Bclac Grant Proposal Final

Lactation Education and Peer Support Program 1
Lactation Education and Peer Support (LEaPS) Program:

A Grant Proposal to Educate and Empower
Male Partners on Breastfeeding Support

A Grant Proposal from the Breastfeeding Coalition of
Los Angeles County

Rachel Cox
Alane Cruz
Jenny (Muoi) Nguyen
Trang Phan
MPH 636
University of San Francisco
School of Nursing and Health Professions
July 9, 2013


The Breastfeeding Coalition of Los Angeles County
10990 Wilshire Blvd, Suite 900 | Los Angeles. CA 90024 | (310) 555-6789

August 6, 2013

Ms. Cherie Clements
Grant Administrator
W.K. Kellogg Foundation
One Michigan Avenue East
Battle Creek, MI 49017-4012

Dear Ms. Cherie Clements,

Our organization, the Breastfeeding Coalition of Los Angeles County (BCLAC), has
created a one year pilot Lactation and Education and Peer Support Program, entitled LEaPS, to
address the need of male partner support for breastfeeding. The goal of the LEaPS program is to
increase six month exclusive breastfeeding rates for women enrolled in the Los Angeles County
WIC program through male partner lactation education and support. Our organization plans to
provide services by partnering with Los Angeles County WIC centers and clinics, and plans to
launch our pilot program at WIC St. Andrews Place Clinic.
In California, the exclusive breastfeeding rate of 21.7% is not far from the Healthy
People 2020 target goal of 25.5%. In Los Angeles County, however,16% of women breastfeed
exclusively for 6 months, while only 9% of WIC participants breastfeed exclusively for 6
months. With the majority of breastfeeding interventions primarily focused in hospital settings
educating only mothers, this proposed program acknowledges the vital role male partners can
have on influencing breastfeeding behavior and will target this underserved population through
educational resources.
We recognize that the W.K. Kellogg Foundation (WKKF) invests in organizations that
aim to strengthen the network of groups working together to increase breastfeeding rates.
Because the overall goal of LEaPS is aligned with WKKFs Healthy Kids priorities, BCLAC
respectfully requests $110,218.00 for the first fiscal year to cover the development and
implementation of the program. Our organization is confident in our capabilities of achieving our
programs goal with the help of your organization. We would like to thank you for your
consideration and look forward to hearing from you.

Best regards,
The Breastfeeding Coalition of Los Angeles County (BCLAC)
Rachel Cox, Alane Cruz, Jenny (Muoi) Nguyen, Trang Phan


INTRODUCTION
Human milk is recognized as one of natures most amazing fluids, able to provide all the
nutritional needs of infants to ensure proper development. Infant formulas are able to mimic
some benefits of breast milk but are unable to fully duplicate the total range of nutrients
produced naturally by mothers. While formulas do provide the vitamins, minerals, and proteins
necessary for development, they fail to provide the antibodies, hormones, enzymes, and growth
factors found in breast milk (U.S. Department of Health and Human Services, 2011).
The benefits of breastfeeding are widely known and largely indisputable. Not only does
breastfeeding strengthen the bond between mother and child, it provides numerous health and
economic benefits as well. Studies have shown that breastfed babies have a reduced risk for
multiple diseases, including obesity, type 2 diabetes, asthma, and leukemia. In fact, a childs
obesity risk declines 4% for each month of exclusive breastfeeding (Miralles, 2006). The health
benefits of breastfeeding are not exclusive to the child either. Sustained breastfeeding has been
found to decrease a mothers risk of diabetes, ovarian cancer, and breast cancer by as much as
28% (Ip, 2007). From an economic viewpoint, breastfeeding is the ideal standard. According to
Bartick, if 90% of US families exclusively breastfed their children for at least 6 months, the US
would save $13 billion each year. Savings would come from reduced health expenditure as a
result of improved health status and reduced number of child deaths. This estimate does not
include families savings from eliminating the cost of formulas.
Despite the demonstrated benefits of sustained, exclusive breastfeeding, the percentage of
women exclusively breastfeeding their children remains low. The World Health Organization
(WHO), Centers for Disease Control and Prevention (CDC) and the US Surgeon General, Regina
Benjamin, all recommend exclusive breastfeeding for at least 6 months after birth. However, the
majority of US mothers do not meet this recommendation. In 2012 the CDC reported that 77%

