breastfeeding: strategies for environmental change
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Breastfeeding: Strategies for Environmental Change. Association of State & Territorial Public Health Nutrition Directors June 12, 2007. Laurence Grummer-Strawn, PhD Nutrition Branch Division of Nutrition and Physical Activity Centers for Disease Control and Prevention. Overview. - PowerPoint PPT PresentationTRANSCRIPT
Breastfeeding: Strategies for Environmental Change
Laurence Grummer-Strawn, PhDNutrition BranchDivision of Nutrition and Physical ActivityCenters for Disease Control and Prevention
Association of State & Territorial Public Health
Nutrition Directors
June 12, 2007
Overview
• Laurence Grummer-Strawn:– Breastfeeding and chronic disease– Evidence-based interventions on breastfeeding– Breastfeeding infrastructure
• Rachel Colchamiro: A Focus on Maternity Care Practices: The Massachusetts Experience
• Karen Flynn: Breastfeeding as a Public Health Issue in Vermont
• Lynn Hellenga: Environmental Change to Support Breastfeeding in Montana
Percent reduction in relative risk of chronic disease outcomes for breastfeeding vs. not breastfeeding
0 10 20 30 40 50 60 70
Childhood Obesity
SIDS
Acute myelogenous lymphoma
Acute lymphocytic lymphoma
Type 2 diabetes
Type 1 diabetes
Asthma
Atopic dermatitis
Source: Agency for Research on Healthcare Research and Quality, 2007
Percent reduction in relative risk of maternal outcomes for breastfeeding vs. not breastfeeding
0 5 10 15 20 25 30 35
Ovarian cancer
Breast cancer
Type 2 diabetes
Source: Agency for Research on Healthcare Research and Quality, 2007
Effect of breastfeeding vs. formula feeding on childhood obesity
0 1
O'Callaghan 1997
Bergmann 2003
Hediger 2001
Li 2003
Poulton 2001
von Kries 1999
Liese 2001
Toschke 2001
Gillman 2001
Meta-analysis
Adjusted odds-ratioSource: Arenz et al. Intl J Obes, 2004
Breastfeeding & Obesity• Duration: 4% reduction of odds of overweight per
additional month breastfeeding (31% reduction for 9 mo. vs. never bf) (Harder et al. 2005)
• Exclusivity: Reduction in risk is greater among studies looking at exclusive bf (24%) than among all studies (13%) (Owen et al. 2005)
• Length of follow-up: Effect similarly strong for adults as for school-age and younger children
(Owen et al. 2005)
Potential biological mechanisms
• Direct effects of formula
• Learned self-regulation of intake
• Altered parent-child interactions
• Residual confounding
Program Purpose Prevent and control obesity and other
chronic diseases by supporting States in the development and implementation of
science-based nutrition and physical activity interventions
CDC Funded States for Nutrition & Physical Activity to Prevent Obesity
and Other Chronic Diseases
• Calls for using evidence-based interventions to change behaviors
• Need for guidance in selecting evidence-based breastfeeding interventions
CDC Funded States for Nutrition & Physical Activityto Prevent Obesity and Other Chronic Diseases
The CDC Guide to Breastfeeding Interventions
• Evidence-Based Interventions
• Interventions Whose Effectiveness Has Not Been Established
Evidence-Based Interventions
• Maternity Care Practices
• Workplace Support
• Peer Support
• Educating Mothers
• Professional Support
• Media and Social Marketing
Maternity Care Practices
• Take place during the intrapartum hospital stay
• Includes the WHO/UNICEF Ten Steps to Successful Breastfeeding
• Includes birthing practices
Ten Steps to Successful Breastfeeding
1. A written breastfeeding policy that is communicated to all healthcare staff
2. Staff training in the skills needed to implement the policy
3. Education of pregnant women about the benefits and management of breastfeeding
4. Early initiation of breastfeeding 5. Education of mothers on how to breastfeed and
maintain lactation 6. Limited use of any food or drink other than human
breast milk 7. Rooming-in 8. Breastfeeding on demand 9. Limited use of pacifiers and artificial nipples 10.Fostering of breastfeeding support groups and
services
Maternity Care Practices
Program Examples
• 53 Baby Friendly facilities in the United States
• Breastfeeding Coalition of the Inland Empire (CA) implemented practice change increasing skin-to-skin contact
• Academy for Breastfeeding Medicine - Model Breastfeeding Policy recommendations
• Massachusetts ban on distribution of infant formula sample packs (www.banthebags.org)
Maternity Care PracticesPotential Action Steps
• Pay for hospital staff to attend 18 hour training
• Examine state maternity care facility regulations – update if necessary
• Establish links between maternity facilities and community breastfeeding support networks
• Work to change ONE hospital practice to be evidence-based
Workplace SupportComponents of worksite lactation programs• Space to express milk or breastfeed
