Communities Working Together to Promote Breastfeeding

Mary Applegate, MD MPHBureau of Women’s Health

NYS Department of Health

“Breastfeeding is one of the simplest, most cost-effective ways to promote good health during infancy.”

Communities Working Together for a Healthier New York

Blueprint for Action on Breastfeeding

US Department of Health & Human Services2000

Why breastfeeding?

Infant healthMaternal healthConvenienceEconomic benefits

Healthy People 2010 goals

75% early postpartum

50% at 6 months

25% at 1 year

New York Stats

In-hospital At 6 months

1990 46.3% 16.2%

2000 64.0% 29.6%

Variation within New York

By region: 56.3% to 75.8%

By hospital: 28.6% to 95.5% 26 hospitals exceed Healthy People

2010 goal

By socio-economic status 67.3% population-wide ~50% among WIC participants

Reasons for variation

Cultural attitudes

Family & community support

Healthcare provider policies

& practices

Employment status &

support

Cultural attitudes

Most challenging . . . most important to change

Changing attitudes

Community education Breastfeeding: First Step to Good Health

-- K-12 Learning Activities http://www.health.state.ny.us/nysdoh/b_feed/

index.htm

NYS Civil Rights Law

Breastfeeding: First Step...

Develop positive attitude toward breastfeeding, starting in early grades

Breastfeeding: First step...

In older grades, learn about breastfeeding biological facts environmental &

economic benefits choices & decision

making . . .

NYS Civil Rights Law

“Notwithstanding any other provision of law, a mother may breast feed her baby in any location, public or private, where the mother is otherwise authorized to be, irrespective of whether or not the nipple of the mother’s breast is covered during or incidental to the breast feeding.”

Reasons for variation

Cultural attitudes

Family & community support

Healthcare provider policies

& practices

Employment status &

support

Family & community support

“Warm chain” for breastfeeding

Family, friends, child care providers supportive & knowledgeable -- regardless of personal experiences

Community support services La Leche League WIC peer counselors Nursing Mothers Counselors

Health care practices

New York State Hospital Code

“Best Practices for Breastfeeding Support” Hospital Managed care Outpatient clinics

Hospital support

Lactation coordinatorEncourage breastfeeding in delivery

room & 24-hour rooming-in Avoid supplemental formula, water,

bottles, pacifiersEducate mother about key issuesEnsure availability of follow-up

Managed care support

Monitor breastfeeding ratesEncourage obstetric & pediatric

providers to promote & support breastfeeding

Include in benefit package: Breastfeeding classes Lactation consultant visits Rental of hospital grade pump if mother &

newborn are separated (e.g. premie in NICU)

Ambulatory care support

Positive staff attitudes Inviting waiting room Lactation specialist on staff Breastfeeding classes on-site Appropriate resource material Breastfeeding “warm line” No formula company material Breastfeeding assessed at each pediatric

visit Duration of breastfeeding monitored

Workplace support

Maternity leave -- 6 weeks or moreAllow infant to be near mother

(in office; on-site childcare)Flexible schedulesBreastfeeding or pumping breaksLactation room -- pump, chair, fridgeLactation consultantBreastfeeding classes

Childcare support

Positive staff attitudesPolicies supportive of feeding

expressed breastmilk and/or having mother visit to breastfeed

Information about combining working & breastfeeding

Suggestions for working with employer

Partners in promotingbreastfeedingPhysicians, midwives, nursesLactation consultantsHospital lactation coordinatorsWIC staff & peer counselorsLa Leche League, community groupsEmployers/businessesSchools, childcare centers

“Breastfeeding is one of the simplest, most cost-effective ways to promote good health during infancy.”

Communities Working Together for a Healthier New York