1. 1 Jonathan E. Fielding, MD, MPH, MBA Director of Public Health and Health Officer L.A. County Department of Public Health Public Health Breastfeeding Policy Initiative Breastfeeding Matters April 7, 2010

2. Chronic Disease & Health Disparities Health disparities are associated with: Poverty Education Race/Ethnicity Breastfeeding has a role to play in disease prevention and addressing health disparities 2

3. Breastfeeding evens the playing field Breastfeeding is a natural "safety net" against the worst effects of poverty...It is almost as if breastfeeding takes the infant out of poverty for those first few months in order to give the child a fairer start in life and compensate for the injustice of the world into which it was born. James P. Grant Former Executive Director UNICEF 3

4. 4 Why is breastfeeding important? Exclusive and extensive breastfeeding reduces the risk for many diseases.

5. 5 Breastfeeding: Important for Babies Risk Differences for Various Disease AcuteChronic Source: Ip, AHRQ, 2007

6. 6 Breastfeeding Reduces the Risk of Childhood Obesity Leptin, ghrelin, adiponectin play a role Infants self-regulate at the breast Different maternal behavior Reduced risk for early growth acceleration Other variables Reduces the risk of obesity by 4% for each month of exclusive breastfeeding Ip, AHRQ, 2007 Dewey, JHL, 2003 Miralles, Obesity, 2006

7. 7 Breastfeeding Reduces the Risk of Childhood Obesity Exclusive BF for 3 to 6 months is associated with reduced risk for childhood overweight Not a panacea, but the start of our obesity prevention efforts BF promotion has become an important component in larger efforts to reduce childhood obesity

8. 8 Breastfeeding: Important for Mothers Risk Differences of Various Disease Ip, AHRQ, 2007

9. Breastfeeding = Optimal Infant Nutrition Good public health outcomes are associated with: extensive breastfeeding exclusive breastfeeding 9

10. Public Health Breastfeeding Policy Initiative Increase exclusive and extensive BF rates Baby Friendly Hospital designation LAC DHS committed, bringing along others Evidence based approach Buy-in from the top Convening regional quality improvement Collaborative approach Multidisciplinary team 10

11. California Any and Exclusive In-Hospital Breastfeeding: 1994-2007 11 Data Source: California Department of Public Health, Genetic Disease Screening Program, Newborn Screening Database 1994-2007 Prepared by: California Department of Public Health, Maternal, Child and Adolescent Health Program Note: Includes cases with feeding marked ‘BRO’ (Breast Only), ‘FOO’ (Formula Only), or ‘BRF’ (Breast & Formula) The “GAP” is Growing

12. 12 Percent Any/Exclusive In Hospital Breastfeeding: 2007 Gap

13. 13 Maternity Care Policy & Practices The maternity care experience exerts unique influence on both breastfeeding initiation and later infant feeding behavior Breastfeeding is an extremely time-sensitive relationship Experience with breastfeeding in the first hours and days of life significantly influence an infant’s later feeding

14. 14 Evidence-Based Interventions Significant evidence that changes in maternity care at the institutional level can increase breastfeeding initiation, exclusivity, and duration CDC recommends bringing key decision makers together to address the importance of evidence-based breastfeeding practices Source: Shealy 2005

15. 15 We look forward to your partnership on this important Public Health issue.

16. Works Cited California Department of Public Health, Maternal, Child and Adolescent Health Program. “California Department of Public Health, Genetic Disease Screening Program, Newborn Screening Database, 1994-2007.” Available at: http://www.cdph.ca.gov/DATA/STATISTICS/Pages/BreastfeedingStatistics.aspx http://www.cdph.ca.gov/DATA/STATISTICS/Pages/BreastfeedingStatistics.aspx Dewey KG. Is breastfeeding protective against child obesity? J Hum Lact 2003;19(1):9-18. Ip S, Tufts-New England Medical Center. Evidence-based Practice Center., United States. Agency for Healthcare Research and Quality. Breastfeeding and maternal and infant health outcomes in developed countries. Rockville, MD: U.S. Dept. of Health and Human Services, Public Health Service, Agency for Healthcare Research and Quality; 2007. Miralles O, Sanchez J, Palou A, Pico C. A physiological role of breast milk leptin in body weight control in developing infants. Obesity (Silver Spring) 2006;14(8):1371-7. Shealy KR, Li R, Benton-Davis S, Grummer-Strawn LM. The CDC Guide to Breastfeeding Interventions. Atlanta: U.S. Department of Health and Human Services. Available at: http://www.cdc.gov/breastfeeding/pdf/breastfeeding_interventions.pdf http://www.cdc.gov/breastfeeding/pdf/breastfeeding_interventions.pdf 16