1. BREASTFEEDING IN KANSAS: WHOS DOING WHAT WHERE? Brenda Bandy, IBCLC Program Director, Business Case for Breastfeeding Kansas Breastfeeding Coalition, Inc. Martha Hagen, MS,RD,LD,IBCLC Breastfeeding Coordinator Nutrition and WIC Services

2. The NORMAL way to feed a baby!

3. Where Do We Stand?

4. Percent of Mothers Who Breastfeed Their Infants at 6 months Kansas and U.S., 2001-2010 Desired Direction = Above Line HP2020 = Healthy People 2020 na = not available Source: National Immunization Survey (birth year; 2007 and 2008 data are provisional.); Pediatric Nutrition Surveillance System (PedNSS) HP2020 60.6% na

5. Indicators of Breastfeeding Support (CDC 2012 Breastfeeding Report Card)

6. Breastfeeding Initiation Rates 2008-2010 6 Lyon Logan Linn Lincoln Leavenworth Lane Labette Wyandotte Kiowa Woodson Kingman Wilson Kearny Wichita Johnson Washington Jewell Wallace Jefferson Wabaunsee Jackson Trego Hodgeman Thomas Haskell Sumner Harvey Stevens Stanton Hamilton Stafford Greenwood Smith Greeley Sherman Gray Sheridan Grant Shawnee Graham Seward Gove Sedgwick Geary Scott Franklin Saline Ford Russell Finney Rush Ellsworth Rooks Ellis Riley Elk Rice Edwards Republic Douglas Reno Doniphan Rawlins Dickinson Pratt Decatur Pottawatomie Crawford Phillips Cowley Pawnee Comanche Ottawa Coffey Osborne Cloud Osage Clay Norton Clark Ness Cheyenne Neosho Cherokee Nemaha Chautauqua Morton Chase Morris Butler Montgomery Brown Mitchell Bourbon Miami Barton Meade Barber McPherson Atchison Marshall Anderson Marion Allen Harper < 70% 70%-81.8% > 81.9% (HP 2020 goal)

7. Breastfeeding Data Sources National Immunization Survey Kansas Birth Certificate Data Kansas WIC Data Pediatric Nutrition Surveillance System Data

8. Surgeon Generals Call to Action to Support Breastfeeding Available at www.surgeongeneral.gov

9. Call to Action to Support Breastfeeding Everyone can help make breastfeeding easier.

10. WHOS DOING WHAT IN KANSAS…AND WHERE A look at breastfeeding initiatives and programs across the state of Kansas as they relate to the Surgeon Generals Call to Action to Support Breastfeeding

11. The Who (not the rock band) Kansas Breastfeeding Coalition Business Case for Breastfeeding (workplace lactation support) Coming in August – window clings for businesses High 5 for Mom and Baby (hospital maternity care improvement) Women, Infant & Children (KDHE) Peer counselors (mother-to-mother support) Maternal & family education Community awareness campaigns La Leche League of Kansas Mother-to-mother support Continuing education to health care professionals Kansas Public Health Association/County Health Depts. County-level grants for a variety of breastfeeding interventions

12. The Where A look at the locations of breastfeeding support activities by county in relation to the Surgeon Generals Call to Action to Support Breastfeeding Clearer understanding of breastfeeding in Kansas

13. Action 1:Give mothers the support they need to breastfeed their babies. 88% of hospitals in Kansas included breastfeeding in their prenatal patient education ( Maternity Practices in Infant Nutrition and Care Survey (mPINC), Centers for Disease Control and Prevention, 2011) Kansas Public Health Association (KPHA) grant funding made possible: Breast pump/aids in 12 counties Breastfeeding prenatal classes in 6 counties Spanish breastfeeding materials in two counties High School education in Johnson County

