Helping Kentuckians Access Nutritious Foods by Promoting Breastfeeding

1. Helping Kentuckians Access Nutritious Foods by Promoting Breastfeeding • Jackie Walters, MBA, RD • Doraine Bailey, MA, IBCLC

2. Objectives • Discuss infant nutrition and the role of breastfeeding • Identify the network of breastfeeding supporters at county, state, and national levels • Consider how agents and assistants can incorporate infant nutrition and breastfeeding lessons into their work plans • Consider how agents and assistants can work with organizations to promote breastfeeding in their communities • Discuss materials and tools agents need to promote breastfeeding and to teach nutrition to expectant mothers and mothers of infants

3. Feeding is one of a parent’s most important jobs (It’s how we help our babies grow healthy and strong)

4. Mealtime is more than just food Meals and snacks give you a chance to help your baby: Learn healthy eating habits Feel important and loved Feel understood and respected Trust that others will care for her

5. Infant feeding recommendations(AAP, WHO, ADA) Breastmilk or iron-fortified formula alone from birth until about 6 months Complementary foods begun around 6 months – typically iron-fortified cereals; meats are being considered Breastfeeding or iron-fortified formula continue until 12 months. Breastfeeding after 12 months as long as mother and baby wish to continue

6. Definitions of Breastfeeding and Exclusive Breastfeeding Breastfeeding: the practice of feeding a mother’s breast milk to her infant(s) on the average of at least once per day Exclusive Breastfeeding: the infant receives only breast milk and nothing else

7. Breastfeeding: Growing Healthy Babies and Moms

8. Growing Babies with Breastfeeding: • best nutrition for appropriate growth and development • active protection against infection (bacterial and viral) • any illnesses less frequent and less severe • lower risk of oral and dental problems • builds trusting relationship with Mom

9. Babies Grow and Glow With Breastmilk Breastfeeding reduces baby’s risk of: Obesity Ear infections Respiratory infections Gastrointestinal infections Skin conditions Type 1 and Type 2 diabetes Leukemia Sudden Infant Death Syndrome West Dade WIC

10. Breastfeeding Is Also Good for Mothers Lowers risk of: Premenopausal breast cancer Ovarian cancer Type 2 diabetes Postpartum depression Improves bonding Lowers healthcare costs Convenient Helps with weight loss Hialeah WIC, Miami, FL

11. Growing Mothers with Breastfeeding excellent way to learn about baby and how to parent builds self esteem, especially if have overcome barriers in order to be able to breastfeed helps ‘reconnect’ with baby after separation

12. Why do we care NOW?

13. Research shows the difference • Key Research on ‘developed’ populations made the case • Agency for Health Care Quality Research, Breastfeeding and Maternal and Infant Outcomes in Developed Countries, 2007. • WHO, Evidence on the long-term effects of breastfeeding: systematic reviews and meta-analysis, May, 2007, • US Preventive Services Task Force, Primary Care Interventions to Promote Breastfeeding, 2008 • CHILD HEALTH is the greatest driving factor • OBESITY Prevention is the biggest HOOK • Decreased health care costs (short- and long-term) • Prevention of readmission to the hospital for severe jaundice or weight loss

14. Why Breastfeeding? • Excellent research shows significant risks for childhood morbidity and mortality when infants are not exclusively breastfed for 6 months. • Holds true even in developed, educated and resource-rich societies • Breastfeeding and Maternal and Infant Health Outcomes in Developed Countries, AHRQ 2007, http://www.ahrq.gov/clinic/tp/brfouttp.htm

15. Surgeon General’s Call to Action to Support Breastfeeding, 2011

16. Breast Milk: Custom Made for Baby

17. Breast Milk: The Standard by WhichEverything Else is Measured

18. Breast Milk: The Standard by Which Everything Else is Measured Breast Milk has: Vitamins and minerals for proper nutrition Growth factors that help with infant growth and development Antibodies that help babies resist illness and disease The ability to change constantly

20. How does breastfeeding reduce the risk for childhood overweight? Possible explanations: Infant has more control on speed of feed and when to stop Less ‘force feeding’ or ‘finishing the bottle’ when breastfed Non-human milk is digested and metabolized in a different way Higher protein in formula = ↑ leptin, insulin and fat storage NOT because breastfeeding families are already healthier

