First Food Policy and Law Scan: How Tribes in the Bemidji Area Are Applying Policy and Systems Approaches to Support Breastfeeding

Abstract

The objective of the First Food Policy and Law Scan was to identify breastfeeding policies adopted by federally recognized Tribes in the Indian Health Service's Bemidji Area to understand how breastfeeding is supported through policy. In 2018-2019, we invited all federally recognized Tribes in the Bemidji Area (Michigan, Minnesota, and Wisconsin) to share information on policies in 6 settings (eg, government, casinos). Tribal contacts shared 61 policies from 31 Tribes. We analyzed the policies for 17 features. The project demonstrated that one way the Bemidji Area Tribal Nations are addressing chronic diseases is by applying policy to support breastfeeding. Objective Breast milk is a traditional, Indigenous first food (1,2) that promotes health and prevents chronic disease among infants and mothers (3). The objective of our study, the First Food Policy and Law Scan, was to identify breastfeeding policies adopted by federally recognized Tribes in the Bemidji Area of the Indian Health Service (Michigan, Minnesota, and Wisconsin). We hypothesized that Tribes are exercising sovereignty to support breastfeeding through policy. We also aimed to facilitate the sharing of information about Tribal breastfeeding policies across Tribal communities to promote awareness of how policy can support first food practices and good health for infants, women, and families across the lifespan. Methods The cross-sectional, descriptive legal epidemiology project collected and analyzed information about breastfeeding policies from federally recognized Tribes in the Bemidji Area. We gathered policies from entities in 6 settings: government (administrative policies, Tribal law), health care (Tribally operated and Indian Health Service [IHS] facilities), casinos, early childcare and education (ECE), Tribally operated Bureau of Indian Education schools, and Tribal colleges. We included the IHS facilities because of their importance to the Tribes they serve. We classified policies as formal or informal. “Formal” policies were adopted by decision makers (eg, Tribal Council, ECE director) and in writing (eg, statute, staff handbook). “Informal” policies were those that contacts described as policies but were not documented in writing. We extended invitations to participate in the project via both letters and emails sent to Tribal leaders, legal counsel, and health directors, asking them for access to information on policies as well as referrals to contacts in relevant settings. Participation was optional and was demonstrated by sharing of policies. Some Tribes publish laws online; for these Tribes, we notified legal counsel that we would collect relevant laws from online sources, but they could opt out if desired. Invitations explained that we would write an aggregate report but would not include identifiable information without permission, to respect Tribal sovereignty.