14. Action 1: Counties providing maternal support through KPHA grants 14 Lyon Logan Linn Lincoln Leavenworth Lane Labette Wyandotte Kiowa Woodson Kingman Wilson Kearny Wichita Johnson Washington Jewell Wallace Jefferson Wabaunsee Jackson Trego Hodgeman Thomas Haskell Sumner Harvey Stevens Stanton Hamilton Stafford Greenwood Smith Greeley Sherman Gray Sheridan Grant Shawnee Graham Seward Gove Sedgwick Geary Scott Franklin Saline Ford Russell Finney Rush Ellsworth Rooks Ellis Riley Elk Rice Edwards Republic Douglas Reno Doniphan Rawlins Dickinson Pratt Decatur Pottawatomie Crawford Phillips Cowley Pawnee Comanche Ottawa Coffey Osborne Cloud Osage Clay Norton Clark Ness Cheyenne Neosho Cherokee Nemaha Chautauqua Morton Chase Morris Butler Montgomery Brown Mitchell Bourbon Miami Barton Meade Barber McPherson Atchison Marshall Anderson Marion Allen Harper

15. Action 3: Strengthen programs that provide mother-to-mother support and peer counseling. La Leche League of Kansas has 56 volunteers providing mother-to-mother support in 20 counties. 1.92 LLL Leaders/1000 live births (LBs) compared to 0.95/1000 LBs nationally 39 WIC Peer Counselors in 47 counties. 13 breastfeeding support groups established with KPHA grants run by county health departments.

16. Action 3: La Leche League 16 Lyon Logan Linn Lincoln Leavenworth Lane Labette Wyandotte Kiowa Woodson Kingman Wilson Kearny Wichita Johnson Washington Jewell Wallace Jefferson Wabaunsee Jackson Trego Hodgeman Thomas Haskell Sumner Harvey Stevens Stanton Hamilton Stafford Greenwood Smith Greeley Sherman Gray Sheridan Grant Shawnee Graham Seward Gove Sedgwick Geary Scott Franklin Saline Ford Russell Finney Rush Ellsworth Rooks Ellis Riley Elk Rice Edwards Republic Douglas Reno Doniphan Rawlins Dickinson Pratt Decatur Pottawatomie Crawford Phillips Cowley Pawnee Comanche Ottawa Coffey Osborne Cloud Osage Clay Norton Clark Ness Cheyenne Neosho Cherokee Nemaha Chautauqua Morton Chase Morris Butler Montgomery Brown Mitchell Bourbon Miami Barton Meade Barber McPherson Atchison Marshall Anderson Marion Allen Harper

17. Action 3: WIC Peer Counselors 17 Lyon Logan Linn Lincoln Leavenworth Lane Labette Wyandotte Kiowa Woodson Kingman Wilson Kearny Wichita Johnson Washington Jewell Wallace Jefferson Wabaunsee Jackson Trego Hodgeman Thomas Haskell Sumner Harvey Stevens Stanton Hamilton Stafford Greenwood Smith Greeley Sherman Gray Sheridan Grant Shawnee Graham Seward Gove Sedgwick Gea r y Scott Franklin Saline Ford Russell Finney Rush Ellsworth Rooks Ellis Riley Elk Rice Edwards Republic Douglas Reno Doniphan Rawlins Dickinson Pratt Decatur Pottawatomie Crawford Phillips Cowley Pawnee Comanche Ottawa Coffey Osborne Cloud Osage Clay Norton Clark Ness Cheyenne Neosho Cherokee Nemaha Chautauqua Morton Chase Morris Butler Montgomery Brown Mitchell Bourbon Miami Barton Meade Barber McPherson Atchison Marshall Anderson Marion Allen Harper

18. Action 3: Breastfeeding Support Groups at County Health Departments (KPHA grants) 18 Lyon Logan Linn Lincoln Leavenworth Lane Labette Wyandotte Kiowa Woodson Kingman Wilson Kearny Wichita Johnson Washington Jewell Wallace Jefferson Wabaunsee Jackson Trego Hodgeman Thomas Haskell Sumner Harvey Stevens Stanton Hamilton Stafford Greenwood Smith Greeley Sherman Gray Sheridan Grant Shawnee Graham Seward Gove Sedgwick Geary Scott Franklin Saline Ford Russell Finney Rush Ellsworth Rooks Ellis Riley Elk Rice Edwards Republic Douglas Reno Doniphan Rawlins Dickinson Pratt Decatur Pottawatomie Crawford Phillips Cowley Pawnee Comanche Ottawa Coffey Osborne Cloud Osage Clay Norton Clark Ness Cheyenne Neosho Cherokee Nemaha Chautauqua Morton Chase Morris Butler Montgomery Brown Mitchell Bourbon Miami Barton Meade Barber McPherson Atchison Marshall Anderson Marion Allen Harper