21. Is Kentucky breastfeeding?

22. Breastfeeding Status National Immunization Data (CDC, 2008 births)

23. National Breastfeeding Rates2011 Breastfeeding Report Card The Bottom 10 TN – 65.6% MO – 64.2 AR – 63.9 PA – 63.4 SC – 62.5 KY – 57.8% AL – 56.7% WVA – 54.1% MS – 50.3 LA – 48.9% US Average: 74.6% (Initiation) The Top 10 OR – 91.2% WA –89.0% CA – 86.6% VT – 85.2% HI – 85.0% UT – 84.5% ID – 84.5% AK – 84.2% WY – 83.2% MT – 82.8%

24. ≤20% 21-30% 31-40% 64.59 53.49 41-50% 51-60% 61-70% 71% -- 48.49 44.06 37.42 44.82 48.60 33.33 40.22 40.31 44.35 52.94 32.91 46.36 50.00 68.35 56.12 28.57 40.11 37.94 48.71 61.63 60.22 57.42 57.79 56.10 43.19 35.06 27.63 60.80 67.88 72.07 28.00 54.57 65.31 50.0 43.55 57.55 28.00 40.72 45.76 61.63 35.04 46.72 47.68 50.35 35.94 18.24 39.68 49.92 54.45 51.06 55.48 40.39 30.58 27.37 36.61 47.21 53.33 45.53 31.58 27.29 39.78 40.87 61.11 31.14 49.70 40.18 44.26 29.84 26.47 30.64 62.77 45.96 42.67 19.77 46.01 52.48 43.22 27.29 35.96 38.37 42.15 50.0 38.21 42.63 22.99 46.46 39.80 44.96 43.58 29.80 31.03 46.57 59.26 31.94 54.79 49.01 38.58 50.91 38.12 45.26 31.16 45.16 56.85 51.91 33.80 37.92 28.70 51.67 40.78 53.23 41.88 29.92 37.97 31.4 50.0 25.19 61.71 35.96 2004 Birth Certificate Data – BF initiation initiation: 50.43%

25. 2009 Birth Certificate Data – BF initiation ≤20% 21-30% 31-40% 69.9 59.3 41-50% 51-60% 61-70% 71% -- 54.1 39.3 42.6 54.3 52.6 . 39.8 32.7 38.3 57.7 36.8 48.9 43 53.9 72.7 55.7 49 51 41.3 45.3 60.5 65.8 63.6 61.5 60 47 37.9 25.7 75.5 74.6 74.5 35.6 67.9 64.5 51.9 48.8 55.1 38.2 44.6 64.7 27.6 54.0 50.2 55.3 53.7 40.7 17.2 27.9 54.1 56.7 64.8 62 41 31.6 27.7 21.6 54.8 64.6 44.9 30.6 27.8 43.2 49.6 57.8 25.3 52.7 46 48.9 42.9 32.8 35.8 47.1 55.8 47.9 26.5 49.1 53.3 56.8 32.4 44.7 59.3 60 54.3 46.6 42.3 24.2 47.4 20.9 52.76 46.7 29.8 30.4 59.4 50.7 45.6 74.5 50.7 54.8 60 39.4 63.3 33.3 71.4 58 69.8 42.7 44.8 24.2 54.7 60.5 62.3 43.9 30.8 39.7 33.9 42.6 35.4 70 35.8 initiation: 55.6%

28. Our Challenge Most babies are being supplemented with infant formula in the hospital Most breastfeeding mothers regularly give formula by 3 months Few affordable classes on breastfeeding are available during pregnancy Obstetric care providers do not strongly inform about breastfeeding Hospitals often have policies, practices and staffing that do not support breastfeeding

29. Our Challenge • Gap in family knowledge and tradition to teach and support breastfeeding • Pre-term birth (often planned) • Few sources for help or support when home • Pediatric care providers may not know how to treat breastfeeding problems • Aggressive formula marketing • Sexualization and objectification of women’s bodies • Women increasingly serve as breadwinners outside the home

30. Breastfeeding Socio-Ecologic Model

31. So, who is doing something about it? • US Government • National entities • State Government • KY entities • Others

32. US Initiatives - Government • Healthy People 2020 • Breastfeeding Report Card • Maternity Practices Survey (mPINC) • WIC • White House Childhood Obesity Prevention Taskforce/ Let’s Move • Patient Protection Act (Health Care Reform) • IRS tax changes • Surgeon General’s Call to Action on Breastfeeding

33. HP2020 – New Targets • Increased the target percentages over previous years, especially since many states were meeting them! • Added targets focusing on • Increasing employers that have worksite lactation support  programs • Reducing breastfed newborns receiving formula supplementation in the hospital • Increasing the number of hospitals that are Baby-Friendly certified