of mothers initiated breastfeeding but only 16.3% sustained exclusive breastfeeding for 6 months
(CDC, 2012).. Studies have shown that these rates are even lower in low-income communities
(Heck, 2006; Nolan, 1995). For these reasons, improved breastfeeding rates are considered a
Healthy People 2020 objective. Objective MICH-21.5 hopes to increase the proportion of infants
who are breastfed exclusively through 6 months to 25.5%. Current standards reveal there is much
work to be done to meet this goal.
The Surgeon Generals Call to Action to Support Breastfeeding states that poor family
support, particularly from fathers, has a strong influence on a womans decision to not
breastfeed. In one study, 25% of women whose partners had participated in a program on
preventing common lactation problems were still breastfeeding at 6 months compared with 15%
of women whose partners did not participate (Pisacane, 2005). While fathers are often weary of
breastfeeding and its influence on a mothers work and family life, they can also be the most
effective positive influence in the decision to breastfeed. For this reason, the fathers role in
breastfeeding support has become a common target for increasing exclusive breastfeeding rates.
The Lactation Education and Peer Support (LEaPS) program will target the male partners
of pregnant women in LA Countys WIC program with the goal of moving the exclusive
breastfeeding rate of participants toward the Healthy People 2020 goal. This one-year pilot
program will partner with WIC Los Angeles County and WIC St. Andrews Place Clinic to
effectively implement the program.
COMMUNITY NEEDS ASSESSMENT
In California, the exclusive breastfeeding rate of 21.7% is not far from the Healthy
People 2020 goal (CDC, 2012). However, the rate in Los Angeles County, particularly among
WIC participants remains much lower. In LA County, 16% of women breastfeed exclusively for

6 months while only 9% of WIC participants do so (Langellier, 2012). These statistics present
an urgent need for intervention in the Los Angeles WIC community.
While there are 20 WIC clinic locations in Los Angeles County and all provide
breastfeeding support to mothers, none currently offer breastfeeding support and education to
male partners. LEaPS will target male partners of WIC participants throughout Los Angeles
County, however sessions will be held at the WIC St. Andrews Place Clinic, which is located
near the highways 110 and 105 interchange in South Los Angeles. Although all Los Angeles
WIC members will be eligible, the specific districts expected to be served most by this location
are Westmont, Willowbrook, and Watts, areas with high Latino and Black populations and
average family income near the federal poverty level (Appendix A).
Low-income minority women are among those least likely to sustain exclusive
breastfeeding for 6 months (Heck, 2006). Reasons for this include barriers to health services and
education, the necessity of returning to work, lack of reliable childcare, and poor family support.
Because family support, particularly from male partners, has been shown to dramatically
improve exclusive breastfeeding rates in low-income communities, partnering with Los Angeles
County WIC and St. Andrews Place presents an ideal opportunity to target those demonstrating
the need for intervention.
PROGRAM THEORY
Theory of Planned Behavior
The Lactation Education and Peer Support (LEaPS) program is based on the Theory of
Planned Behavior (TPB). TPB explains that intention is the strongest predictor of behaviors and
focuses on three main constructs that affect intention: attitude, subjective norms, and perceived
control (Glanz, Rimer, & Viswanath, 2008). Attitude is defined as the positive or negative

feelings about performing the behavior. Subjective norms are beliefs of how others view you and
the social pressure to perform the behavior. Perceived control is simply ones perception of their
ability to carry out the behavior. TPB also inserts that attitude towards the behaviors is a much
better predictor of the behavior than attitudes towards the object (Glanz et al., 2008).
In accordance to TPB, it is predicted that through educating male partners about the
benefits and significance of maintaining breastfeeding for at least 6 months, LEaPS will promote
a positive attitude towards the behavior, thus increasing male partners support for breastfeeding.
Indirectly, LEaPS will affect mothers subjective norms of breastfeeding, influencing mothers
intention to sustain the behavior.
Evidence Base
Recent studies have found measurable effects between male partners attitude and
mothers intention to breastfeed. Mitchell-Box et al. (2013) examined infant-feeding attitudes in
low-income women and their male partners using the Iowa Infant Feeding Attitude Scale
(IIFAS) (Appendix C), a measure of association between male partners attitude and mothers
intention to breastfeed. Results indicated that scores between the two variables were highly
correlated, with higher scores linked to greater intention to breastfeed. Mothers intention to
breastfeed increased almost 20% based on their partners attitude. With the strong relationship
between the attitude of a male partner and a mothers intention to breastfeed, we can further
improve breastfeeding rates through targeting male partners attitude and increasing their support
for breastfeeding.
Education-based program interventions designed for male partners have been effective in
increasing partner support for breastfeeding. Wolfberg et al. (2004) administered a two-hour pre-
natal intervention which educated fathers about infant care and encouraged fathers to advocate

