Domain: Perinatal/Infant Health

Planning for October 2023-September 2024

Objective

• By 2025, increase the percentage of infants who have been breastfed ever by 5%, and increase the percentage of infants breastfed exclusively through 6 months by 20%.
• By 2025, increase the percentage of infants placed to sleep on their backs by 5%; increase the percentage of infants placed to sleep on a separate sleep surface by 15%; and increase the percentage of infants placed to sleep without soft objects or bedding by 15%
• By 2025, Minnesota aims to reduce the overall SUID rate by 15% and reduce the SUID rates between whites and African Americans and American Indians by 15%.

National Performance Measure

(NPM 4) A) Percent of infants who are ever breastfed; B) Percent of infants breastfed exclusively through 6 months.

Minnesota’s goal for FY2024 is that 94.5% of all infants are ever breastfed and 41.3% of infants are exclusively breastfed through 6 months.

(NPM 5) A) Percent of infants placed to sleep on their backs; B) Percent of infants placed to sleep on a separate approved sleep surface; C) Percent of infants placed to sleep without soft objects or loose bedding.

Minnesota’s goal for FY2024 is that 89.3% of infants are placed to sleep on their backs, 45.5% of infants are s placed to sleep on a separate approved sleep surface, and 60% of infants are placed to sleep without soft objects or loose bedding.

Evidence-Informed Strategy Measure

(ESM 4.1) Percent of births delivered at MDH Breastfeeding-Friendly Birth Centers.

Minnesota is constantly working toward policy and systems changes that foster optimal infant health outcomes in Minnesota. Supporting Baby-Friendly hospitals and birth centers[1], as well as environments, policies, and practices conducive to breastfeeding, are two avenues that Minnesota is fostering toward optimal infant health outcomes. MDH’s Minnesota Breastfeeding Friendly Birth Center (BFFBC) Recognition Program recognizes birth centers across the state that have taken steps toward implementing the Ten Steps to Successful Breastfeeding, and, in partnership with the Minnesota Breastfeeding Coalition, MDH convenes the monthly community of practice - 10 Steps Learning Collaborative for Birth Centers.

Minnesota’s goal for FY2024 is that 29.4% of births are delivered at a MDH breastfeeding-Friendly Maternity Center.

(ESM 5.2) Proportion of mothers who were told by a healthcare provider to place their baby on his or her back to sleep.

Safe sleep modeling occurs when hospitals develop, implement, maintain, and enforce a safe sleep policy that aims to prevent sleep-related injuries and deaths. Additionally, staff in turn serve as role models for safe sleep by intentionally conveying messages and cues to parents that promote sleep safety for infants.

Minnesota’s goal for FY2024 is that 95.8% of mothers were told by a healthcare provider to place their baby on their back to sleep.

Community-Identified Priority Need: Infant Mortality

For more information on the impact and importance of infant mortality on the lives of people living in Minnesota, see the Infant/Perinatal Health 2022 Report.

Strategies and Activities

A.  Strategy A: Apply Culturally Specific, Community Based Best Practices

1.  State Level Activities

1.1  Provide Supports for Healthy Pregnancy and Parenting Outcomes

African American Babies Coalition (AABC)  

The AABC is a community group through the Wilder Foundation focused on improving birth outcomes in Black and Brown communities in Minneapolis and St. Paul. In 2023, the Minnesota State Legislature allocated a total of $576,000 grant to the AABC for FY2024 and 2025 to: 

• Provide community-driven training and education on community-informed best practices to support healthy development of babies during pregnancy and postpartum. 
• Build capacity, train, educate, and improve practices among individuals, from youth to elders, serving families with members who are Black, Indigenous, or people of color during pregnancy and postpartum. 

One component offered by the AABC is the Birthing Fruition 5 Prong Training Program. This program was designed to train community health workers, health care workers, early childhood educators, and doulas to provide quality culturally appropriate services to families with the goals of reducing health disparities and achieving health equity. In 2023, the Legislature extended the grant until June 2027, and MDH will continue to support AABC’s programs with this additional funding.  

1.2  Partner with Community Organizations to Support System Change and Innovative Solutions

In 2017, St. Paul-Ramsey County Public Health used Title V funds to create and implement the Birth Equity Community Council (BECC), a community-led collaborative to improve birth outcomes and reduce infant mortality racial disparities. BECC’s activities are around the core strategy areas of training, celebrations, policy, and a key priority, supporting fathers – such as the Doula Dads Project. Title V staff will continue to partner with BECC in FFY2024, serving as a state public health advisor and participating on BECC subcommittees, as well as providing technical assistance, strategic planning, and data analysis support. MDH benefits from this partnership by learning from the African American community about what matters to them in improving birth outcomes through drawing from their expertise, wisdom, strength, and resilience. 