34. Breastfeeding Report Card • Published by CDC • Reports national and state data • Outcomes: • Overall initation and duration, plus exclusivity (using HP2020) • “Process” Indicators: • # Births at BFH • # IBCLC, # BF FTE in State Gov’t • Presence of protecting laws • Presence of coalition, website

35. mPINC • Survey of birthing hospitals to see if they’re using state-of-the-art evidence-based practices for birth and mother/newborn care • Collected 2007, 2009, 2011 • Statewide data reported by CDC at http://www.cdc.gov/breastfeeding/data/mpinc/index.htm • Kentucky in the bottom quartile for first and second rounds • Do well on documenting feeding decisions • Do poorly on prenatal education, post-discharge follow-up and support • Do poorly on limiting formula supplementation • 75% of KY hospitals participated in 2009

36. WIC • Half of all American children are on WIC • Over half of KY children 0 – 5 qualify • Nutrition education and healthy foods • Funded through USDA • In KY, primarily offered through public health framework. • Moving to EBT by December 2011 • Offer breast pumps to working mothers

37. Fully Breastfeeding Food Package “Grand Deluxe Package” Fully Breastfeeding Mom – up to 12 months Infant 6-11 months Photos Courtesy of Texas WIC State Agency

38. Partially Breastfeeding Food Package “Deluxe Package” Partially Breastfeeding Mom – up to 12 months Infant 6-11 months Photos Courtesy of Texas WIC State Agency

39. Patient Protection and Affordable Care Act (Health Care Reform) • Provisions require employers to provide accommodations for hourly-waged lactating employees • Expands payments for preventive care services, including clinical lactation consulting, education. • http://www.dol.gov/whd/nursingmothers/

40. IRS - Tax Breaks for Pumps • Breast pumps and breastfeeding equipment are considered ‘qualified medical expenses’ • Can fund with Flexible Spending Accounts (FSA) or Health Savings Accounts (HSA). • Can deduct as medical expenses on tax returns (Fed and state)

41. Surgeon General Call to Action • First federal statement of action/purpose/plan for breastfeeding since 2000. • 20 “Actions” in Mother support, community infrastructure, health care, worksites, research and policy. • Action 4. Use community-based organizations to promote and support breastfeeding.

42. US Initiatives • US Breastfeeding Committee • The Joint Commission • Baby-Friendly Hospital Initiative • Patient-care Guidelines • Lactation Consultants • National Business Group on Health • Childcare Providers

43. US Initiatives - Collaborative US Breastfeeding Committee • Representatives from government, health care associations, lactation education and support • Promoting state-based coalitions through bi-monthly conference calls in collaboration with the CDC • State Coalitions Conference in Aug 2012

44. The Joint Commission • Perinatal Core Measure Set includes exclusive breastfeeding • Speak Up™ campaign helps support and prepare mothers for successful breastfeeding, “What You Need to Know About Breastfeeding.” • www.jointcommission.org/Speakup_breastfeeding/

45. Baby-Friendly Hospital Initiative • Voluntary private program to reward hospitals that practice 10 evidence-based steps. • St. Elizabeth Hospital only BFH in KY • Others are preparing for certification • www.babyfriendlyusa.org

46. Patient Care Guidelines: • Prenatal, in-hospital, postpartum • Growing number of evidence-based protocols for prenatal, inpatient, and outpatient service: • Academy for Breastfeeding Medicine • American Academy of Pediatrics • Assoc. of Women’s Heath, Obstetric and Neonatal Nursing

47. Who helps with breastfeeding? IBCLC CLC/CLS/BSE, etc WIC Breastfeeding Peer Counselor Public Health: HANDS, HVN EFNEP Health professionals: MD, RN, RD

48. Lactation Consultants International Board Certified Lactation Consultant (IBCLC) ONLY credential for this allied health professional. No other independent board certification is available Educational and clinical services Hospital, private practice, private clinic, public health Over 125 IBCLCs in Kentucky “Find a Lactation Consultant” at www.ilca.org

49. The National Business Group on Health www.businessgrouphealth.org Focuses on worksite wellness and health care Support worksite lactation programs as cost-effective Online materials that complement The Business Case for Breastfeeding Model Health Benefit Plan – Investing in Maternal and Child Health

50. Let’s Move: Child Care • Part of larger “Let’s Move” campaign to reduce childhood obesity • “Infant Feeding” an important component under “Nutrition” • Webpage has various tools: http://www.healthykidshealthyfuture.org/nutrition/infantfeeding.html