for breastfeeding. They found that there was 74% breastfeeding initiation rate in the intervention
group compared to 41% in the control group. Education played a key role in transforming
attitudes of male partners and also filled the knowledge gap on breastfeeding. Male partners not
only learned about the benefits of breastfeeding but also how they can actively become a part of
the feeding process, which has historically been viewed as a womens responsibility.
Cohen, Lange, and Slusser (2002) found that mothers identified their babys father as one
of the strongest influences on the initiation and duration of breastfeeding. Several studies have
supported the significant role that family members play in a mothers intention to breastfeed
(Humphrey, Thompson, & Miner, 1998; Mitchel Box et al., 2013). Humphrey et al. (1998) found
that intention to breastfeed was correlated with hearing about the benefits of breastfeeding from
family members, the babys father, and lactation consultants, but not other health professionals.
With the majority of breastfeeding interventions primarily focused in hospital settings and
educating only mothers, this proposed program shifts to acknowledge the vital role that male
partners can have on influencing breastfeeding behavior and targets this underserved population
through providing lactation education and peer support.
PROGRAM DESCRIPTION AND ACTIVITIES
The LEaPS one-year pilot program will enlist a lactation consultant and a male peer
counselor to deliver support and education to male partners of breastfeeding women. The
program will recruit male partners of expecting mothers from the Los Angeles County WIC
Program. Recruited male partners will be assigned into three cohorts in the third, fourth, and fifth
month of the grant period.
Each cohort will be composed of the first 20 male partners to enroll. Cohort 1 will begin in
the third month, cohort 2 will begin in the fourth month, and cohort 3 will begin in the fifth

month. All cohorts will receive the same curriculum, with session 1 taught during week 1 and
session 2 taught during week 3 of their respective months. With an emphasis on education and
support, session 1 will be led by a lactation consultant and session 2 will be led by a peer
counselor. Each session will be one hour in length and held at the WIC St. Andrews Place
Clinic. Figure 1 shows the division of cohorts by months and session week.

Figure 1. LEaPS Pilot Program Cohorts and Session Weeks

Standardized measures will be utilized along with follow-up calls to assess the attitudes
of participants and the duration of breastfeeding. The Iowa Infant Feeding Attitude Scale
(IIFAS), which has been employed in various studies on male attitudes of infant feeding, will be
administered to male partners at baseline during the initial recruitment and again upon the
completion of the two sessions to measure change.
Description of duties and requirements for core program staff are detailed below.
1. LEaPS Lactation Consultant
Duties: The LEaPS Lactation Consultant will be responsible for providing the first introductory
session (Session 1) to male partners. Session 1 will cover topics such as what to expect the first
few weeks of birth, basics of breastfeeding, health benefits of breast milk, infant nutrition,
applicable laws and the importance of maintaining breastfeeding during the first six months. The
Cohort 1
(20 participants):

Begin in 3rd month
Session 1 (week 1):
Lactation Consultant
Session 2 (week 3 ):
Peer Counselor
Cohort 2
(20 participants):

Begin in 4th month
Session 1 (week 1):
Session 2 (week 3):
Peer Counselor
Cohort 3
(20 parcipants):

Begin in 5th month
Session 1 (week 1):
Session 2 (week 3):
Peer Counselor

lactation consultant will be responsible for providing training and supervision for peer
counselors. This personnel will also be responsible for assessing perceived barriers and cultural
differences to sustaining breastfeeding and assist participants to overcome these barriers.
Requirements:
Licensed as a Registered Nurse (RN) in the State of California.
Completed training and obtained a registration as an International Board Certified
Lactation Consultant (IBCLC).
Knowledge of federal, state, and local policies and regulations that pertain to WIC
services, breastfeeding and lactation consultation.
Experience with supervising and training peer counselors
Bilingual in Spanish and English
Supervision: The Lactation Consultant will operate under the Program Director.
2. LEaPS Peer Counselor
Duties: The LEaPS Peer Counselor will be responsible for teaching Session 2 to each cohort,
which will examine the topic of male partners role in breastfeeding, how to support a
breastfeeding mother, and how to encourage mothers to maintain breastfeeding. As part of
the programs protocol, the Peer Counselor will maintain documentation of concerns and
suggestions from participants of the program. The Peer Counselor will also administer the
final IIFAS (Iowa Infant Feeding Attitude Scale) to participants upon the completion of the
two sessions.
Requirements: (Similar requirements of a trained Female WIC Peer Counselor):
Will attend a series of breastfeeding classes which includes a 16-hour competency-based
course overseen by the Lactation Consultant