1.3  Promote Culturally Specific Policy for Cradleboard Usage in Licensed Childcare Settings

MDH staff participate in a workgroup convened by the state legislature to examine current DHS statutes to ensure infant sleep safety in childcare settings and make recommendations for updating policy. In FY2021, MDH provided technical assistance to DHS for statute revisions related to licensed childcare providers requesting a variance to use cradleboards for cultural reasons when a parent requests one (Cradleboard is a traditional baby-carrier used by many Indigenous populations). The suggested revised language calls for MDH and DHS to create a cradleboard variance form in partnership with tribal social service agencies. In 2023, legislation passed and was signed into law by the Governor. MDH and DHS will continue to collaborate on the implementation of the new licensing requirements.

1.4  Promote Safe-Sleep Practices for All Infants

In 2023, the Legislature ended the Positive Alternative (PA) grant program, which among other activities provide safe sleep education and cribs to families in Minnesota. While this source of funding is no longer available, MDH will continue to support community-owned safe sleep education and support through new infant health grants under the Healthy Beginnings, Healthy Families program, which was created by the Legislature in 2003.

A strategy to reduce infant mortality in FFY2024 is to focus on reducing the incidence of sleep-related tragedies among infants by applying culturally specific community-based best practices. MDH will promote consistent and inclusive safe sleep messaging statewide and collaborate with our community stakeholders to expand community-based infant mortality prevention and culturally specific resources for populations at greatest risk of experiencing an infant death. This includes exploring partnerships with tribal health departments for cradleboard training/making classes available for American Indian families. 

MDH and stakeholders messaging will model the AAPs safe sleep recommendations to avert preventable sleep-related tragedies. The safe sleep and infant health promotion activities with community groups include: 

• The Governor’s proclamation for Infant Safe Sleep Week in Minnesota including a press release, social media and media coverage of safe sleep best practices 
• Partner with communities to conduct a needs assessment related to infant sleep and public awareness campaign 
• Expand collaboration with partners to provide infant health promotion messages, especially where baby products are sold 
• Promote infant public health messages at conferences, community, and tribal events, and at other types of family related activities and gatherings
• Provide trainings and/or presentations on SUID and infant safe sleep best practices to community-based organizations or professional groups upon request.

1.5  Expand Community-Based Infant Mortality Prevention Education

Although MDH has its own safe sleep campaign, the agency participates in the National Institute of Child Health and Development’s (NICHD) Safe to Sleep campaign, including NICHD’s safe sleep resources that target the public, parents, caregivers, grandparents, racial/ethnic groups, and health care providers. In addition to distributing the NICHD’s resources, MDH will continue to disseminate the safe sleep resources it has developed in house in multiple languages widely spoken in Minnesota, such as Hmong, Somali, and Spanish. 

To ensure that infant mortality prevention strategies reach Minnesota families, we plan to collaborate with existing community-based infant mortality initiatives, programs serving families of color and American Indian populations such as BECC, AABC, Healthy Black Pregnancies, Head Start, Tribal Health, and organizations that serve immigrants and refugees to further define strategies that support infant health promotion. We will use these partnerships to engage families of color and American Indian families for their input and recommendations for strategies to reduce the incidence of preterm birth, low birth weight, and birth defects, and to support infant safe sleep practices within their communities. Using this community input will help build interventions tailored to meet each community’s unique needs and strengths and provide a foundation to expand other activities to promote infant health and reduce infant mortality.

MDH will continue to use social media and other communication methods to focus on groups and geographic hot spots with the highest incidence of poor birth outcomes to disseminate information and resources to improve infant health and safety practices. MDH will also explore the possibility of including infant health promotion information (e.g., safe sleep and shaken baby prevention) into middle and high school health curricula, since some students may have younger siblings, are sometimes babysitters for neighbors, friends, and relatives, or may be/becoming parents themselves.

