Determination of Need Program

The Determination of Need Program (DoN) is a tool that breastfeeding advocates may wish to use to help assure the provision of appropriate breastfeeding care and services in hospitals. This program may vary from state to state but the goal of this concept is to promote the availability and accessibility of cost effective quality health care services to the citizens of a state and assist in controlling health care costs. For example, the DoN was established in Massachusetts by the Legislature in 1971 to encourage equitable geographic and socioeconomic access to health care services, to help maintain standards of quality, and to constrain overall health care costs by eliminating duplication of expensive technologies, facilities, and services. DoN receives applications from health care facilities planning substantial capital expenditures or change in services. Citizens of the Commonwealth of Massachusetts can form a ten taxpayer group (TTG) as a party of record to comment and request a public hearing on applications for projects proposed in their community. Once a TTG has requested such a hearing, they can recommend for instance, that appropriate breastfeeding support and services be included as one of the requirements for approval of the facility’s desire to add beds to a maternity unit or nursery. Check with your state department of public health and make your voice heard.

Communicating with Your Legislators

Many people are reluctant to communicate with their elected representatives. Legislators are often perceived as too busy to read mail and unavailable for meeting with constituents. Contrary to this belief, legislators are very interested in what you have to say. Their staff pays close attention to your communications. Your first contact with an elected official may be through a letter. Your letter might ask that breastfeeding be addressed in some manner, such as in legislation, in health policy regulations, in maternal child health program funding, in worksite policies, etc. The least effective letters are form letters, prepared post cards, and petitions. More effective letters are neatly handwritten or computer generated with a hand written personalized post script. The following are some letter-writing do’s and don’ts.

Properly address your elected officials
• State senator
The Honorable _____________
(name of state) Senate
State House, Room #
City, State, Zip
Dear Senator:

• Federal senator
The Honorable _____________
United States Senate
Washington, DC 20510
Dear Senator:

• State congressional representative
The Honorable _____________
(name of state) House of Representatives
State House, Room #
City, State Zip
Dear Representative:

• Federal congressional representative
The Honorable _____________
US House of Representatives
Washington, DC 20515
Dear Representative :

• Chair of a committee:
Dear Madam Chairwoman:
Dear Mr. Chairman

• Speaker of the House
Dear Mr. Speaker
Dear Madam Speaker

• Misspell their name
• Call them by the wrong title
• Overwhelm them with too much detail, personal history, or rambling narratives
• Use hostile language, pick fights, or threaten them
• Use abbreviations, medical jargon, or gross exaggerations
• Advertise or market yourself or your services

Anatomy of a letter
• State your purpose for writing in the first paragraph of the letter. If your letter pertains to a specific piece of legislation, refer to it by its number as follows:
* House Bill=H.R.
* Senate Bill=S.
• Establish your credibility immediately by identifying yourself, your connection to the legislation or problem, and your profession. Include information on the local impact of your concern. Attach pertinent fact sheets, brochures, and short background materials to the letter
• The rule of one—one issue per letter, one page per letter
• Include key issues and documentation
• The outcome of what you are asking for should be addressed as benefits for constituents
• Ask for a specific action
• Offer to be a future resource
• Ask for a written response to your letter
• Always sign your letter and make sure your address and telephone number are included
• Proofread your letter, even if it was composed on a computer. Run the spellchecking program
• Be constructive
• Be persistent

Report breastfeeding in public or workplace/employment problems 


What's Out There Already?
There are a number of tools or “supplies” to be familiar with no matter where or what breastfeeding lobbying you are engaged in. The US has numerous documents, not only calling for breastfeeding reform, but also describing what needs to be done. Secure copies of these for background purposes, to quote in letters or testimony, for benchmarking and evaluation, or to simply write your congressman and ask why little or nothing has been done to fulfill the various recommendations. Click on the link below to download a list of advocacy resources and where to get them.

Resources for Breastfeeding Advocacy