Will observe other peer counselors or lactation consultants helping mothers breastfeed
Will read assigned books or materials about breastfeeding
Will complete required Breastfeeding Peer Counselor trainings
Has personal experience as a male partner of a breastfeeding mother
Supervision: The Peer Counselor will be supervised by the Lactation Consultant
3. Program Assistant
Duties: The Program Assistant is responsible for operational functions. This personnel will be
responsible for the recruitment process by maintaining a mailing database of potential
participants. They will also be responsible for enrollment by keeping a roster of participants,
database of participant information, and an attendance log. They will support the data collection
process by calling mothers to collect the following data at 3 months and 6 months.
Mothers perceived support
Duration of breastfeeding
Continuing barriers (if any)
Requirements:
Bachelors degree
At least one year of administrative experience
Preferred knowledge of breastfeeding and associated barriers
Strong interpersonal skills to communicate with program staff and participants
Bilingual in Spanish and English preferred
Supervision: The Program Assistant will be supervised by the Program Director.
4. Program Director
Duties: The Program Director is responsible for the executive management of LEaPs. This

individual will implement LEaPs goal and main objectives. The Program Director will be
responsible for the hiring process, staff development, and community collaboration.
Additionally, the Program Director will manage program budget, staff, and communication
with grant funders.
Requirements:
Bachelors degree
Preferred knowledge of breastfeeding and associated barriers
At least 2 years of management experience
Must have experience with managing staff and fiscal budgeting
Strong leadership skills to manage and oversee program staff and participants
Bilingual in Spanish and English preferred
PROGRAM GOAL AND OBJECTIVES
The program goal is to increase the six month exclusive breastfeeding rate among LEaPS
participants through male partner education and support. To accomplish this goal, the following
objectives and evaluation methods were developed.
Objective 1: By the end of the two sessions, 80% of male participants will have a positive
attitude toward breastfeeding and understand its benefits.
Evaluation: The Iowa Infant Feeding Attitude Scale (IIFAS) (Appendix C), a
standardized survey, will be administered at baseline during the initial recruitment of
male partners and again after the completion of session two to measure change in
attitude.
Objective 2: 80% of participating mothers will feel that male partners are supportive and
encouraging of breastfeeding maintenance.

Evaluation:
Mothers will be contacted via phone to complete pre and post surveys to measure
perceived partner support.
o Contacted one week before male partners begin program
o Contacted three months after program enrollment
o Contacted six months after program enrollment
We will establish a threshold of what is considered successful attitudes.
Objective 3: 25.5% of women whose partners are enrolled in LEaPS will exclusively breastfeed
for at least 6 months.
Evaluation: Duration of exclusive breastfeeding will be measured through a self-reported
questionnaire which will be administered during a follow-up call to mothers six months
following matriculation.
RESOURCE NEEDS AND BUDGET
Resources
In partnership with WIC St. Andrews Place, the clinic will provide the following in-kind
contributions for program use. A Memorandum of Understanding (MOU) has been drafted to
establish partnership agreements (Appendix D).
Facility use (one classroom to be used twice a month for three months)
Basic breastfeeding supplies for educational use (hand breast pump, electric breast pump,
and baby bottles)
Electronic and technological equipment for classroom instruction (projector and
computer)


Budget
The budget will account for the employment of two FTE employees, two part-time hourly
employees, one contractor, and operational supplies. LEaPs Lactation Consultant will be paid an
hourly rate of $34/hr and Peer Counselor will be paid $15/hr, based on national average wage
derived from Indeed.com. The direct cost of $103,200 will be allocated to employ the Program
Director and Program Assistant and account for fringe benefits. An external Program Evaluation
Consultant will be hired as a contractor at the hourly rate of $40/hr to ensure unbiased program
evaluation. An MOU has been drafted to establish employment agreements (Appendix D).
Material costs include office supplies, educational pamphlets and promotional flyers, which are
necessary for program operations. The detailed projected budget for fiscal year 2014-2015 is
shown in Appendix E.
OVERALL PROGRAM IMPLEMENTATION
LEaPS will begin January 1, 2014 and continue through January 1, 2015.
Recruitment
In the first month of the program, LEaPS will hire a Lactation Consultant, a Peer
Counselor, and supporting staff. Flyers will be sent to LA WIC participants households to
recruit male partners. The recruitment of participants will continue from the first month to the
fourth month of the program. Eligible participants will be male partners of mothers who have
given birth within two weeks prior to cohort start date.
Program duration The Program Director and Program Assistant will oversee the
implementation of LEaPS curriculum. The Lactation Consultant and Peer Mentor will conduct
cohort sessions and will report participants feedback directly to executive staff.