19. Action 3: Mother-to-Mother Support Composite 19

20. Action 4: Use community-based organizations to promote and support breastfeeding. KPHA grants funded: 24/7 warm helpline in two counties Breastfeeding events in three counties Healthy Start home visitors continue to serve breastfeeding mothers Parents As Teachers educators receive specific training on breastfeeding Formation of African-American peer support project in KC Coming soon…Breastfeeding Welcome Here window- clings for businesses from the KBC

21. Action 4: Community-based organizations to support breastfeeding – KPHA grants 21 Lyon Logan Linn Lincoln Leavenworth Lane Labette Wyandotte Kiowa Woodson Kingman Wilson Kearny Wichita Johnson Washington Jewell Wallace Jefferson Wabaunsee Jackson Trego Hodgeman Thomas Haskell Sumner Harvey Stevens Stanton Hamilton Stafford Greenwood Smith Greeley Sherman Gray Sheridan Grant Shawnee Graham Seward Gove Sedgwick Geary Scott Franklin Saline Ford Russell Finney Rush Ellsworth Rooks Ellis Riley Elk Rice Edwards Republic Douglas Reno Doniphan Rawlins Dickinson Pratt Decatur Pottawatomie Crawford Phillips Cowley Pawnee Comanche Ottawa Coffey Osborne Cloud Osage Clay Norton Clark Ness Cheyenne Neosho Cherokee Nemaha Chautauqua Morton Chase Morris Butler Montgomery Brown Mitchell Bourbon Miami Barton Meade Barber McPherson Atchison Marshall Anderson Marion Allen Harper

22. Action 5: Create a national [local] campaign to promote breastfeeding KPHA grants funded media campaigns in five counties.

23. Barton County Marketing Project Included: Billboards Newspaper ads Radio spots

25. Action 5: Create a national [local] campaign to promote breastfeeding 25 Lyon Logan Linn Lincoln Leavenworth Lane Labette Wyandotte Kiowa Woodson Kingman Wilson Kearny Wichita Johnson Washington Jewell Wallace Jefferson Wabaunsee Jackson Trego Hodgeman Thomas Haskell Sumner Harvey Stevens Stanton Hamilton Stafford Greenwood Smith Greeley Sherman Gray Sheridan Grant Shawnee Graham Seward Gove Sedgwick Geary Scott Franklin Saline Ford Russell Finney Rush Ellsworth Rooks Ellis Riley Elk Rice Edwards Republic Douglas Reno Doniphan Rawlins Dickinson Pratt Decatur Pottawatomie Crawford Phillips Cowley Pawnee Comanche Ottawa Coffey Osborne Cloud Osage Clay Norton Clark Ness Cheyenne Neosho Cherokee Nemaha Chautauqua Morton Chase Morris Butler Montgomery Brown Mitchell Bourbon Miami Barton Meade Barber McPherson Atchison Marshall Anderson Marion Allen Harper

26. Action 7. Ensure that maternity care practices around the United States are fully supportive of breastfeeding. 26% of birthing facilities in KS reported not giving out discharge packs containing infant formula samples and marketing products to breastfeeding patients. (2009 mPINC survey, CDC) NO Baby Friendly designated hospitals in Kansas. Wesley in Wichita selected for Best Fed Beginnings project. KPHA grants funded: Breastfeeding discharge bags in 5 counties. Hospital policy improvement in 2 counties.

