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Transcript of Helping Kentuckians Access Nutritious Foods by Promoting Breastfeeding Jackie Walters, MBA, RD...
Helping Kentuckians Access Nutritious Foods by Promoting
Breastfeeding
Jackie Walters, MBA, RD
Doraine Bailey, MA, IBCLC
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
Feeding is one of a parent’s most important jobs
(It’s how we help our
babies grow healthy
and strong)
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
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
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
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
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
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
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
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
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
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
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
Breastfeeding StatusKY 2008 US 2008 HP2020
goalInitiation 57.8% 74.6% 81.9%
Bf at 6 months 32.9% 43.3% 60.6%
Bf at 12 months 18.6% 23.8% 34.1%
Excl BF 3 months 24.2% 35.0% 46.2%
Excl BF 6 months 9.8% 14.8% 25.5%
National Immunization Data (CDC, 2008 births)
National Breastfeeding Rates 2011 Breastfeeding Report Card
The Bottom 10TN – 65.6%MO – 64.2AR – 63.9PA – 63.4SC – 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%
46.46
45.16
35.96
50.051.67
46.57
61.71
50.91 56.8
5
38.12 51.9
1
45.26 40.7
853.23
54.79
38.37
41.88
49.01
42.63
46.0138.2
159.26
35.96
62.77
39.78
36.61
39.68
49.92
40.87 49.7
040.1842.15
52.48
38.58 33.8
0
39.80
29.92
31.94
37.92
50.0
45.96
45.76 46.7
2
57.55
54.45
61.11
45.53
47.68
54.57
57.42
25.19
37.97
44.96
43.22
31.4
31.16
43.58
28.70
29.80
22.99 31.0
3
44.26 42.6
7
29.84
26.47 27.2
9
19.77
30.64
27.2931.1
4
27.37
35.04 18.2
4
28.0040.7
230.5831.5
8
40.39
55.4853.3
347.21
50.3551.0
6
65.31
60.80
27.63
28.0035.9
4
37.94
48.71
46.36
43.19
32.91
40.1135.06
44.35
61.63
72.07 50.0 43.5
5
60.22
67.88
61.6357.7
9
68.35
56.12
40.22
37.42
44.06
56.10
50.00
44.82
28.57
52.94
48.60 40.3
1
33.33
48.49
53.49
64.59
2004 Birth Certificate Data – BF initiation
41-50%
51-60%
61-70%
71% --
≤20%
21-30%
31-40%
initiation: 50.43%
2009 Birth Certificate Data –
BF initiation41-50%
51-60%
61-70%
71% --
≤20%21-30%31-40%
47.4
71.4
35.8
42.654.7
59.4
70
6058
39.469.8
63.3
60.5 62.3
74.5
59.3
43.9
50.7
42.3
49.1
46.6
50.7
44.7
47.1
43.2
21.627.9 54.1
49.652.7 46
6053.3
54.8
42.7
20.9
30.8
45.6
44.8
54.3
55.8
50.2
55.1
56.7
57.844.9
55.3
67.9
63.6
35.439.7
52.76
56.8
33.9
33.3
46.7
24.2
29.824.2
30.4
48.947.9
42.9 32.8
32.4
26.535.8
27.825.3
27.7
27.617.2
35.6
44.6
31.6
30.6
4162 64.6
54.8
53.764.8
64.575.5
25.7
38.2
40.7
41.3 45.3
43
47
48.9
51
37.9
57.7
64.7
74.551.9 48.8
65.8
74.6
60.561.5
72.7 55.7
32.742.6
39.3
60
53.9
54.3
49
36.8
52.6. 38.3
39.8
54.1 59.3
69.9
54.0
initiation: 55.6%
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
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
So, who is doing something about it?
• US Government• National entities• State Government• KY entities• Others
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
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
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
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
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
Fully Breastfeeding Food Package
Photos Courtesy of Texas WIC State Agency
“Grand Deluxe Package”
Fully Breastfeeding Mom – up to 12 months Infant 6-11 months
Partially Breastfeeding Food Package
Photos Courtesy of Texas WIC State Agency
“Deluxe Package”
Partially Breastfeeding Mom – up to 12 months Infant 6-11 months
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/
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)
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.