Evaluation
Key milestones will be recorded and reported to funders during the fourth, eighth, and
twelfth months. Program evaluation will be conducted from months ten to twelve.
Appendix F depicts the detailed program timeline to be implemented upon funding.
PROGRAM EVALUATION
The program evaluation will assess the outcomes of LEaPS objectives and what made
these outcomes possible. We will determine the success of the program based on both
quantitative and qualitative data that will be collected via surveys and questionnaires from male
participants and their female partners.
All data acquired from program evaluation will be used to make any necessary
improvements for future development. Qualitative data collected will assess the overall
experience, attitude, feelings, concerns and suggestions of the male participants and their female
partners. The survey results taken at the beginning of our program will be compared to the final
survey taken by all our participants. Quantitative data will measure the number of female
participants exclusively breastfeeding six months after enrollment. Attrition rate will be
measured through attendance records.
The Program Director will submit reports to funders during the fourth, eighth, and twelfth
months of the program. Documentation of participant feedback regarding programmatic, cultural,
and informational barriers will be recorded throughout the program. These reports will verify
that services are being offered on schedule and to ensure that necessary data has been collected.
The Program Director will also conduct the initial comprehensive evaluation of LEaPS. Towards
the end of the evaluation period, a consultant will be contracted to conduct an independent

evaluation, which will then be compared to the Program Directors. This will ensure a complete
and unbiased evaluation.
ETHICAL CONSIDERATIONS
There are a few ethical elements to consider. In regards to any existing federal legislation
concerned with breastfeeding, under section 4207 of the Patient Protection and Affordable Care
Act of 2010 (also known as Health Care Reform), employers are required to provide reasonable
break time and a private, non-bathroom place for nursing mothers to express breast milk during
the workday, for one year after the childs birth. LEaPS will ensure that men and their partners
are aware of this law.
Another thing to be mindful of are confidentiality policies, namely the Health Insurance
Portability and Accountability Act (HIPAA). It is vital that all medical information is kept
private, and that every discussion held in our facility is kept confidential. For data collecting and
analyzing purposes, participants will be assigned identification numbers. Every program
participant will be fully informed about confidentiality policies during their enrollment process.
One last thing to be aware of are potential cultural and financial conflicts of interest.
LEaPS will not include anything in the curriculum that may not be culturally sensitive. LEaPS
will not pressure participants to purchase any supplemental equipment or product.
SUSTAINABILITY PLAN
LEaPS will continue to work with those enrolled in the Los Angeles County WIC
program. With the continued support of WIC, funders, and community partners, LEaPS plans to
offer services to as many male partners as possible. If this program is found to be successful,
LEaPS will expand services to surrounding WIC centers in Los Angeles County, provided the
program receives increased funding and community support. Each on-site location will be

responsible for hiring and training their staff for their respective program. Programs will be as
uniform as possible, with the exception that certain WIC centers may make adjustments to cater
to any unique demographics in the population they are serving.
CONCLUSION
Breastfeeding is beneficial not only to the infants health, but the mothers health as well
(Harwood, 2011). With the support of their male partners, mothers are more likely to sustain
breastfeeding exclusively for a longer duration of time (Maycock, Binns, Dhaliwal, Tohotoa,
Hauck, Burns & Howat, 2012). Thus, educating and training males on how to support their
partners during the experience of breastfeeding is crucial in reaching the goal of increasing the
rates of exclusive breastfeeding for up to six months amongst women. Current interventions are
generally hospital-based and do not take into account the role of male partners, leaving this
population underserved. Using the Theory of Planned Behavior to target this population will
increase positive attitudes towards breastfeeding, thus promoting successful, exclusive
breastfeeding maintenance for six months.
Targeting the Los Angeles County WIC population will provide the low-income,
minority population with the breastfeeding resources and expertise to overcome perceived
barriers. This will ensure a healthier lifestyle for them and their child(ren). Male partners should
realize that they must be involved in the process of breastfeeding as well it is not only the
mothers responsibility. LEaPS seeks to empower male partners to be more involved not only
during this unique time of breastfeeding, but in any and every health decision for their child and
female partner.