27. Action 7. Maternity care improvement through KPHA grants (discharge bags & hospital policies) 27 Lyon Logan Linn Lincoln Leavenworth Lane Labette Wyandotte Kiowa Woodson Kingman Wilson Kearny Wichita Johnson Washington Jewell Wallace Jefferson Wabaunsee Jackson Trego Hodgeman Thomas Haskell Sumner Harvey Stevens Stanton Hamilton Stafford Greenwood Smith Greeley Sherman Gray Sheridan Grant Shawnee Graham Seward Gove Sedgwick Geary Scott Franklin Saline Ford Russell Finney Rush Ellsworth Rooks Ellis Riley Elk Rice Edwards Republic Douglas Reno Doniphan Rawlins Dickinson Pratt Decatur Pottawatomie Crawford Phillips Cowley Pawnee Comanche Ottawa Coffey Osborne Cloud Osage Clay Norton Clark Ness Cheyenne Neosho Cherokee Nemaha Chautauqua Morton Chase Morris Butler Montgomery Brown Mitchell Bourbon Miami Barton Meade Barber McPherson Atchison Marshall Anderson Marion Allen Harper

28. Action 8: Develop systems to guarantee continuity of skilled support for lactation between hospitals and health care settings in the community. KPHA grants funded: Resource directories & referral systems in 8 counties. Post-discharge follow-up visits to mothers in 7 counties. Walk-in breastfeeding clinics in 5 counties.

29. Action 8: Continuity of Care from KPHA funding 29 Lyon Logan Linn Lincoln Leavenworth Lane Labette Wyandotte Kiowa Woodson Kingman Wilson Kearny Wichita Johnson Washington Jewell Wallace Jefferson Wabaunsee Jackson Trego Hodgeman Thomas Haskell Sumner Harvey Stevens Stanton Hamilton Stafford Greenwood Smith Greeley Sherman Gray Sheridan Grant Shawnee Graham Seward Gove Sedgwick Geary Scott Franklin Saline Ford Russell Finney Rush Ellsworth Rooks Ellis Riley Elk Rice Edwards Republic Douglas Reno Doniphan Rawlins Dickinson Pratt Decatur Pottawatomie Crawford Phillips Cowley Pawnee Comanche Ottawa Coffey Osborne Cloud Osage Clay Norton Clark Ness Cheyenne Neosho Cherokee Nemaha Chautauqua Morton Chase Morris Butler Montgomery Brown Mitchell Bourbon Miami Barton Meade Barber McPherson Atchison Marshall Anderson Marion Allen Harper

30. Action 9. Provide education and training in breastfeeding for all health professionals who care for women and children. KPHA grants funded: 56 people from 12 counties to attend 3 day Certified Breastfeeding Educator (CBE) trainings Education for health care professionals (HCPs) in 16 counties 250 HCPs from across Kansas attended La Leche League of KS Continuing Education Program in March 2012, funded in part by the Kansas Health Foundation. Save the Date – March 8, 2013 for next LLL of KS CE Program featuring Dr. Tina Smillie.

31. Action 9: Education for HCPs from KPHA funding 31 Lyon Logan Linn Lincoln Leavenworth Lane Labette Wyandotte Kiowa Woodson Kingman Wilson Kearny Wichita Johnson Washington Jewell Wallace Jefferson Wabaunsee Jackson Trego Hodgeman Thomas Haskell Sumner Harvey Stevens Stanton Hamilton Stafford Greenwood Smith Greeley Sherman Gray Sheridan Grant Shawnee Graham Seward Gove Sedgwick Geary Scott Franklin Saline Ford Russell Finney Rush Ellsworth Rooks Ellis Riley Elk Rice Edwards Republic Douglas Reno Doniphan Rawlins Dickinson Pratt Decatur Pottawatomie Crawford Phillips Cowley Pawnee Comanche Ottawa Coffey Osborne Cloud Osage Clay Norton Clark Ness Cheyenne Neosho Cherokee Nemaha Chautauqua Morton Chase Morris Butler Montgomery Brown Mitchell Bourbon Miami Barton Meade Barber McPherson Atchison Marshall Anderson Marion Allen Harper