US Initiatives • US Breastfeeding Committee• The Joint Commission• Baby-Friendly Hospital Initiative• Patient-care Guidelines• Lactation Consultants• National Business Group on Health• Childcare Providers
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
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/
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
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
Who helps with breastfeeding?IBCLC
CLC/CLS/BSE, etc
WIC Breastfeeding Peer Counselor
Public Health: HANDS, HVN
EFNEP
Health professionals: MD, RN, RD
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
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
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
• National Standards, 3rd Edition
• Available free on-line (pdf file) through National Resource Center for Health and Safety in Childcare: http://nrckids.org/
• Specific State-by-State regulations available at this website, too
Kentucky Initiatives• WIC• Breastfeeding Coalitions• Kentucky Breastfeeding Strategic Plan• HANDS• Child Care Providers• Obesity prevention• Retailers • Cooperative Extension• Public Protection
Kentucky WIC• Promote breastfeeding with standard WIC services
– Special food packages – Breastpumps
• Regional Breastfeeding Coordinators for advocacy and outreach
• WIC Breastfeeding Peer Counselor services in many counties (Nancy Merk)
• Released State Breastfeeding Strategic Plan in April, 2011
• Publishes Breastfeeding Resource Guide, www.breastfeedinglink.org or http://www.chfs.ky.gov/dph/mch/ns/breastfeeding.htm
Breastfeeding Coalitions
• Lactation Improvement Network of KY (LINK)
• Kentuckiana Lactation Improvement Coalition (KLIC)
• Other smaller, regional groups• www.breastfeedinglink.org
Kentucky Breastfeeding Strategic Plan
• Six target areas with actions and strategies– Maternity care/hospital practices– Worksites– Peer Support– Health Care Providers– Educating Mothers and Families– Social Media
• Full plan at www.breastfeedinglink.org
HANDS
• Public health program for first-time parents• General promotion and support of
breastfeeding• Can make referrals for skilled
breastfeeding care (if available)
Child Care Providers
• Child Care Health Consultants (DPH)– Regional contacts in state– Technical assistance
• Resource and Referral Agencies (KDE)– Training for caregivers– Consultation for STARS ratings
• “Breastfeeding and Child Care” point person is Doraine Bailey (Lex Health Dept)
Obesity Prevention
• Partnership for a Fit Kentucky• Policy and collaboration• Breastfeeding part of portfolio
Equipment Resources• Specialty breastfeeding shops
―pumps―assistance by appointment if IBCLC
• Durable Medical Equipment suppliers– Rent pumps– Sell kits, other supplies
• General Retailers– Pillows, pumps, general supplies, – Often not ‘first quality’, effective pumps– Limited knowledge among salespeople
Cooperative Extension
• Projects and services targeting– Pre-pregnant citizens– Pregnant/new mothers– Social supports of new families
• Could include– EFNEP– World’s Biggest Baby Shower– Parenting classes– Family nutrition classes
Public Breastfeeding Protection• No laws in the USA that prohibit bf
outside the home• Most state laws protecting public bf have
no punitive/enforcement provisions• Federal law (1999) established protection
to bf child on any Federal Property where otherwise authorized to be– Public Law 106-058, sec. 647 (1999).