References

Bartick M, Reinhold A (2010). The burden of suboptimal breastfeeding in the United States: a
pediatric cost analysis. Pediatrics. 125:e1048e1056.
Centers for Disease Control and Prevention (2012). Breastfeeding Report Card United States,
2012. Atlanta, GA: Centers for Disease Control and Prevention, Division of Nutrition,
Physical Activity, and Obesity.
Cohen, R., Lange, L., & Slusser, W. (2002). A description of a male focused breastfeeding
promotion corporate lactation program. Journal of Human Lactation. 18(1):61-65.
De La Mora, A., Russell, D. W., Dungy, C. I., Losch, M., & Dusdieker, L. (1999). The Iowa
infant feeding attitude scale: analysis of reliability and validity. Journal of Applied Social
Psychology, 29(11), 2362-2380.
Glanz, K., Rimer, B.K., Viswanath, K. (2008). Health Behavior and Health Education.
Theory, Research, and Practice. San Francisco, CA: Jossey-Bass.
Harwood, K. (2011). Intent of expecting fathers to encourage breastfeeding, perceptions of
support and barriers to encourage breastfeeding. (Doctoral dissertation, University of
Nebraska-Lincoln). Retrieved from http://digitalcommons.unl.edu/cgi/viewcontent.
cgi?article=1022&context=nutritiondiss
Heck K, Braveman P, Cubbin C, Chavez G, Kiely J (2006). Socioeconomic status and
breastfeeding initiation among California mothers. Public Health Reports. 121.
Humphreys, A. S., Thompson, N. J., & Miner, K. R. (1998). Intention to breastfeed in
low income pregnant women: The role of social support and previous experience. Birth,
25(3), 169-174.


Indeed.com (2013, August 3). Lactation Consultant Salary in the United States. Retrieved from
http://www.indeed.com/salary?q1=Lactation+Consultant&l1=united+states
Indeed.com (2013, August 3). Peer Counselor Salary in the United States. Retrieved from
http://www.indeed.com/salary?q1=Peer+counselor&l1=United+States
Ip S, Chung M, Raman G, Chew P, Magula N, DeVine D, et al (2007). Breastfeeding and
maternal and infant health outcomes in developed countries: evidence report/technology
assessment no. 153. Rockville, MD: Agency for Healthcare Research and Quality.
AHRQ Publication No. 07-E007.
Langellier B, Pia Chaparro M, Whaley S (2012). Social and Institutional Factors that Affect
Breastfeeding Duration Among WIC Participants in Los Angeles County, California.
Maternal & Child Health Journal. 16(9), 1887-1895.
Maycock, B., Binns, C., Dhaliwal, S., Tohotoa, J., Hauck, Y., Burns, S., & Howat, P. (2013).
Education and support for fathers improves breastfeeding rates a randomized controlled
trial. Journal of Human Lactation. Retrieved from http://jhl.sagepub.com/content/early
/2013/04/18/0890334413484387.full.pdf+html
Miralles O, Snchez J, Palou A (2006). A physiological role of breast milk leptin in body weight
control in developing infants. Obesity. 14(8):1371-1377.
Mitchell-Box, K., Braun, K. L., Hurwitz, E. L., & Hayes, D. K. (2013). Breastfeeding
attitudes: Association between maternal and male partner attitudes and breastfeeding
intent. Breastfeeding Medicine.
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Patient Protection and Affordable Care Act, 156 U.S.C. 4207 (2010).

Pisacane A, Continisio GI, Aldinucci M, DAmora S, Continisio P (2005). A controlled trial of
the fathers role in breastfeeding promotion. Pediatrics. 116:e494e498.
Tohotoa, J., Maycock, B., Hauck, L.H., Howat, P., Burns, S., & Binns, C.W. (2009). Dads make
a difference: an exploratory study of paternal support for breastfeeding in Perth, Western
Australia. International Breastfeeding Journal, 4(15). Retrieved from
http://www.internationalbreastfeedingjournal.com/content/4/1/15
U.S. Department of Health and Human Services (2010). Office of Disease Prevention and Health
Promotion. Healthy People 2020. Available at
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nfant,%20and%20Child%20Health&objective=MICH-21.5&anchor=102929. Accessed
July 6, 2013.
U.S. Department of Health and Human Services (2011). The Surgeon Generals Call to Action
to Support Breastfeeding. Washington, D.C.: U.S. Department of Health and Human
Services, Office of the Surgeon General.
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J.(2004). Dads as breastfeeding advocates: results from a randomized controlled trial of
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Appendix A

Demographics of Los Angeles County Surrounding WIC St. Andrews Place

Figure A1. Demographics of Westmont neighborhood in Los Angeles County. Retrieved from
http://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=DEC_10_D
P_DPDP1

Figure A2.Demographics of Willowbrook neighborhood in Los Angeles County. Retrieved from
http://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_11_5Y
R_DP05

Figure A3. Demographics of Watts neighborhood in Los Angeles County. Retrieved from
http://maps.latimes.com/neighborhoods/neighborhood/watts/#ethnicity


Appendix B

LA County WIC demographics of women and pregnant women by race.

