1. GradCon 2016 Mandi Zanto MPH Candidate Lisa Schmidt, MPH Epidemiologist Terry Miller, IBCLC, CLC Evaluating Montana’s Baby Friendly Hospital Initiative

2.  What is the importance of breastfeeding in Public Health  What is the Baby Friendly Hospital Initiative (BFHI)  How can we evaluate the success of the Montana’s BFHI through The Maternity Practices in Infant Nutrition and Care (mPINC) Survey  Future steps Overview

3. Why Is Breastfeeding Important? Benefits to Mom and Baby

4. Breastfeeding Rates, 2014 D dtetswas Montana: The State of the State of Breastfeeding NIS Indicator MontanaU.S.HP 2020 Ever Breastfed 91.279.281.9 At 6 months 50.749.460.6 At 1 year 25.526.734.1 Exclusively through 3 months 53.440.742.6 Exclusively through 12 months 19.318.825.5 Center for Disease Control and Prevention, National Immunization Survey (NIS), 2011 births

5.  The Baby Friendly Hospital Initiative (BFHI) is a global movement, directed by WHO and UNICEF, that aims to give every baby the best start in life by creating a health care environment where breastfeeding is the norm. The BFHI has two main goals: 1)to transform maternity wards and hospital facilities by establishment of the Ten Steps to Successful Breastfeeding. 2)To end the practice of distribution of free and low-cost formula to hospitals and birth centers.  http://http://www.unicef.org/nutrition/index_24850.html & http://www.unicef.org/nutrition/files/BFHI_2009_s3.1and2.pdf http://http://www.unicef.org/nutrition/index_24850.html What is the Baby Friendly Hospital Initiative?

6. Ten Successful Steps to Baby Friendly 1) Model Policy 2) Staff Training/Competency 3) Prenatal Breastfeeding Education 4) Early Initiation 5) Teach Breastfeeding Techniques

7. Ten Successful Steps to Baby Friendly 6) Limit Supplements 7) Rooming In 8) Teaching Feeding Cues 9) Limit Pacifiers 10) Discharge Support

8.  Institutional changes in maternity care practices can increase breastfeeding initiation and duration rates and engagement in the Baby Friendly Hospital Initiative increases the likelihood of breastfeeding initiation  Mean rate for breastfeeding initiation in Baby Friendly Hospital 83.8%  Mean rate for breastfeeding initiation in the US 69.5%  Meerewood A, Mehta SD, Chamberlain LB, Philipp BL, Bauchner H. Breastfeeding Rates in the US Baby-Friendly Hospitals: Results of a Nation Survey, Pediatrics 2005; 116(3):628-634. Why Implement the BFHI

9.  The Maternity Practices in Infant Nutrition and Care (mPINC) Survey Success of the Implementation of the Ten Steps 1)67 question survey administered by the CDC to every birthing facility in the US every other year 2)Survey questions are placed under 7 dimensions and sub scores are calculated 3)The 7 means of the sub scores make up the overall facility mPINC score-a number between 0-100 The mPINC survey links maternity practices to the Ten Steps to Successful Breastfeeding How Can We Evaluate the BFHI’s Success

10. mPINC Dimensions Related to the Ten Steps Step 4 (Early Initiation) Dimension 1: Labor and Delivery Care Step 6 (Limit Supplements) Dimension 2: Feeding of Breastfed Infants Steps 3, 5, 8 & 9 (BF Ed, BF Techniques, Teaching Feeding Cues, Limiting Pacifiers Dimension 3: Breastfeeding Assistance Step 7 (Rooming In) Dimension 4: Contact Between Mother and Infant Step 10 (Discharge Support) Dimension 5: Facility Discharge Care Step 2 (Staff Training) Dimension 6: Staff Training Step 1 (Model Policy) Dimension 7: Structural and Organization Aspects of Care Delivery

11. Montana: The State of the State of Breastfeeding

13. Evaluating Baseline Data

14. Next Steps Evaluate 2015 mPINC Scores Compare scores from engaged facilities in MT vs not engaged facilities in 2015 Is there a statistically significant difference in scores between engaged and not engaged facilities Compare 2013 with 2015 Data Compare overall scores from 2013 and 2015: as more facilities are engaged and designated are overall mPINC scores higher Increase Number of Designated Facilities Work to increase engagement of new facilities and continue to work with facilities engaged in the process to increase number of MT facilities designated as Baby Friendly

15. THANK YOU!!!!!! Mandi Zanto Program Manager Nutrition and Physical Activity Program 406-444-7373 mzanto@mt.gov