MDH will manage the AABC grant to improve pregnancy and postpartum outcomes among African American/Black communities and communities of color through capacity building, training education and improved practices. In FFY2024, AABC plans to:

• Collaborate with multiple partners, including Ramsey County’s BECC and the Cultural Wellness Center to implement several trainings and interventions aimed at improving maternal and infant health outcomes in communities of color and American Indian communities. Activities to be implemented include several community training sessions that cover a broad range of topics, including the social determinants of health, safety, breastfeeding, safety/health and the environment, children’s developmental milestones, adverse childhood experiences (ACES), and civic awareness and involvement. In addition to these activities, AABC plans to host a Black and Brown Birthing Summit in October 2023 that brings together health care providers, doulas, community advocates, and consumers to learn about successful or promising culturally appropriate efforts/interventions to improve maternal and infant health outcomes in Black and Brown populations in Minnesota or nationally. The summit will also include panel discussions or breakout sessions on MCH topics of great importance to Black and Brown communities such as systemic and environmental changes needed to facilitate improved pregnancy and birth outcomes within their communities. 
• Create two library spaces within a childcare center and an elementary school serving/attended filled with culturally relevant books by African American/Black, American Indian, and authors of color to promote story time and reading to Black and Brown infants and young children.
• Implement a Healthy Birthing Campaign based on learning and insights from Black and Brown communities.

1.6  Reduce Disparities in Modifiable Risk Factors for Birth Defects

IMPLICIT Model

The IMPLICIT grant (Interventions to Minimize Preterm and Low Birth-Weight Infants Using Continuous Quality-Improvement Techniques) facilitates the implementation of the IMPLICIT Interconception Care Model in primary care and family practice clinical settings, which involves parental screening at well child checks to identify risk factors for birth defects for future pregnancies. The grantee selected to implement the program recruited two Minnesota clinics for cohort one, which ran from January 2021 through March 2022.

The grantee began recruiting for cohort three in October 2022 and identified three clinics to begin implementation in April 2023, and these three clinics will continue through March 2025. The clinic from cohort two will assist in the implementation of the IMPLICIT Interconception Care Model for cohort three. 

Universal Congenital Cytomegalovirus (cCMV) Newborn Screening

In 2021, the Minnesota legislature passed a law known as the Vivian Act – named for Vivian Henrikson who was identified with congenital cytomegalovirus (cCMV) shortly after birth. The Vivian Act directs the Commissioner of Health to:

• Make information about cCMV, including preventative measures, available to health care providers, women who may become pregnant, expectant parents, and parents of infants.
• Establish an outreach program to educate women who many become pregnant, expectant parents, and parents of infants about cCMV.
• Raise awareness for cCMV among health care providers.
• Require the Advisory Committee on Heritable and Congenital Disorders to review cCMV for possible inclusion on Minnesota's newborn screening panel.

In 2022, the Advisory Committee recommended adding cCMV to the newborn screening panel, and the Commissioner of Health approved the recommendation. In 2023 Minnesota became the first state in the nation to screen every newborn for cCMV. In FFY 2024, Title V CYSHN staff will continue to partner with stakeholders to raise awareness for cCMV and provide information about cCMV, including preventative measures. 

1.7  Provide Culturally Specific Support for Breastfeeding

MDH staff will continue to support collaboration with cultural partners to develop breastfeeding materials and expand outreach to targeted cultural groups including the Hmong, Karen, American Indian and Somali communities. The collaborative efforts with each of these cultural communities will involve developing a better understanding of the meaning behind the community-specific data, determining community-specific data to share, and discussing community-driven strategies to reduce disparities. Additionally, MDH will conduct the following activities:

• In collaboration with the Minnesota Breastfeeding Coalition (MBC), MDH staff will provide financial and technical support to the Hmong Breastfeeding Coalition (HBC). With funding from HealthConnect One (HCO), HBC is creating a social media campaign to educate the Hmong community on breastfeeding. Upcoming projects for FFY2024 include developing support groups in the Hmong community, monthly gatherings focused on maternal and child health topics, and outreach at community events including the Hmong Freedom Festival and Hmong New Year. 
• MDH staff will continue to participate on the MBC Equity and Access, Finance, Governance, Events Planning, and Membership subcommittees. The coalition has statewide reach and includes two cultural coalitions. MBC is instrumental in policy, systems, and environment change (PSE). MDH will continue to foster connections with other community organizations pursuing PSE changes designed to improve perinatal health and breastfeeding and to reduce infant and maternal morbidity and mortality. 
• MN WIC and Title V staff will collaborate with the MDH Statewide Health Improvement Partnerships (SHIP) program to support local breastfeeding coalitions, and to mentor organizations to achieve workplace, public health, and childcare designation as MDH Breastfeeding-Friendly facilities. 