Retrieved from http://www.phfewic.org/Projects/DataMining.aspx

Race
Women in LA County
WIC
Pregnant Women in LA
County WIC
Black or African
American
8.27% 8.74%
Hispanic or Latino 78.43% 79.62%
Indian 0.15% 0.15%
Islander 0.34% 0.28%
Multiracial 1.68% 1.56%
White 5.69% 5.06%
Asian 5.36% 4.46%
Other 0.09% 0.13%

Appendix C
Retrieved from http://www.docstoc.com/docs/31992513/Iowa-Infant-Feeding-Attitude-Scale-
_IIFAS


Appendix D

BCLAC Drafted Memorandums of Understanding

Figure D1. Memorandum of Understanding between BCLAC and WIC
DRAFT OF MEMORANDUM OF UNDERSTANDING

Memorandum of Understanding
Between
and
Californias Women, Infants, and Children (WIC) Clinic of St. Andrews Place

I. PARTIES

The Breastfeeding Coalition of Los Angeles County (BCLAC) and Californias Women, Infants,
and Children (WIC) Clinic of St. Andrews Place have entered into this Memorandum of
Understanding (MOU).

II. PURPOSE

This MOU is developed for the ultimate purpose of establishing a formal office and classroom
setting and access to breastfeeding materials intended to implement, the Lactation Education and
Peer Support (LEaPS) Program, a one-year pilot education and support program targeting male
partners of low-income women in the Los Angeles County WIC Program developed by the
Breastfeeding Coalition of Los Angeles County (BCLAC).

III. AGREEMENT

Both parties agree that this collaboration is intended to:

a. Support women in maintaining six-month exclusive breastfeeding rates in low-income
women in Los Angeles County
b. Increase and enhance referrals between the St. Andrews Place and LEaPS Program thus
benefiting low-income, eligible families
c. Reduce program costs by collaborating on selected educational materials and
training/professional development opportunities for staff of both programs
d. Foster collaboration and planning between the two programs

By partnering with BCLAC, WICs St. Andrews Place agrees to provide the following
contributions for LEaPs pilot program use:

Facility use:
a. Accessed to one classroom twice a month for three months
i. At a minimum each room will meet the following basic requirements:
1. Private locked room or other space (not restroom)

2. A minimum of 200 square feet of space
3. Clean, safe environment
4. Electrical outlets with surge protector to expand the outlets to 6

Basic breastfeeding supplies:
b. Hand breast pump, electric breast pump, and baby bottles
i. Hospital grade breast pump (durable pump that more than one mother can
use safely), which is approved by FDA and is BPA/DEHP free.

Electronic and technological equipment for classroom instruction:

c. Use of projector and laptops/computers

IV. TERMS OF UNDERSTANDING

The term of this MOU is for one year in length effective the date of this agreement and may be
extended upon written mutual agreement. Either organization may terminate this MOU upon
thirty (30) days written notice without penalties or liabilities.

Authorization

This Agreement is effective upon signatory approval from the parties and will remain effective
through _________.


Authorized Agency Representative Date

Californias Women, Infants, and Children (WIC) Clinic of St. Andrews Place



Figure D2. Memorandum of Understanding between BCLAC and External Evaluation Group
DRAFT OF MEMORANDUM OF UNDERSTANDING

Memorandum of Understanding
Between
and
External Program Evaluation Group

I. PARTIES

The Lactation Education and Peer Support (LEaPS) pilot program and External Program
Evaluation Group have entered into this Memorandum of Understanding (MOU).

II. BACKGROUND

In the years 2014-2015, the Breastfeeding Coalition of Los Angeles County (BCLAC) will
implement the Lactation Education and Peer Support (LEaPS) one-year Pilot Program whose
aim is to increase six month exclusive breastfeeding rates for women enrolled in the Los Angeles
County WIC program through male partner lactation education and support. The program will
utilize standardized measures and qualitative measures as methods of evaluation of male
partners attitude and mothers perceived support of breastfeeding from their partner. LEaPS
shall enlist the services from External Program Evaluation Group to evaluate the corresponding
questionnaires and data collected from LEaPS one-year pilot program participants. The allocated
funds are appropriated for their service at an hourly rate of $40/hour.

