Helping Kentuckians Access Nutritious Foods by Promoting

Breastfeeding

Jackie Walters, MBA, RD

Doraine Bailey, MA, IBCLC

Objectives

• Discuss infant nutrition and the role of breastfeeding• Identify the network of breastfeeding supporters at

county, state, and national levels• Consider how agents and assistants can incorporate

infant nutrition and breastfeeding lessons into their work plans

• Consider how agents and assistants can work with organizations to promote breastfeeding in their communities

• Discuss materials and tools agents need to promote breastfeeding and to teach nutrition to expectant mothers and mothers of infants

Feeding is one of a parent’s most important jobs

(It’s how we help our

babies grow healthy

and strong)

Mealtime is more than just food

Meals and snacks give you a chance to help your baby:

• Learn healthy eating habits• Feel important and loved• Feel understood and respected• Trust that others will care for her

Infant feeding recommendations(AAP, WHO, ADA)

• Breastmilk or iron-fortified formula alone from birth until about 6 months

• Complementary foods begun around 6 months – typically iron-fortified cereals; meats are being considered

• Breastfeeding or iron-fortified formula continue until 12 months.

• Breastfeeding after 12 months as long as mother and baby wish to continue

Definitions of Breastfeeding and Exclusive Breastfeeding

• Breastfeeding: the practice of feeding a mother’s breast milk to her infant(s) on the average

of at least once per day

• Exclusive Breastfeeding: the infant receives only breast milk

and nothing else

Breastfeeding: Growing Healthy Babies and Moms

Growing Babies with Breastfeeding:

• best nutrition for appropriate growth and development

• active protection against infection (bacterial and viral)

• any illnesses less frequent and less severe

• lower risk of oral and dental problems• builds trusting relationship with Mom

Babies Grow and Glow With Breastmilk

Breastfeeding reduces baby’s risk of:– Obesity – Ear infections– Respiratory infections– Gastrointestinal infections– Skin conditions– Type 1 and Type 2 diabetes– Leukemia– Sudden Infant Death

Syndrome West Dade WIC

Breastfeeding Is Also Good for Mothers

• Lowers risk of:– Premenopausal breast

cancer– Ovarian cancer– Type 2 diabetes – Postpartum depression

• Improves bonding• Lowers healthcare costs• Convenient• Helps with weight loss

Hialeah WIC, Miami, FL

Growing Mothers with Breastfeeding

• excellent way to learn about baby and how to parent

• builds self esteem, especially if have overcome barriers in order to be able to breastfeed

• helps ‘reconnect’ with baby after separation

Why do we care NOW?

Research shows the difference• Key Research on ‘developed’ populations made the case

– Agency for Health Care Quality Research, Breastfeeding and Maternal and Infant Outcomes in Developed Countries, 2007.

– WHO, Evidence on the long-term effects of breastfeeding: systematic reviews and meta-analysis, May, 2007,

– US Preventive Services Task Force, Primary Care Interventions to Promote Breastfeeding, 2008

• CHILD HEALTH is the greatest driving factor– OBESITY Prevention is the biggest HOOK– Decreased health care costs (short- and long-term)– Prevention of readmission to the hospital for severe

jaundice or weight loss

Why Breastfeeding?

• Excellent research shows significant risks for childhood morbidity and mortality when infants are not exclusively breastfed for 6 months.

• Holds true even in developed, educated and resource-rich societies

• Breastfeeding and Maternal and Infant Health Outcomes in Developed Countries, AHRQ 2007, http://www.ahrq.gov/clinic/tp/brfouttp.htm

Surgeon General’s Call to Action to Support Breastfeeding, 2011

Breast Milk: Custom Made for Baby

Breast Milk: The Standard by WhichEverything Else is Measured

Breast Milk: The Standard by Which Everything Else is Measured

Breast Milk has:

• Vitamins and minerals for proper nutrition

• Growth factors that help with infant growth and development

• Antibodies that help babies resist illness and disease

• The ability to change constantly

How does breastfeeding reduce the risk for childhood overweight?

Possible explanations:• Infant has more control on speed of feed and

when to stop– Less ‘force feeding’ or ‘finishing the bottle’ when

breastfed

• Non-human milk is digested and metabolized in a different way– Higher protein in formula = ↑ leptin, insulin and fat

storage

• NOT because breastfeeding families are already healthier

Is Kentucky breastfeeding?

