1. Developing Community Partnerships to Promote Breastfeeding on the Flathead Indian Reservation Amy Stiffarm, cMPH 1, The Breastfeeding Coalition of the Mission Valley 2, Kari Harris, Ph.D 1, Emily Colomeda, MPH, RN 2 1 School of Public and Community Health Sciences, University of Montana, Missoula, MT. 2 Lake County Public Health Department, Polson, MT.

2. Introduction - Breastfeeding Acute and long-term health benefits for both Mom and Baby. Economic benefit for family, community, nationally and globally.

3. Introduction - Breastfeeding The World Health Organization (WHO) recommends exclusive breastfeeding for 6 months. Thereafter infants should receive complementary foods with continued breastfeeding up to 2 years of age or beyond. (WHO, 2016) The Healthy People 2020 Goals for Breastfeeding are 81% ever breastfed, 61% at 6 mos. (25.5% exclusively) and 34% at 1 yr.

4. Breastfeeding in Montana Breastfeeding support indicators include: No. of La Leche League Leaders, IBCLCs, CLCs per 1,000 live births.

5. Introduction - Breastfeeding Barriers Specific to AI/AN Women High teen pregnancy rates. No local birthing/prenatal care. Few lactation specialists and support groups on reservations. Low pump-at-work support from employers. Access to free formula through federal nutrition programs.

6. Intervention- Breastfeeding Support Space PUBH 540 Social and Behavioral Health Assignment (Harris, 2015) PUBLIC HEALTH PROBLEM: Discontinuing breastfeeding too early and not meeting WHO recommendations for breastfeeding. TARGET POPULATION: Native American nursing mothers PROPOSED INTERVENTION: Provide comfortable setting for breastfeeding at various powwows in the state of Montana through out the year.

7. Breastfeeding Support Space Methods Identify community partners, supporters and potential sponsors. – Local, tribal, county, state. Create the space at the annual Standing Arrow Pow-wow.

8. Standing Arrow Pow-wow Breastfeeding Support Space Results and Discussion ~ 5 mothers used the space to breastfeed. ~ 10 mothers used the space to change their children. The support space contributed to the normalization of breastfeeding.

9. Improvements and Future Directions Expand support space to additional pow wows and baby and health fairs. Establishment of breastfeeding support groups on the reservation. Offering more outreach education events on the reservation.

10. References Center for Disease Control. (2014). Breastfeeding Report Card. http://www.cdc.gov/breastfeeding/pdf/2014breastfeedingreportcard.pdf http://www.cdc.gov/breastfeeding/pdf/2014breastfeedingreportcard.pdf Center for Disease Control. (2014). Nutrition, Physical Activity and Obesity: Data, Trends and Maps: Montana location summary. Retrieved from https://nccd.cdc.gov/NPAO_DTM/LocationSummary.aspx?statecode=93https://nccd.cdc.gov/NPAO_DTM/LocationSummary.aspx?statecode=93 Child Trends Data Bank. (2014). Breastfeeding. Retrieved from http://www.childtrends.org/?indicators=breastfeedinghttp://www.childtrends.org/?indicators=breastfeeding Goldhammer, C. (2014). Indian Country Breastfeeds. Retrieved from http://www.indiancountrybreastfeeds.org/bloghttp://www.indiancountrybreastfeeds.org/blog The Lancet. (2016). Breastfeeding: achieving the new normal. Retrieved from file:///Users/amystiffarm/Documents/PIIS0140673616002105.pdf file:///Users/amystiffarm/Documents/PIIS0140673616002105.pdf Montana State Breastfeeding Coalition. (2016). Local Coalitions. http://www.mtbreastfeedingcoalition.com/local- coalitions.htmlhttp://www.mtbreastfeedingcoalition.com/local- coalitions.html Office of Disease Prevention and Health Promotion. (2016). Maternal, Infant and Child Health. Retrieved from https://www.healthypeople.gov/2020/topics-objectives/topic/maternal-infant-and-child-health/objectives https://www.healthypeople.gov/2020/topics-objectives/topic/maternal-infant-and-child-health/objectives Office on Women’s Health. (2014). Womenshealth.gov Victora, Cesar G et al. Association between breastfeeding and intelligence, educational attainment, and income at 30 years of age: a prospective birth cohort study from Brazil. The Lancet Global Health. Retrieved from http://www.thelancet.com/journals/langlo/article/PIIS2214-109X(15)70002-1/fulltext http://www.thelancet.com/journals/langlo/article/PIIS2214-109X(15)70002-1/fulltext World Health Organization. (2016). Breastfeeding. Health Topics. Retrieved from http://www.who.int/topics/breastfeeding/en/ http://www.who.int/topics/breastfeeding/en/ World Health Organization. (2016). Donor human milk for low-birth-weight infants. http://www.who.int/elena/titles/donormilk_infants/en/ http://www.who.int/elena/titles/donormilk_infants/en/

11. Acknowledgements MSBC World Breastfeeding Week Award Funding Standing Arrow Pow-wow Committee Breastfeeding Coalition of the Mission Valley Lake County Public Health Department University of Montana School of Public and Community Health Sciences

12. Questions?? Email: amy.stiffarm@gmail.com