32. Action 11. Ensure access to services provided by International Board Certified Lactation Consultants (IBCLCs). Currently 135 IBCLCs in KS 3.4 IBCLCs in KS/1000 live births compared to 3.24/1000 LBs nationally 9 new IBCLCs from KPHA grant funding

33. Action 11: IBCLCs in Kansas 33 Lyon Logan Linn Lincoln Leavenworth Lane Labette Wyandotte Kiowa Woodson Kingman Wilson Kearny Wichita Johnson Washington Jewell Wallace Jefferson Wabaunsee Jackson Trego Hodgeman Thomas Haskell Sumner Harvey Stevens Stanton Hamilton Stafford Greenwood Smith Greeley Sherman Gray Sheridan Grant Shawnee Graham Seward Gove Sedgwick Geary Scott Franklin Saline Ford Russell Finney Rush Ellsworth Rooks Ellis Riley Elk Rice Edwards Republic Douglas Reno Doniphan Rawlins Dickinson Pratt Decatur Pottawatomie Crawford Phillips Cowley Pawnee Comanche Ottawa Coffey Osborne Cloud Osage Clay Norton Clark Ness Cheyenne Neosho Cherokee Nemaha Chautauqua Morton Chase Morris Butler Montgomery Brown Mitchell Bourbon Miami Barton Meade Barber McPherson Atchison Marshall Anderson Marion Allen Harper

34. Action 14. Ensure that employers establish and maintain comprehensive, high-quality lactation support programs for their employees. The Kansas Business Case for Breastfeeding has trained over 160 people to help businesses create a workplace lactation support program in 13 counties. Employer assistance in 9 counties provided with funding from KPHA grants.

35. Action 14: Business Case for Breastfeeding trainings 35 Lyon Logan Linn Lincoln Leavenworth Lane Labette Wyandotte Kiowa Woodson Kingman Wilson Kearny Wichita Johnson Washington Jewell Wallace Jefferson Wabaunsee Jackson Trego Hodgeman Thomas Haskell Sumner Harvey Stevens Stanton Hamilton Stafford Greenwood Smith Greeley Sherman Gray Sheridan Grant Shawnee Graham Seward Gove Sedgwick Geary Scott Franklin Saline Ford Russell Finney Rush Ellsworth Rooks Ellis Riley Elk Rice Edwards Republic Douglas Reno Doniphan Rawlins Dickinson Pratt Decatur Pottawatomie Crawford Phillips Cowley Pawnee Comanche Ottawa Coffey Osborne Cloud Osage Clay Norton Clark Ness Cheyenne Neosho Cherokee Nemaha Chautauqua Morton Chase Morris Butler Montgomery Brown Mitchell Bourbon Miami Barton Meade Barber McPherson Atchison Marshall Anderson Marion Allen Harper

36. Action 14: Employer Assistance/Outreach from KPHA funding 36 Lyon Logan Linn Lincoln Leavenworth Lane Labette Wyandotte Kiowa Woodson Kingman Wilson Kearny Wichita Johnson Washington Jewell Wallace Jefferson Wabaunsee Jackson Trego Hodgeman Thomas Haskell Sumner Harvey Stevens Stanton Hamilton Stafford Greenwood Smith Greeley Sherman Gray Sheridan Grant Shawnee Graham Seward Gove Sedgwick Geary Scott Franklin Saline Ford Russell Finney Rush Ellsworth Rooks Ellis Riley Elk Rice Edwards Republic Douglas Reno Doniphan Rawlins Dickinson Pratt Decatur Pottawatomie Crawford Phillips Cowley Pawnee Comanche Ottawa Coffey Osborne Cloud Osage Clay Norton Clark Ness Cheyenne Neosho Cherokee Nemaha Chautauqua Morton Chase Morris Butler Montgomery Brown Mitchell Bourbon Miami Barton Meade Barber McPherson Atchison Marshall Anderson Marion Allen Harper

37. Action 14: Composite of Employer Support for Breastfeeding 37

38. Action 15: Expand the use of programs in the workplace that allow lactating mothers to have direct access to their babies. 14 State agencies in Kansas allow approximately 6850 employees to bring their babies to work. Over 270 babies have been brought to work to date. Source -Babies in the Workplace website – www.babiesatwork.org