Breastfeeding StatusKY 2008 US 2008 HP2020

goalInitiation 57.8% 74.6% 81.9%

Bf at 6 months 32.9% 43.3% 60.6%

Bf at 12 months 18.6% 23.8% 34.1%

Excl BF 3 months 24.2% 35.0% 46.2%

Excl BF 6 months 9.8% 14.8% 25.5%

National Immunization Data (CDC, 2008 births)

National Breastfeeding Rates 2011 Breastfeeding Report Card

The Bottom 10TN – 65.6%MO – 64.2AR – 63.9PA – 63.4SC – 62.5

KY – 57.8%AL – 56.7%

WVA – 54.1%MS – 50.3

LA – 48.9%

US Average: 74.6% (Initiation)

The Top 10

OR – 91.2%

WA –89.0%

CA – 86.6%

VT – 85.2%

HI – 85.0%

UT – 84.5%

ID – 84.5%

AK – 84.2%

WY – 83.2%

MT – 82.8%

46.46

45.16

35.96

50.051.67

46.57

61.71

50.91 56.8

5

38.12 51.9

1

45.26 40.7

853.23

54.79

38.37

41.88

49.01

42.63

46.0138.2

159.26

35.96

62.77

39.78

36.61

39.68

49.92

40.87 49.7

040.1842.15

52.48

38.58 33.8

0

39.80

29.92

31.94

37.92

50.0

45.96

45.76 46.7

2

57.55

54.45

61.11

45.53

47.68

54.57

57.42

25.19

37.97

44.96

43.22

31.4

31.16

43.58

28.70

29.80

22.99 31.0

3

44.26 42.6

7

29.84

26.47 27.2

9

19.77

30.64

27.2931.1

4

27.37

35.04 18.2

4

28.0040.7

230.5831.5

8

40.39

55.4853.3

347.21

50.3551.0

6

65.31

60.80

27.63

28.0035.9

4

37.94

48.71

46.36

43.19

32.91

40.1135.06

44.35

61.63

72.07 50.0 43.5

5

60.22

67.88

61.6357.7

9

68.35

56.12

40.22

37.42

44.06

56.10

50.00

44.82

28.57

52.94

48.60 40.3

1

33.33

48.49

53.49

64.59

2004 Birth Certificate Data – BF initiation

  

41-50%

51-60%

61-70%

71% --

≤20%

21-30%

31-40%

initiation: 50.43%

2009 Birth Certificate Data –

BF initiation41-50%

51-60%

61-70%

71% --

≤20%21-30%31-40%

47.4

71.4

35.8

42.654.7

59.4

70

6058

39.469.8

63.3

60.5 62.3

74.5

59.3

43.9

50.7

42.3

49.1

46.6

50.7

44.7

47.1

43.2

21.627.9 54.1

49.652.7 46

6053.3

54.8

42.7

20.9

30.8

45.6

44.8

54.3

55.8

50.2

55.1

56.7

57.844.9

55.3

67.9

63.6

35.439.7

52.76

56.8

33.9

33.3

46.7

24.2

29.824.2

30.4

48.947.9

42.9 32.8

32.4

26.535.8

27.825.3

27.7

27.617.2

35.6

44.6

31.6

30.6

4162 64.6

54.8

53.764.8

64.575.5

25.7

38.2

40.7

41.3 45.3

43

47

48.9

51

37.9

57.7

64.7

74.551.9 48.8

65.8

74.6

60.561.5

72.7 55.7

32.742.6

39.3

60

53.9

54.3

49

36.8

52.6. 38.3

39.8

54.1 59.3

69.9

54.0

initiation: 55.6%

Our Challenge

• Most babies are being supplemented with infant formula in the hospital

• Most breastfeeding mothers regularly give formula by 3 months

• Few affordable classes on breastfeeding are available during pregnancy

• Obstetric care providers do not strongly inform about breastfeeding

• Hospitals often have policies, practices and staffing that do not support breastfeeding

Our Challenge• Gap in family knowledge and tradition to teach and

support breastfeeding• Pre-term birth (often planned) • Few sources for help or support when home• Pediatric care providers may not know how to treat

breastfeeding problems• Aggressive formula marketing• Sexualization and objectification of women’s bodies• Women increasingly serve as breadwinners outside the

home

Breastfeeding Socio-Ecologic Model

So, who is doing something about it?

