Promoting, Protecting and Supporting Breastfeeding in North Carolina

1. Promoting, Protecting and Supporting Breastfeeding in North Carolina Breastfeeding Work Group Perinatal Health Committee North Carolina Child Fatality Task Force

2. Breastfeeding Work Group • Sheryl Abrahams • Selena Barrier • Joe Holliday • Miriam Labbok • Alice Lenihan • Steve Shore • Catherine Sullivan • Mary Rose Tully • Sarah Verbiest • Tom Vitaglione

3. Our Charge… • Study the link between breastfeeding and the reduction of infant mortality, disease and obesity

4. Experts Agree…. • American Academy of Pediatrics (AAP) • American Academy of Family Physicians (AAFP) • American College of Obstetrics and Gynecology (ACOG) • American Dietetic Association (ADA)

5. Breastfeeding is the normal way to feed a baby

6. ADA, AAP, AAFP, ACOG Recommendations Breastfeeding is best for babies • Exclusively breastfeeding for the first 6 months of life • Gradually add complementary solids after 6 months of age • Continue breastfeeding for at least one year • And as long as mutually desired for mom and baby • WHO recommends breastfeeding for at least 2 years

7. Breastfeeding goals for the United States: 75% of babies breastfed at birth 50% continue to breastfeed at 6 months 25% are breastfeeding at 1 year Additional goals from Midcourse Review: 60% exclusively breastfeeding through 3 months 25% exclusively breastfeeding through 6 months Healthy People 2010 Goals

8. Breastfeeding=Best Practice Evidence Based Reports 2007

9. Horta BL, Bahl R, Martines JC, Victora CG. Evidence on the long-term effects of breastfeeding: Sytematic Reviews and Meta-Analyses. World Health Organization 2007 • World Health Organization (WHO) found • Lower mean blood pressure • Lower total cholesterol • Higher performance in intelligence tests • Reduced overweight/obesity • Reduced Type 2 Diabetes

10. Breastfeeding and Maternal and Infant Health Outcomes in Developed Countries.Evidence Report/Technology Assessment No. 153. AHRQ Publications No. 07-E007. Rockville, MD: Agency for Healthcare Research and Quality. April 2007 • Infants/AHRQ found reduced • Otitis media* • Gastroenteritis* • Severe lower respiratory tract infections* • Atopic dermatitis • Asthma* (infant and children <10 strongest impact) • Obesity* • Type 2 Diabetes* • SIDS* • Necrotizing enterocolitis (*preterm infants) *=strongest conclusions

11. American Institute for Cancer Research • AICR’s Second Expert Report: Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective (2007). • “It’s best for mothers to breastfeed exclusively for six months and then add other liquids and foods”

13. Vision North Carolina mothers will be enabled to begin their children’s lives by breastfeeding - the best possible foundation for infant and young child feeding.

14. Recommendations • Encourage the adoption of activities that create breastfeeding-friendly communities. • Create a breastfeeding-friendly health care system. • Encourage the adoption of breastfeeding-friendly workplaces. • Assist child care facilities in promoting, protecting and supporting breastfeeding. • Advocate for insurance coverage by all third-party payers for breastfeeding care, services, and equipment when necessary. • Involve media and use social marketing and public education to promote breastfeeding. • Promote and enforce new and existing laws, policies and regulations that support and protect breastfeeding. • Encourage research and evaluation on breastfeeding outcomes, trends, quality of care, and best practices.

15. From Recommendations to Action • Communities • Health Care System • Workplaces • Child Care Facilities • Insurance Coverage • Media, Social Marketing, and Public Education • Laws, Policies, and Regulations • Research and Evaluation

16. Breastfeeding Work Group Recommendations

17. Communities • Statewide campaign should be implemented to enhance public awareness about the benefits of breastfeeding • Foundation funding • Legislative appropriations * Other states with language/laws: California, Illinois, Missouri, Vermont

18. Breastfeeding-Friendly Healthcare System • North Carolina Hospital Association • Engage NCHA in championing the implementation of a “Baby Friendly Hospital Initiative” including policies and practices to promote breastfeeding * Other states with language/laws: Florida, California, Missouri

19. Breastfeeding Friendly Workplaces • Employers (start with state agencies) • Provide paid break time • Provide private place for breastfeeding and/or expressing milk *Other states with language/laws: California, Connecticut, Georgia, Hawaii, Illinois, Minnesota, Montana, New Mexico, New York, Oklahoma, Oregon, Rhode Island, Tennessee, Texas, Washington, Wyoming

20. Assist Child Care Facilities • Division of Child Development • North Carolina Partnership with Children • Help assure that breastfed infants and their mothers will receive equal access and care in child care facilities * Other states with language/laws: Louisiana, Mississippi

21. Media, Social Marketing & Public Education • Department of Public Instruction • Incorporate breastfeeding information into K-12 school health curriculum * K-12 curriculum: New York

22. Law, Policy and Regulations • Seek legislation to create a jury exemption for breastfeeding women • Enhance access to support services • Creation of a registry for board certified lactation consultants • Define a scope of practice for registered lactation consultants • Insurance coverage for services post-discharge • Enhanced insurance coverage for the use of human milk in NICU’s *Other states with language/laws related to jury duty exemption: California, Idaho, Illinois, Iowa, Kansas, Kentucky, Minnesota, Mississippi, Nebraska, Oklahoma, Oregon, Virginia *Joint study for insurance coverage: Louisiana *Regulation minimum guidelines for sale of milk, donor milk banks: Texas, California

23. Breastfeeding/Provision of Human Breast Milk=Primary Prevention!