• MDH will continue to work with Coffective on the Strengthening Maternal and Child Health (MCH) Partners Collaboration Initiative. Improved collaboration helps to reduce disparities in birth and breastfeeding outcomes. The initiative will partner with WIC local agencies and local public health to strengthen local networks and improve community partnership coordination, with an emphasis on building relationship with local hospitals and clinics. 
• Strengthen connections with community organizations, including the Twin Cities Regional Breastfeeding Coalition, the MNPQC, the Minnesota Perinatal Organization and the BECC is ongoing. Conversations continue with African American/Black advocates, including the Moving Health Equity Data to Action (MEDA) project coordinator, to identify needs and opportunities in Black communities. The MBC will assist with grant writing to fund equity projects. 
• Improves breastfeeding rates and reduce cultural disparities in breastfeeding through MN WIC’s Peer Breastfeeding Support Program (PBSP). The PBSP applied for grant funding for FFY2024 to implement the HUG Your Baby program with WIC participants receiving peer services. The program would provide training to peer counselors on how to support parents understanding of infant cues and child development to extend breastfeeding duration. The program includes videos and handouts in English and Spanish to provide anticipatory guidance related to infant developmental stages that can impact breastfeeding success.
• Partner with FHV programs to encourage use of their funding to provide breastfeeding counselor training for home visitors, make referrals to the MN WIC Peer Breastfeeding Support programs, and actively partner with local breastfeeding coalitions.  
• Partner with MBC to continue exploring the feasibility of a certificate program in lactation at St. Catherine University, which would provide the prerequisites required for certification as an IBCLC.

In FFY2024, MDH will request operational adjustment grants through the United States Department of Agriculture (USDA) to: 

• Support projects that target Black, Indigenous, Hispanic, Hmong and rural communities that continue to experience disparities and inequities in breastfeeding rates. 
• Making webinars, through the Michigan Breastfeeding Network, available to health professionals beyond just WIC staff.  The webinars provide on-demand free breastfeeding-focused trainings with continuing education credit and focus on disparities and inequities. 
• Provide multi-level lactation trainings to WIC local agency staff and community partners. 
• Support the lactation station at the Minnesota State Fair, which offers a private, distraction free space to nurse and change diapers. It will feature four to five individual booths for families or individuals to use, as well as a lobby area inside the tent and two changing tables along with WIC outreach brochures.

2.  Local Public Health and Community Spotlight

2.1  Support Families to Achieve their Chest/Breastfeeding goals

The Minnesota Breastfeeding Coalition (MBC) will work with MDH, the Minnesota Milk Bank for Babies (MMBB) and food pantries across the state on a project to fully support chest/breastfeeding families. MMBB will continue efforts to expand the donor milk distribution model with Bridge Bags as their preferred community outreach. In 2024 MBC will expand implementation of these initiatives to locations across the state. Minnesota aspires to foster community-created solutions to cultural and historical barriers to achieving breastfeeding goals. 

2.2  Provide professional Development Support to Emerging and Established Lactation Professionals

MBC will continue efforts to foster the development of Black, Indigenous, Hispanic, Hmong, and rural lactation leadership in Minnesota, continuing partnerships with Saint Paul Ramsey WIC, Hennepin WIC, Hennepin Health, Regions Hospital, Methodist Hospital, and other birthing centers. Funding will be sought for development of a long-term, sustainable pathway for increased diversity in lactation leadership in Minnesota. 

Additionally, MBC will host its first in-person educational event since the pandemic, on October 12 & 13, 2023. The conference and annual meeting will be an opportunity for lactation advocates from across the state to build and strengthen relationships across sectors to improve continuity of care and consistent messaging.

B.  Strategy B: Improve Data Collection and Evaluation

1.  State Level Activities

1.1  Improve Data-Sharing between MDH and Partners

Minnesota has strict data privacy laws, which sometimes impede sharing infant health and mortality data among divisions within a state agency, with other state agencies, and with the public. Of particular concern is not being able to share infant mortality data when there are fewer than twenty infant deaths in a population even when such data are needed for policy and programmatic purposes.  In FFY 2024 MDH plans to: 

• Collaborate with the MN DHS – MN’s Medicaid Agency – to share pregnancy related vital records and/or other state programs to explore opportunities to improve pregnancy outcomes.  
• Work with MN WIC program to use vital records data and WIC data to evaluate pregnancy outcomes and services.  
• Continue efforts with the SDY Case Registry to share SUID data with all birthing hospitals around the state to help improve training and infant safe sleep practices.
• Seize opportunities to share or present data on infant health and mortality, including on social media, at conferences, meetings, and summits. 