• US Government• National entities• State Government• KY entities• Others

US Initiatives - Government• Healthy People 2020 • Breastfeeding Report Card• Maternity Practices Survey (mPINC)• WIC • White House Childhood Obesity Prevention

Taskforce/ Let’s Move• Patient Protection Act (Health Care Reform)• IRS tax changes• Surgeon General’s Call to Action on

Breastfeeding

HP2020 – New Targets

• Increased the target percentages over previous years, especially since many states were meeting them!

• Added targets focusing on – Increasing employers that have

worksite lactation support  programs – Reducing breastfed newborns receiving

formula supplementation in the hospital– Increasing the number of hospitals that are

Baby-Friendly certified

Breastfeeding Report Card• Published by CDC • Reports national and state data• Outcomes:

– Overall initation and duration, plus exclusivity (using HP2020)

• “Process” Indicators:– # Births at BFH– # IBCLC, # BF FTE in State Gov’t– Presence of protecting laws– Presence of coalition, website

mPINC• Survey of birthing hospitals to see if they’re using

state-of-the-art evidence-based practices for birth and mother/newborn care

• Collected 2007, 2009, 2011• Statewide data reported by CDC at

http://www.cdc.gov/breastfeeding/data/mpinc/index.htm

• Kentucky in the bottom quartile for first and second rounds– Do well on documenting feeding decisions– Do poorly on prenatal education, post-

discharge follow-up and support– Do poorly on limiting formula

supplementation– 75% of KY hospitals participated in 2009

WIC

• Half of all American children are on WIC• Over half of KY children 0 – 5 qualify• Nutrition education and healthy foods• Funded through USDA• In KY, primarily offered through public

health framework.• Moving to EBT by December 2011 • Offer breast pumps to working mothers

Fully Breastfeeding Food Package

Photos Courtesy of Texas WIC State Agency

“Grand Deluxe Package”

Fully Breastfeeding Mom – up to 12 months Infant 6-11 months

Partially Breastfeeding Food Package

Photos Courtesy of Texas WIC State Agency

“Deluxe Package”

Partially Breastfeeding Mom – up to 12 months Infant 6-11 months

Patient Protection and Affordable Care Act (Health Care Reform)

• Provisions require employers to provide accommodations for hourly-waged lactating employees

• Expands payments for preventive care services, including clinical lactation consulting, education.

• http://www.dol.gov/whd/nursingmothers/

IRS - Tax Breaks for Pumps

• Breast pumps and breastfeeding equipment are considered ‘qualified medical expenses’

• Can fund with Flexible Spending Accounts (FSA) or Health Savings Accounts (HSA).

• Can deduct as medical expenses on tax returns (Fed and state)

Surgeon General Call to Action

• First federal statement of action/purpose/plan for breastfeeding since 2000.

• 20 “Actions” in Mother support, community infrastructure, health care, worksites, research and policy.– Action 4. Use community-based

organizations to promote and support breastfeeding.

US Initiatives • US Breastfeeding Committee• The Joint Commission• Baby-Friendly Hospital Initiative• Patient-care Guidelines• Lactation Consultants• National Business Group on Health• Childcare Providers

US Initiatives - Collaborative

US Breastfeeding Committee– Representatives from government, health

care associations, lactation education and support

– Promoting state-based coalitions through bi-monthly conference calls in collaboration with the CDC

– State Coalitions Conference in Aug 2012

The Joint Commission

• Perinatal Core Measure Set includes exclusive breastfeeding

• Speak Up™ campaign helps support and prepare mothers for successful breastfeeding, “What You Need to Know About Breastfeeding.” – www.jointcommission.org/

Speakup_breastfeeding/

Baby-Friendly Hospital Initiative

• Voluntary private program to reward hospitals that practice 10 evidence-based steps.