• Provision or access to a pump
• Maternity leave
• Flexible work arrangements: telecommuting, part-time work, job sharing, flex time
• On-site child care
• Breaks for expressing milk or breastfeeding
• Workplace education and clinical support
• Protection for breastfeeding women in sexual harassment policy
Workplace Support
Increases:• Breastfeeding duration
• Staff productivity and loyalty
• Public image of employers
Decreases:• Absenteeism
• Employer health care costs
• Employee turnover
Workplace Support
Program Examples
• Employer recognition programs – Oregon’s Breastfeeding Mother Friendly Employer project
• Employer incentives – HRSA workplace initiative The Business Case for Breastfeeding
• Employee Support – AZ Dept of Health Services breastfeeding policy for employees
Workplace SupportPotential Action Steps
• Provide information to employers about workplace support & local resources
• Establish a model lactation support program for all state employees
• Promote legislation to support work site lactation programs
• Recognize work sites and employers who support their breastfeeding employees
Peer Support
Encouragement & support provided by mothers who are breastfeeding or who have done so in the past
Peer Support
Peer support is a cost-effective, individually tailored approach, especially important where professional support is unavailable
Source: Chapman et al., 2004
• Peer support programs are effective by themselves in increasing breastfeeding initiation & duration
Source: Fairbank et al., 2000
Peer SupportPotential Action Steps
• Coordinate peer counseling services for women not eligible for WIC
• Expand coverage of the WIC peer counseling program
• Improve existing peer support programs
• Ensure support and supervision of peer
counselors by an IBCLC
Educating Mothers
• Although many women know benefits of breastfeeding, they lack information on how to do it
• US Preventive Services Task Force:
Maternal education is the most effective single intervention for increasing breastfeeding
initiation and short-term duration
Educating MothersProgram Examples
• Hospital-based prenatal breastfeeding classes
• Intrapartum education
• Postpartum follow-up and information
• WIC• Breastfeeding education throughout
prenatal period
• Breastfeeding instruction available postpartum
Educating MothersPotential Action Steps
• Encourage health professional organizations to provide training for their members in providing breastfeeding education to mothers
• Incorporate breastfeeding education into Early Intervention, women’s programs, teen pregnancy programs, and home visiting programs
• Encourage health plans to offer prenatal classes on bf to their members
Professional Support
• Lack of professional support is a major barrier to breastfeeding
• Many women do not know how to get help from a lactation consultant
• Most third-party payers do not reimburse for IBCLC services
Professional Support
• ILCA provides a Find a Lactation Consultant directory to connect mothers & providers to professional lactation support
• Hospital-based bf clinics ensure professional support and follow-up for bf dyads
Program examples
Professional SupportPotential Action Steps
• Work with state Medicaid and insurance commissioners to ensure lactation support is a standard, reimbursable service
• Fund establishment of sustainable, financially supported, walk-in clinics for all new mothers with IBCLCs
• Develop & disseminate a resource directory of locally available lactation support services
Media & Social Marketing
• Media campaigns, particularly TV, improves breastfeeding attitudes and initiation
• Social marketing approach has increased initiation & duration of breastfeeding while improving community support for breastfeeding
Media & Social Marketing
Potential Action Steps
• Identify local experts who can pitch stories to the media that highlight breastfeeding
• Provide Loving Support materials to interested local physicians, schools, clinics, hospitals, and child care centers
Breastfeeding infrastructure and communications
• Need for state breastfeeding coalitions– Clinical care providers– Public health– Businesses
• National Conference of State Breastfeeding Coalitions--Jan. 2006 & 2008
• Breastfeeding listserv• State Breastfeeding Coalitions national
teleconference every 2 months
Thank You
http://www.cdc.gov/breastfeeding
State Breastfeeding Report Card
• Breastfeeding outcome indicators• Breastfeeding process indicators
– % of babies born in Baby Friendly facilities– Lactation consultants per 1000 live births– Mother-to-mother support groups per 1000
live births– Legislation protecting breastfeeding in public– Legislation supporting breastfeeding at work– Existing coalition– Coalition website– State staff dedicated to breastfeeding