1.2  Establish a Fetal and Infant Mortality Review (FIMR)

In 2001, the infant mortality statute that required the Commissioner of Health to conduct a FIMR in Minnesota was eliminated. Without the legislation in place, MDH lacks statutory authority to establish a FIMR process and committee. Without a FIMR, it will be difficult to access relevant information from important sources such as medical records, birth and death records, and coroner’s reports to understand fully the circumstances that may have contributed to infant deaths. Since 2014, staff have put forward legislative proposals to reinstate the FIMR without success. In 2021, the proposal advanced as part of the Governor’s biennial budget, but the proposal stalled because of concerns about data privacy. During the 2023 legislative session, MDH submitted a proposal to reinstate the FIMR, and it has been included in the Governor’s revised budget proposals for the 2024-2025 biennium. Unfortunately, the proposal was not successful, but MDH will continue to look for opportunities to advance other infant data initiatives, and provide support to cities, counties, tribes or other jurisdictions seeking to implement a FIMR or strategies to further reduce infant mortality and improve birth outcomes.

1.3  Establish the Minnesota Partnership to Prevent Infant Mortality (MPPIM)

In 2023, MDH reintroduced a proposal to support Healthy Beginnings, Healthy Families, which included the creation of the MPPIM. The proposed MPPIM is a statewide multisectoral effort that seeks to leverage existing partnerships and award competitive grants to community-based organizations, tribes, and local public health to improve infant health outcomes in the state’s Black/African American, American Indian, and communities of color in Minnesota. The MPPIM would serve as the implementation platform for the state’s Infant Mortality Reduction Initiative, and activities would include community engagement, exchange of best practices, data management, and advocacy. The proposal successfully passed by the Legislature and MDH will provide detailed information in future Title V reports as this new program is established in FFY 2024.

C.  Strategy C: Facilitate Policy and Systems Changes to Reduce Infant Mortality

1.  State Level Activities

1.1  Promote Infant Sleep Safety by Providing Consistent and Inclusive Safe Sleep Messaging

MDH, partners, and other stakeholders will continue to promote consistent and inclusive safe sleep messaging from the AAP safe sleep recommendations to support preventable sleep-related tragedies during infancy. A variety of avenues will be utilized to share safe sleep messaging, including several electronic publications/platforms such MDH’s FHV Tuesday Topics newsletter, MNPQC fnewsletter, and GovDelivery – a MDH mailing list for the public. The FHV Tuesday Topics e-newsletter alone is sent to more than 2,000 subscribers. Additionally, MDH, partners, and other stakeholders will continue implementing a variety of activities to support placing infants to sleep on their back and in a safe sleeping environment and raise awareness of sleep related SUID and infant mortality – especially during Minnesota’s annual “Infant Safe Sleep Week” in November.

1.2  Implement a Statewide Perinatal Health Strategic Plan

In 2015, MDH developed and released part one of the state’s infant mortality reduction plan.  Developed in partnership with stakeholders from around the state, it contained seven broad recommendations to reduce infant mortality overall and to address disparities in rates across communities in Minnesota. This plan expired in 2020. 

Part One of the plan focused exclusively on infant mortality. During FFY 2022, staff began drafting the second part, the Perinatal Strategic Health Plan, focusing on improving both maternal and infant health outcomes. The draft plan articulated a vision for the state, and outlined values, guiding principles, goals and accompanying evidence- and practice-based strategies based on the input or recommendations generated by stakeholders in past strategic planning meetings. In August 2022, MDH was awarded a State Maternal Health Innovation and Data Capacity Program Grant, which requires creating and implementing a strategic plan that includes activities outlined in the state’s most recent Title V strategic plan.  A draft of the plan, which incorporates work already completed on the draft Perinatal Health Plan, is due to HRSA in September 2023, and work from the plan will be implemented starting in FFY 2024.