• St. Elizabeth Hospital only BFH in KY • Others are preparing for certification• www.babyfriendlyusa.org

Patient Care Guidelines:

• Prenatal, in-hospital, postpartum• Growing number of evidence-based

protocols for prenatal, inpatient, and outpatient service:– Academy for Breastfeeding Medicine– American Academy of Pediatrics– Assoc. of Women’s Heath, Obstetric and

Neonatal Nursing

Who helps with breastfeeding?IBCLC

CLC/CLS/BSE, etc

WIC Breastfeeding Peer Counselor

Public Health: HANDS, HVN

EFNEP

Health professionals: MD, RN, RD

Lactation Consultants• International Board Certified Lactation

Consultant (IBCLC)– ONLY credential for this allied

health professional. No other independent board certification is available

• Educational and clinical services• Hospital, private practice, private

clinic, public health• Over 125 IBCLCs in Kentucky• “Find a Lactation Consultant” at

www.ilca.org

The National Business Group on Health

www.businessgrouphealth.org• Focuses on worksite

wellness and health care• Support worksite lactation

programs as cost-effective• Online materials that

complement The Business Case for Breastfeeding

• Model Health Benefit Plan – Investing in Maternal and Child Health

Let’s Move: Child Care

• Part of larger “Let’s Move” campaign to reduce childhood obesity

• “Infant Feeding” an important component under “Nutrition”

• Webpage has various tools: http://www.healthykidshealthyfuture.org/nutrition/infantfeeding.html

• National Standards, 3rd Edition

• Available free on-line (pdf file) through National Resource Center for Health and Safety in Childcare: http://nrckids.org/

• Specific State-by-State regulations available at this website, too

Kentucky Initiatives• WIC• Breastfeeding Coalitions• Kentucky Breastfeeding Strategic Plan• HANDS• Child Care Providers• Obesity prevention• Retailers • Cooperative Extension• Public Protection

Kentucky WIC• Promote breastfeeding with standard WIC services

– Special food packages – Breastpumps

• Regional Breastfeeding Coordinators for advocacy and outreach

• WIC Breastfeeding Peer Counselor services in many counties (Nancy Merk)

• Released State Breastfeeding Strategic Plan in April, 2011

• Publishes Breastfeeding Resource Guide, www.breastfeedinglink.org or http://www.chfs.ky.gov/dph/mch/ns/breastfeeding.htm

Breastfeeding Coalitions

• Lactation Improvement Network of KY (LINK)

• Kentuckiana Lactation Improvement Coalition (KLIC)

• Other smaller, regional groups• www.breastfeedinglink.org

Kentucky Breastfeeding Strategic Plan

• Six target areas with actions and strategies– Maternity care/hospital practices– Worksites– Peer Support– Health Care Providers– Educating Mothers and Families– Social Media

• Full plan at www.breastfeedinglink.org

HANDS

• Public health program for first-time parents• General promotion and support of

breastfeeding• Can make referrals for skilled

breastfeeding care (if available)

Child Care Providers

• Child Care Health Consultants (DPH)– Regional contacts in state– Technical assistance

• Resource and Referral Agencies (KDE)– Training for caregivers– Consultation for STARS ratings

• “Breastfeeding and Child Care” point person is Doraine Bailey (Lex Health Dept)

Obesity Prevention

• Partnership for a Fit Kentucky• Policy and collaboration• Breastfeeding part of portfolio

Equipment Resources• Specialty breastfeeding shops

―pumps―assistance by appointment if IBCLC

• Durable Medical Equipment suppliers– Rent pumps– Sell kits, other supplies

• General Retailers– Pillows, pumps, general supplies, – Often not ‘first quality’, effective pumps– Limited knowledge among salespeople

Cooperative Extension

• Projects and services targeting– Pre-pregnant citizens– Pregnant/new mothers– Social supports of new families

• Could include– EFNEP– World’s Biggest Baby Shower– Parenting classes– Family nutrition classes

Public Breastfeeding Protection• No laws in the USA that prohibit bf

outside the home• Most state laws protecting public bf have

no punitive/enforcement provisions• Federal law (1999) established protection

to bf child on any Federal Property where otherwise authorized to be– Public Law 106-058, sec. 647 (1999).

• KY, TN, IN all have laws protecting nursing in public, but no enforcement

Counseling Resources• BF flyers from State WIC

– Complete listing in PHPR Nutrition Section– Available from Pamphlet Library, Local Health Depts– in English and Spanish

• Bf Resource Guide (2011)– In print and online at CHFS webpage (below)

• CHFS Breastfeeding Webpage: http://chfs.ky.gov/dph/mch/breastfeeding.htm

• Int’l Lactation Consultant Assn (ILCA) “Find A Lactation Consultant”www.ilca.org

Kentucky Resources• Kentucky WIC Program State Office,

502-564-2339 • Kentucky Breastfeeding Website (WIC)

