2. Communities Working Together to Promote Breastfeeding Mary Applegate, MD MPH Bureau of Women’s Health NYS Department of Health

3. “Breastfeeding is one of the simplest, most cost- effective ways to promote good health during infancy.” Communities Working Together for a Healthier New York

4. Blueprint for Action on Breastfeeding US Department of Health & Human Services 2000

5. Why breastfeeding? zInfant health zMaternal health zConvenience zEconomic benefits

6. Infant health zOptimal nutrition, including for “premies” zGrowth & development zMaternal bonding, comfort zDisease prevention yInfections yAllergies yChronic diseases ySIDS

7. Maternal health zPostpartum recovery zBirth spacing zPsychological benefits zDisease prevention yBreast cancer yUterine & ovarian cancer

8. Convenience zAlways the right temperature zSterile zPortable

9. Economic benefits zCost of formula and related paraphernalia zHealth care costs yDoctor visits yPharmacy yHospitalizations zLess time lost from work & other responsibilities

10. Healthy People 2010 goals z75% early postpartum z50% at 6 months z25% at 1 year

11. New York Stats

12. Variation within New York zBy region: 56.3% to 75.8% zBy hospital: 28.6% to 95.5% y26 hospitals exceed Healthy People 2010 goal zBy socio-economic status y67.3% population-wide y~50% among WIC participants

13. Reasons for variation zCultural attitudes zFamily & community support zHealthcare provider policies & practices zEmployment status & support

14. Cultural attitudes zMost challenging... most important to change

15. Cultural attitudes 1

16. Cultural attitudes 2

17. Changing attitudes zCommunity education yBreastfeeding: First Step to Good Health -- K-12 Learning Activities yhttp://www.health.state.ny.us/nysdoh/b_feed/index.htm zNYS Civil Rights Law

18. Breastfeeding: First Step... zDevelop positive attitude toward breastfeeding, starting in early grades

19. Breastfeeding: First step... zIn older grades, learn about breastfeeding ybiological facts yenvironmental & economic benefits ychoices & decision making...

20. NYS Civil Rights Law “Notwithstanding any other provision of law, a mother may breast feed her baby in any location, public or private, where the mother is otherwise authorized to be, irrespective of whether or not the nipple of the mother’s breast is covered during or incidental to the breast feeding.”

21. Reasons for variation zCultural attitudes zFamily & community support zHealthcare provider policies & practices zEmployment status & support

22. Family & community support z“Warm chain” for breastfeeding zFamily, friends, child care providers supportive & knowledgeable -- regardless of personal experiences zCommunity support services yLa Leche League yWIC peer counselors yNursing Mothers Counselors

23. Health care practices zNew York State Hospital Code z“Best Practices for Breastfeeding Support” yHospital yManaged care yOutpatient clinics

24. Hospital support zLactation coordinator zEncourage breastfeeding in delivery room & 24-hour rooming-in zAvoid supplemental formula, water, bottles, pacifiers zEducate mother about key issues zEnsure availability of follow-up

25. Managed care support zMonitor breastfeeding rates zEncourage obstetric & pediatric providers to promote & support breastfeeding zInclude in benefit package: yBreastfeeding classes yLactation consultant visits yRental of hospital grade pump if mother & newborn are separated (e.g. premie in NICU)

26. Ambulatory care support z Positive staff attitudes z Inviting waiting room z Lactation specialist on staff z Breastfeeding classes on-site z Appropriate resource material z Breastfeeding “warm line” z No formula company material z Breastfeeding assessed at each pediatric visit z Duration of breastfeeding monitored

27. Workplace support zMaternity leave -- 6 weeks or more zAllow infant to be near mother (in office; on-site childcare) zFlexible schedules zBreastfeeding or pumping breaks zLactation room -- pump, chair, fridge zLactation consultant zBreastfeeding classes

28. Childcare support zPositive staff attitudes zPolicies supportive of feeding expressed breastmilk and/or having mother visit to breastfeed zInformation about combining working & breastfeeding zSuggestions for working with employer

29. Partners in promoting breastfeeding zPhysicians, midwives, nurses zLactation consultants zHospital lactation coordinators zWIC staff & peer counselors zLa Leche League, community groups zEmployers/businesses zSchools, childcare centers

30. “Breastfeeding is one of the simplest, most cost- effective ways to promote good health during infancy.” Communities Working Together for a Healthier New York