• KY, TN, IN all have laws protecting nursing in public, but no enforcement
Counseling Resources• BF flyers from State WIC
– Complete listing in PHPR Nutrition Section– Available from Pamphlet Library, Local Health Depts– in English and Spanish
• Bf Resource Guide (2011)– In print and online at CHFS webpage (below)
• CHFS Breastfeeding Webpage: http://chfs.ky.gov/dph/mch/breastfeeding.htm
• Int’l Lactation Consultant Assn (ILCA) “Find A Lactation Consultant”www.ilca.org
Kentucky Resources• Kentucky WIC Program State Office,
502-564-2339 • Kentucky Breastfeeding Website (WIC)
– http://www.chfs.ky.gov/dph/mch/ns/breastfeeding.htm
• Kentuckiana Lactation Improvement Coalition (KLIC), www.klicbreastfeeding.org
• Lactation improvement Network of KY (LINK), www.breastfeedinglink.org
Community Resources• La Leche League
―1-800-LA-LECHE, www.lalecheleague.org
―www.llleus.org/state/kentucky.html • Other Mother-to-Mother Support Groups
– Mother’s Forum in Berea – McDowell Hospital in Danville
• Retailers―Babies R Us, Mother Nurture―“Big Box” – Target, Walmart―DME: AbleCare, VDK at Grogans,
MedShoppe Medical
USDA Resources
• USDA has limited titles and resources in SNAP-ED database or Healthy Meals Resource system– USDA Resource Library includes some titles,
mostly to purchase.• MyPlate has detailed information for
pregnant and breastfeeding women.
Cooperative Extension Examples
• Michgan State University Extension: Breastfeeding Initiative Mother to Mother Peer Program– Mothers with breastfeeding experience are recruited
and hired from the community by the local Extension and WIC agency to serve as peers. Peers are trained to provide WIC and SNAP/Bridge Card eligible women with breastfeeding information, encouragement, and support. They are available to see mothers in person or by telephone, in the home, the hospital, or the WIC clinic.
– http://bfi.fcs.msue.msu.edu/
Cooperative Extension Examples
• Cornell Cooperative Extension“Breastfeeding for the Health of It” class series– 6 2-hour sessions– Rotating lesson plans– Targeting low-income women; free– New or pregnant mothers– http://ccetompkins.org/nutrition/breastfeeding-
support
Cooperative Extension Resources
• Breastfeeding and Infant Nutrition in Child Care (eXtension website)– http://www.extension.org/pages/25774/breastf
eeding-and-infant-nutrition-in-child-care• “Handle With Care: Guidelines for Safe
Storage and Use of Mother’s Milk” (Rutgers, New Jersey Ag Experiment Station)– http://njaes.rutgers.edu/pubs/publication.asp?
pid=FS949
Cooperative Extension Resources
• Clemson Extension Home and Garden Information Center– Breastfeeding Fact Sheets– http://www.clemson.edu/extension/hgic/hot_topics/20
09/08breastfeeding_series.html
• “Breastfeed Your Baby,” North Carolina State U Extension– Position/advocacy background paper – http://www.ces.ncsu.edu/depts/fcs/pdfs/BreastfeedPa
per.pdf
Cooperative Extension Resources
• National Network for Child Care (NC Extension)– Breastfeeding and Infant Nutrition page has
numerous resources developed by Coop Ext programs throughout the nation.
– Materials cited good for parents, childcare providers, etc.
– http://cyfernet.ces.ncsu.edu/nncc/index.php?c=1128
Results of Family and Consumer Sciences Accessing Nutritious Foods Survey (Bowling
Green)Program Number of Agents
Utilizing Program to Educate/ Promote Breastfeeding
SNAP-Ed 1
Just in Time Parenting 3
USDA materials 2
WIC materials 0
Policy change 0
Social marketing: newsletters radio and TV Facebook text messaging Twitter
65302
Other Programs 2
In what other programs do you or your assistants currently discuss parenting or infant
nutrition with women of childbearing age?
For more information:Doraine Bailey, MA, IBCLCBreastfeeding Support Services
Lexington-Fayette County Health Dept.805A Newtown CircleLexington, KY 40504
Tel: 859-288-2348 Fax: [email protected]
International Board Certified Lactation ConsultantLocal Health Department staff
Jackie Walters, MBA, RDExtension Specialist in Nutrition Education
ProgramsUniversity of Kentucky Cooperative
Extension ServiceOne Quality Street, Suite 692
Lexington, KY 40507Tel: 859-257-2948 Fax: 859-257-2990