1.3  Increase the Number of Safe Sleep Certified Hospitals

As of April 2022, Minnesota has three hospitals that are certified through Crib for Kids® National Safe Sleep Hospital Certification Program. Two are certified at the silver level, and one has received designation at the gold level.  Minnesota’s goal is to increase the number of safe sleep certified hospitals from three to five during FFY2024. To do this, in the coming year, staff plan to do the following: 

• Explore collaboration with non-profits in Minnesota that currently collaborate with Crib for Kids to distribute cribs to families in need while in the hospital to determine strategies to encourage hospitals to become certified. 
• Explore working with larger hospitals, health systems and health plans on possible trainings, resource identification – such as Cribs for Kids – and supports for postpartum mothers. 
• Explore presenting at local grand rounds to inform providers of infant mortality reduction activities and solicit input into what they need. 
• Develop kits with presentations and information about the certification program for community partners and Minnesota to use when recruiting hospitals for certification. 
• Recognize hospitals publicly that have become safe sleep certified during Safe Sleep Week in Minnesota. 

Title V staff will continue work on policy and systems changes aimed at fostering optimal infant health outcomes in Minnesota. Strategies to support Baby-Friendly hospitals and breastfeeding, will include meeting with the MBC and WIC staff to discuss what hospitals identified as needs in implementing the requirements. Title V and other MDH staff will work with the DHS and other community partners to support legislation to increase Medicaid reimbursement to Baby-Friendly Hospitals in an effort to help hospitals recover costs for implementing activities for certification, as well as reward hospitals for saving Medicaid money by improving infant health outcomes. Title V staff will discuss with DHS, the return-on-investment data for infants born in Baby-Friendly Hospitals.   

1.4  Increase the Number of MDH Breastfeeding-Friendly Recognized Birth Centers

With funding from the SHIP, MBC staff facilitate a 10-Step Learning Collaborative (10-SLC) to work on implementation of the World Health Organization’s Ten Steps to Successful Breastfeeding. The 10-SLC brings together staff from hospitals across the state to work on a minimum of two steps, utilizing the MDH Breastfeeding-Friendly Birth Center 5-Star Recognition Program guidance and tools. SHIP has applied for another five-year grant to continue the work of the 10-SLC. 

Additionally, the Perinatal Hospital Leadership hosted by the MBC have helped increase the number of Baby Friendly Hospitals in the state. Due to the pandemic, the Summit and other MBC educational workshops were held virtually in 2020-2023. In 2024, staff will work with MBC to provide both virtual and in-person training opportunities for hospital staff and other lactation supporters to promote evidence-based breastfeeding friendly practices and policies. 

1.5  Address Prematurity

Babies born before 37 weeks represent just under 10% of all births in Minnesota, but prematurity remains one of the top causes of infant mortality, representing 25% of all infant deaths. Persistent racial and ethnic inequities contribute to the overall rates of premature birth. In 2019, American Indian (14.7%) and Black (11.1%) women had higher rates of premature births than white women (8.8%). The effects of prematurity can be long lasting for the child, including difficulty breathing, developmental and learning delays, as well as the family who may experience feelings of guilt, anger and increased financial and emotional stress while caring for babies born prematurely.

To address this important issue, Minnesota is implementing the IMPLICIT model to incorporate interconception care for the mother into well child visits to improve future birth outcomes. In addition, the MNPQC has concluded, and will be continuing follow-up activities for, two quality improvement efforts on hypertension and substance use disorder in pregnant and postpartum people both of which contribute to improving outcomes for babies born before 37 weeks. These activities are described in the 2022 Women/Maternal Health Report and 2024 Women/Maternal Health Plan. 

D.  Additional Related Activities

1.  State Level Activities

1.1  Provide Trainings on Safe Sleep Infant Mortality, Bereavement, and Breastfeeding to Partners

Title V staff will partner with FHV to provide safe sleep training for public health nurses/home visitors and other health professionals working with families. This training is an opportunity to remind home visiting staff and others about the AAP safe sleep recommendations so that they can better communicate with families receiving home visiting and other services about infant sleep safety. In FY 2024, Title V will explore collaborating with Star Legacy Foundation to provide a training on compassionate care to home visitors working with bereaved families adversely affected by the death of an infant or a stillbirth on an ongoing basis. Additionally, MN WIC will provide foundational training in breastfeeding management and support to all local WIC staff. To promote protective factors for infant health, Title V and FHV staff will continue to encourage FHV programs to use grant funds for staff to become lactation counselors, which may support the initiation and duration of breastfeeding.

[1] Baby-Friendly USA - About (babyfriendlyusa.org)