39. Action 16: Ensure that all child care providers accommodate the needs of breastfeeding mothers and infants. In Johnson County -Training for childcare providers covering the latest breastfeeding guidelines from Caring for Our Children: National Health and Safety Performance Standards 3rd edition, 2011 Working with Child Care Aware to provide training. Now available through KS- TRAIN

40. Action 19: Develop a national [local] monitoring system to improve the tracking of breastfeeding rates as well as the policies and environmental factors that affect breastfeeding. Monitoring breastfeeding rates in 4 counties from KPHA grant funding. Currently breastfeeding rates come from: Kansas birth certificate data (2 years behind) Kansas WIC population (by county, timely) National Immunization Survey (3 years behind)

41. Action 19: Collecting breastfeeding rates 41 Lyon Logan Linn Lincoln Leavenworth Lane Labette Wyandotte Kiowa Woodson Kingman Wilson Kearny Wichita Johnson Washington Jewell Wallace Jefferson Wabaunsee Jackson Trego Hodgeman Thomas Haskell Sumner Harvey Stevens Stanton Hamilton Stafford Greenwood Smith Greeley Sherman Gray Sheridan Grant Shawnee Graham Seward Gove Sedgwick Geary Scott Franklin Saline Ford Russell Finney Rush Ellsworth Rooks Ellis Riley Elk Rice Edwards Republic Douglas Reno Doniphan Rawlins Dickinson Pratt Decatur Pottawatomie Crawford Phillips Cowley Pawnee Comanche Ottawa Coffey Osborne Cloud Osage Clay Norton Clark Ness Cheyenne Neosho Cherokee Nemaha Chautauqua Morton Chase Morris Butler Montgomery Brown Mitchell Bourbon Miami Barton Meade Barber McPherson Atchison Marshall Anderson Marion Allen Harper

42. Action 20: Improve national leadership on the promotion and support of breastfeeding. Specifically, to increase the capacity of…affiliated state coalitions to support breastfeeding. 9 county/regional breastfeeding coalitions in Kansas (4 from funding from KPHA grants) Listing of local coalitions - www.ksbreastfeeding.org/contactus/localcoalitions.aspx. www.ksbreastfeeding.org/contactus/localcoalitions.aspx Starting a Community Conversation Summit on Coalition Building Nov. 9 th, at Wesley Medical Center, Wichita – FREE!!

43. Action 20: Local Breastfeeding Coalitions 43 Lyon Logan Linn Lincoln Leavenworth Lane Labette Wyandotte Kiowa Woodson Kingman Wilson Kearny Wichita Johnson Washington Jewell Wallace Jefferson Wabaunsee Jackson Trego Hodgeman Thomas Haskell Sumner Harvey Stevens Stanton Hamilton Stafford Greenwood Smith Greeley Sherman Gray Sheridan Grant Shawnee Graham Seward Gove Sedgwick Geary Scott Franklin Saline Ford Russell Finney Rush Ellsworth Rooks Ellis Riley Elk Rice Edwards Republic Douglas Reno Doniphan Rawlins Dickinson Pratt Decatur Pottawatomie Crawford Phillips Cowley Pawnee Comanche Ottawa Coffey Osborne Cloud Osage Clay Norton Clark Ness Cheyenne Neosho Cherokee Nemaha Chautauqua Morton Chase Morris Butler Montgomery Brown Mitchell Bourbon Miami Barton Meade Barber McPherson Atchison Marshall Anderson Marion Allen Harper

44. Composite of all Actions 44

45. A BIG thank you to the United Methodist Health Ministry Fund! For contributing so generously to: Kansas Public Health Association breastfeeding grants Kansas Business Case for Breastfeeding High 5 for Mom & Baby program

46. Resources Kansas Breastfeeding Coalition, Inc. www.ksbreastfeeding.org Business Case for Breastfeeding www.kansasbusinesscase.com High 5 for Mom & Baby www.kansashigh5.org La Leche League of Kansas www.kansasLLL.org