III. PURPOSE

This Memorandum of Understanding serves as a written agreement between the Lactation
Education and Peer Support (LEaPS) Pilot Program and the External Program Evaluation Group
to enlist its services in evaluating quantitative measures collected exclusively from LEaPS pilot
program participants.

IV. RESPONSIBILITIES

Within the scope of this agreement, External Evaluator Program Group will be responsible
for:

1. Establish and adhere to confidential procedures
2. Write final evaluation reports
3. *Duties will be further developed as needed


Within the scope of this agreement, LEaPS Program will be responsible for:
1. Provide feedback about data collection tools
2. Keep evaluator informed of program changes
3. Specify information to be included in report
4. Assist in interpretation of findings

V. TERMS OF AGREEMENT

The term of this MOU is intended to fund __X___hours of services from ___DATE____ to
___DATE____, effective the date of this agreement and may be extended upon written mutual
agreement. Either organization may terminate this MOU upon thirty (30) days written notice
without penalties or liabilities.

Authorization

This Agreement is effective upon signatory approval from the parties and will remain effective
through _________.



External Program Evaluation Group



Appendix E

LEaPS Projected Program Budget for the Fiscal Year 2014-2015
*Hours include required training hours and classroom instruction
** Fringe benefits are only available to FTE employees

MATERIAL BUDGET JUSTIFICATION
UNIT
AMOUNT
UNIT
COST
ANNUAL
COST
N
O
N
-
P
E
R
S
O
N
N
E
L

Office supplies Purchase of pens, pencils, paper, and postage ---------------- -------------- $500.00
Promotional flyers
Printing of program promotional flyers @$35/unit
(1 unit = 25 copies)
20.0 $35.00 $700.00
Educational pamphlets
Printing of pamphlets with educational breastfeeding
information @$35(1 unit = 25 copies)
4.0 $35.00 $140.00
Laptop computers
Needed for program word processing, record keeping, data
collection, reporting, and analysis
2.0 $1,500.00 $3,000.00
Subtotal 26.00 $1,570.00 $4,340.00

PERSONNEL

FTE
WORK
DAYS
HOURS
TOTAL
LABOR COST
PER HR($)
ANNUAL COST

P
R
O
G
R
A
M

P
E
R
S
O
N
N
E
L

FTE EMPLOYEES
Program Assistant 1.0 --------------- -------------- -------------------- $35,000.00
Program Director 1.0 --------------- -------------- -------------------- $45,000.00
PART-TIME EMPLOYEES
Lactation Consultant (hourly) * ------------- 7.00 22.00 $34.00 $748.00
Peer Mentor (hourly) * ------------- 7.00 22.00 $15.00 $330.00
CONTRACTOR
Program Evaluation Consultant ------------- 5.00 40.00 $40.00 $1,600.00
BENEFITS
Fringe Benefits (29% of salaries) ** $23,200.00
Subtotal 2.0 19.00 84.00 89.00 $105,878.00
Total $110,218.0

Appendix F

LEaPS Projected Program Timeline

PROJECTED PROGRAM TIMELINE
Activities
MONTH
1 2 3 4 5 6 7 8 9 10 11 12
Establish curriculum
(already completed)

Recruit and hire lactation
consultant, male peer counselor,
supporting staff, and volunteers

Train staff

Mail flyers to mothers and fathers
in LA County WIC program

Participants start courses (actual
instruction)

Participants will receive no
instructions

Evaluation of participant progress

Program evaluation

Progress to funders

Please note:
C1 = Cohort 1
C2 = Cohort 2
C3 = Cohort 3

C1
C2
C3
C1
C2
C3
C1
C2
C3
C1
C2
C3

Inputs
Outputs Outcomes
Our investments
Staff
Time
Money
Materials
WIC Partnership
Curriculum
development

What we provide
Classes conducted by
Lactation Consultants
and Peer Counselors to
educate male partners of
pregnant or
breastfeeding women
who are enrolled in the
Los Angeles County
WIC program

Who we reach
Mothers and male
partners in the Los
Angeles County WIC
program
Evaluation
1. 80% of male
partners support
breastfeeding
2. 80% of mothers
feel that male
partners are
supportive of
breastfeeding
3. 25.5% of mothers
will exclusively
breastfeed for at
least 6 months

Increased understanding
and knowledge of
breastfeeding
Increased positive
attitudes for
breastfeeding leading to
changed behavior
Increased motivations to
support mothers through
breastfeeding process
Increased peer support to
encourage and maintain
changed behavior
Feedback
LEaPS Program Framework
Appendix G

Lactation Education and Peer Support (LEaPS) Program Logic Model

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