– http://www.chfs.ky.gov/dph/mch/ns/breastfeeding.htm

• Kentuckiana Lactation Improvement Coalition (KLIC), www.klicbreastfeeding.org

• Lactation improvement Network of KY (LINK), www.breastfeedinglink.org

Community Resources• La Leche League

―1-800-LA-LECHE, www.lalecheleague.org

―www.llleus.org/state/kentucky.html • Other Mother-to-Mother Support Groups

– Mother’s Forum in Berea – McDowell Hospital in Danville

• Retailers―Babies R Us, Mother Nurture―“Big Box” – Target, Walmart―DME: AbleCare, VDK at Grogans,

MedShoppe Medical

Photo by Judi Harris Photo by Doraine Bailey

Photo: Centers for Disease Control and PreventionPhoto credit: Judy Harris

USDA Resources

• USDA has limited titles and resources in SNAP-ED database or Healthy Meals Resource system– USDA Resource Library includes some titles,

mostly to purchase.• MyPlate has detailed information for

pregnant and breastfeeding women.

Cooperative Extension Examples

• Michgan State University Extension: Breastfeeding Initiative Mother to Mother Peer Program– Mothers with breastfeeding experience are recruited

and hired from the community by the local Extension and WIC agency to serve as peers. Peers are trained to provide WIC and SNAP/Bridge Card eligible women with breastfeeding information, encouragement, and support. They are available to see mothers in person or by telephone, in the home, the hospital, or the WIC clinic.

– http://bfi.fcs.msue.msu.edu/

Cooperative Extension Examples

• Cornell Cooperative Extension“Breastfeeding for the Health of It” class series– 6 2-hour sessions– Rotating lesson plans– Targeting low-income women; free– New or pregnant mothers– http://ccetompkins.org/nutrition/breastfeeding-

support

Cooperative Extension Resources

• Breastfeeding and Infant Nutrition in Child Care (eXtension website)– http://www.extension.org/pages/25774/breastf

eeding-and-infant-nutrition-in-child-care• “Handle With Care: Guidelines for Safe

Storage and Use of Mother’s Milk” (Rutgers, New Jersey Ag Experiment Station)– http://njaes.rutgers.edu/pubs/publication.asp?

pid=FS949

Cooperative Extension Resources

• Clemson Extension Home and Garden Information Center– Breastfeeding Fact Sheets– http://www.clemson.edu/extension/hgic/hot_topics/20

09/08breastfeeding_series.html

• “Breastfeed Your Baby,” North Carolina State U Extension– Position/advocacy background paper – http://www.ces.ncsu.edu/depts/fcs/pdfs/BreastfeedPa

per.pdf

Cooperative Extension Resources

• National Network for Child Care (NC Extension)– Breastfeeding and Infant Nutrition page has

numerous resources developed by Coop Ext programs throughout the nation.

– Materials cited good for parents, childcare providers, etc.

– http://cyfernet.ces.ncsu.edu/nncc/index.php?c=1128

• Jackie Walters on WTVQ:– http://www.youtube.com/watch?

v=VDZUsbtyDqc

Results of Family and Consumer Sciences Accessing Nutritious Foods Survey (Bowling

Green)Program Number of Agents

Utilizing Program to Educate/ Promote Breastfeeding

SNAP-Ed 1

Just in Time Parenting 3

USDA materials 2

WIC materials 0

Policy change 0

Social marketing: newsletters radio and TV Facebook text messaging Twitter

65302

Other Programs 2

In what other programs do you or your assistants currently discuss parenting or infant

nutrition with women of childbearing age?

What barriers do you commonly encounter when teaching or promoting breastfeeding?

What kind of materials or support do you need to educate about breastfeeding?

What kind of materials or support do you need to promote breastfeeding?

For more information:Doraine Bailey, MA, IBCLCBreastfeeding Support Services

Lexington-Fayette County Health Dept.805A Newtown CircleLexington, KY 40504

Tel: 859-288-2348 Fax: 859-252-0292DoraineF.Bailey@ky.gov

International Board Certified Lactation ConsultantLocal Health Department staff

Jackie Walters, MBA, RDExtension Specialist in Nutrition Education

ProgramsUniversity of Kentucky Cooperative

Extension ServiceOne Quality Street, Suite 692

Lexington, KY 40507Tel: 859-257-2948 Fax: 859-257-2990

Jackie.Walters@uky.edu