has talked to have been mostly supportive of the law but have raised concerns that it would be unfair to other employees and said that if working mothers wanted time to breast feed, they just had to ask.

 

Duncan estimates that 5,000 women of childbearing age, between 16 and 44 years old, would be affected under the law.

 

Amanda Singer, a breast feeding counselor for the federal Women, Infants and Children, or WIC, program on the reservation, said if a woman chooses to breast feed, the agency calls ahead to the woman's employer and asks how she will be accommodated. "We try to encourage them to approach their supervisors whether they're female or male," Singer said. Breast feeding has been praised as a nutritional, economical and emotional benefit for both women and children, but the number of women who breast feed on the reservation declines mostly as a result of returning to work, Duncan said. According to WIC statistics on the reservation, 74 percent of mothers start out breast feeding, and that declines to 35 percent after six months and to 23 percent after 12 months.

 

Council Delegate Alice Benally, who sponsored the tribal measure, breast fed both of her children, and as a grandmother, encourages younger family members to do the same. "As a mother, I feel it is a healthy start for our children, and this service to our babies will never end as long as we have females, we have pregnancies, we have child birth," she said.

 

Mothers who breast feed already have some protections under tribal law, which requires that employers provide a safe and clean working environment free from prejudice, intimidation and harassment.

The breast-feeding law would be overseen by the Navajo Nation Labor Commission.

 

Benally said she is hopeful businesses will adhere to the law and the commission won't have to enforce sanctions.

"I guess we won't really know what we're up against until the act actually comes into play," she said. "If there are any abuses, misuses, the supervisors in these various programs where these mothers are employed will have to adhere to the policies that are already in place.

 " Copyright 2008 Associated Press

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The SUCCESSES:

• In October 2008 the Navajo Tribal Council voted overwhelmingly to approve the Health Start Act.

• In November 2008, Navajo Nation President Joe Shirley signed the Act.

• The act formally provides provision for unpaid flexible breaks and a clean place that is not a bathroom to allow a working mother to breastfeed or use breast pump.

• In the winter of 2008, the NNBC along with the Arizona Breastfeeding Coalition (ABC)were award the US DHHS Health Resources and Service Administration (HRSA) and the Office on Women’s Health (OWH) grant. The HRSA Business Case for Breastfeeding training grant will provide training for about 50 and funding for outreach to businesses on the Navajo reservation.

The Future:

NNBC will use the HRSA training and the many collaborations to implement the new law.  Evaluating progress and maintaining momentum (15-18):

• US Breastfeeding Report Card • 2007 CDC National Survey of Maternity Practices in Infant Nutrition and Care ( mPINC)• CDC and State Breastfeeding Teleconferences and the CDC Guide to Breastfeeding

Interventions. • Indian Health Service (including Navajo Area Indian Health Service) has recently added infant

feeding questions to the electronic health record data base to capture breastfeeding data among AI/AN population

The NNBC has demonstrated Margaret Mead’s quote, “Never doubt that a small group of thoughtful, committedcitizens can change the world. Indeed, it's the only thing that ever has.“

• A small group of compassionate and informed tribal members began with an important goal. • They worked strategically to gain partnerships with agencies, communities and tribal leaders

across the Navajo reservation. • They inspired the Navajo Nation Council to complete the legislative process for the passage of the

Navajo Nation workplace breastfeeding support law. • Resources and strong partners are working to make accomodation of breastfeeding in the

workplace a reality. • The voice of the Navajo Nation Breastfeeding Coalition has been heard and powerful change has

resulted. • The future is brighter now.

 

References1. U.S. Census Bureau, The American Indian and Alaska Native Population: 20002. Navajo Nation Division of Economic Development. 2002-2003 Comprehensive Economic Development Strategy of The Navajo Nation.3. Indian Health Service. Regional Differences in Indian health. Rockville, MD: US/DHHS 20004. CDC. Prevalence of Diagnosed Diabetes Among American Indian/Alaska Native United States, 1996. Morbidity and Mortality Weekly

Report 1998/ 47(42);901-9045. Centers for Disease Control and Prevention (CDC) Pediatric Nutrition Surveillance 2007 Report.6. Acton, K. J.et.al.: (2000) Trend in diabetes prevalence among American Indian and Alaska Native children, adolescents, and young adults .

Am J Public Health. 2002;92(9):1485-90. 7. Ip S et al. Breastfeeding and maternal and infant health outcomes in developed countries. Evid Rep Technol Assess. 2007 Apr;(153):1-186.  8. Owen CG. et al. Effect of infant feeding on the risk of obesity across the life course: a quantitative review of published evidence .

Pediatrics 2005;115(5):1367-77.9. Fein, B. et al. (1998). The effect of work status on initiation and duration of breastfeeding. American Journal of Public Health. 88(7): 1042-

1046.10. Cardenas R & Major D.(2005) Journal of Business and Psychology. 20(1):31-51.11. Galtry J. (2003). Lactation and the labor Market: breastfeeding, labor market changes, and public policy in the US. Health Care Women

Int.18:467-480.12. Cohen, R, Mrtek, MB, & Mrtek, RG. (1995). Comparison of maternal absenteeism and infant illness rates among breastfeeding and

formula-feeding women in two corporations. American J of Health Promotion, 10(2):148-153.13. Mutual of Omaha. (2001). Prenatal and lactation education reduces newborn health care costs. Omaha, NE: Mutual of Omaha.14. Ortiz, J, Mc Gilligan K, & Kelly P. (2004). Duration of breast milk expression among working mothers enrolled in an employer-sponsored

lactation program Pediatric Nursing, 30(2):11-119.6.15. CDC/Division of Nutrition, Physical Activity and Obesity, National Center for Chronic Disease Prevention and Health Promotion. The

Breastfeeding Report Card. July 29, 2008. http://www.cdc.gov/breastfeeding/data/report_card.htm 16. CDC/Division of Nutrition, Physical Activity and Obesity, National Center for Chronic Disease Prevention and Health Promotion. 2007 CDC

National Survey of Maternity Practices in Infant Nutrition and Care (mPINC). 17. National Immunization Survey. (2005). www.cdc.gov/breastfeeding/data/NIS_data/data_2005.htm 18. I.H.S. Infant Feeding Tool. http://www.ihs.gov/MedicalPrograms/MCH/M/bf.cfm   

When a mother nurses her baby, she is giving that child her name,

her story and her life’s song.

A nursed baby will grow to be strong in body, mind and spirit.

Annie Kahn, Traditional Wisdom

Bin dii awee’ be ma deelt’ o’

Chapters

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