2014 Legislative Session Week Three – Breastfeeding Friendly Washington
Breastmilk is a baby’s perfect first food. It has special nutrients a baby needs that are not found in formula and changes to meet the needs of a growing child, including giving your baby protection against illness and infection. As a result, breastfed babies have fewer earaches, colds, and allergies and are less likely to experience Sudden Infant Death Syndrome. Besides the many health benefits, breastfeeding also helps build a special bond between a mother and her baby.
Moving Upstream. . . One Training at a Time
544 providers. More specifically: 296 nurses, 147 doctors, 24 dieticians, 19 nurse practitioners, 4 midwives, (and a partridge in a pear tree!) What do all these people have in common?
They all provide care for Washington families and they’ve all recently gone through a breastfeeding education training organized by WithinReach.
Recent studies show that provider lactation education has a statistically significant increase on breastfeeding outcomes. In other words, the more that doctors, nurses and other support staff learn about and support breastfeeding, the more likely the women in their care will meet their own breastfeeding goals, and we know that longer breastfeeding leads to better maternal child health.
Health care providers play a critical role in supporting breastfeeding women. The recently published CDC Guide to Breastfeeding Interventions affirms that “health care professionals need in-depth knowledge and skills directly related to breastfeeding and lactation management because 86% of Americans still turn to a health professional as their primary source of health information”. Lack of adequate support is the main reason we hear about for why women discontinue breastfeeding. Here at WithinReach, we’re working to change this. One training at a time, we’re working to ensure that Washington State health care providers are equipped with the knowledge and skills to support moms and babies with breastfeeding.
In the field of public health, we often talk about ‘upstream’ and ‘downstream’ approaches to improving community health, preventing disease and eliminating disparities. Watch this quick video for a brief overview. To sum it up: “Investing upstream in prevention, rather than downstream in intervention, is often wiser and more effective, and is the essence of public health.” Many challenges with breastfeeding could be prevented before they turn into substantial concerns. Ensuring moms are appropriately supported, from prenatal breastfeeding education to support at the hospital bedside and beyond, is a key way to do this. For another analogy about the impact of public health prevention strategies and the social determinants of health, see the fabulous Dr. Camara Jones’ well known talk about the Cliff of Good Health.
While we could choose to focus our efforts to promote breastfeeding on direct support for mothers and babies, that work is really best done by IBCLCs (Lactation Consultants), peer counselors, community programs and other perinatal support professionals. This is indeed a critical element of a broader community that supports breastfeeding. WithinReach and the Breastfeeding Coalition of Washington’s work is primarily focused on providing tools and information directly to health care providers. Moving further upstream and taking a public health approach allows us, with a relatively small amount of resources, to facilitate training for the providers that care for mothers and families and to impact organizational policies and practices. With this approach, we are able to reach tens of thousands of breastfeeding moms and babies. By working with nineteen hospitals around the state through our Evidence-Based Hospital Breastfeeding Support (EBBS) Learning Collaborative, in 2013 we have positively impacted the care received by over 40% of babies born in Washington.
With support from the Washington State Department of Health, Public Health- Seattle & King County and SeaMar Community Health Centers, and a partnership with Molly Pessl, BSN, IBCLC (owner and lactation education trainer) from Evergreen Perinatal Education, WithinReach has coordinated five trainings over the past several months that have reached well over 500 health care providers. We’re helping support breastfeeding throughout the state, one training at a time. Thank you for supporting us in this work!
Community Clinics Prioritize Breastfeeding
Nearly 10 months ago we began our Community Health Center Breastfeeding Promotion Project. The goal of this project is to address breastfeeding support at the primary care level. Although nine out of ten Washington babies begin life breastfeeding, we see a steady decrease in breastfeeding rates the moment mothers leave the hospital. Research shows that the support of the primary care provider is an essential part of a mother reaching her breastfeeding goals. During this project, clinics have been provided technical assistance from WithinReach as well as monetary funds from the Department of Health to help implement programmatic changes. A comprehensive evaluation of this project has been conducted by the UW Center for Public Health Nutrition’s Erica Lamson (Skagit Breastfeeding Coalition member!).
Some highlights from our eight clinics were:
- Six of the eight clinics now have Infant Feeding Policies stating that breastfeeding is the preferred method of feeding infants.
- Nearly 80 clinic employees received 8 hours of clinical lactation education hosted by WithinReach and taught by Evergreen Perinatal Education, while several more staff attended the Simkin Center’s 45 hour Foundations for Best Practice in Lactation Care and are not Certified Lactation Eductors.
- Seven clinics are now formula free.
- Seven clinics have designated space for both patients and employees who need to express their milk or nurse their babies in private (if they prefer).
- All of the clinics have prioritized prenatal one-on-one breastfeeding education with patients.
- Half of our clinics have begun or are planning on offering breastfeeding classes for prenatal patients.
- Six clinics have adopted policies to ensure that all babies are seen in the clinic within 5-7 days post birth.
- All clinics have begun tracking or are in the process of tracking breastfeeding rates.
As this project comes to a close we want to give a huge congratulations to the Roger Saux Health Center (Quinault Tribe), SeaMar Community Health Center-South Park, Port Gamble S’Klallam Health Clinic (Port Gamble S’Klallam Tribe), North Bend Family Clinic/Tolt Community Clinic (Snoqualmie Tribe), Community Health Centers of Central Washington-Ellensburg, Tri-Cities Community Health Center-Pasco, Yakima Valley Farm Workers Clinic and the David C. Wynecoop Memorial Clinic (Spokane Tribe) for all your great work. The work accomplished by these clinics has been inspiring and the mothers and babies of Washington State will benefit for years to come!
We also want to thank these clinics for helping us pilot test the materials for the Washington Steps Up for Breastfeeding Success initiative. Once finalized, the clinic self-assessment, resource toolkit and provider reference card will be available to all clinics and providers in Washington State so they too can step up in support of breastfeeding.
Washington Steps Up to Support Breastfeeding Moms
I Want You to Support Breastfeeding
- If your daughter does not breastfeed your grandbaby, her risk of breast and ovarian cancer goes up.
- If your employee does not breastfeed her child, she will take more time off taking care of a sick child.
- If your sister does not breastfeed, your niece or nephew will have a higher chance for diabetes and respiratory infections.
- If your baby is not exclusively breastfed, his or her risk of dying from SIDS goes up 73%.
- If your neighbor does not breastfeed, her risk of post-partum depression goes up.
- And did you know that if 80% of mothers breastfed for just 6 months that the US would save $13 billion dollars and nearly 1000 lives?
Breastfeeding is your business. It is our responsibility. It is your role as a grandmother, uncle, friend, boss, neighbor and citizen to support the breastfeeding mother in your life. That mother is doing something profound for her child and, in turn, your community. Let’s make sure she knows she’s supported. Visit our breastfeeding section for more information and resources to help provide moms and babies with the best breastfeeding support possible.
Breastfeeding Support: Close to Mothers
From inquiry to impact to action: The Inequity in Breastfeeding Support Summit
Inquiry: What is inequity in breastfeeding support and why does it matter?
Breastfeeding is a cornerstone of public health. Mothers know breastfeeding is important, yet the care and support provided to all women is not the same (like educational opportunities or job access), setting some mothers up for success and creating barriers for others. In short, white women tend to experience a more supportive mainstream healthcare system, with greater breastfeeding resources made available to them, than women of color. This inequity in support leads to long-term disparities in care and health. Breastfeeding significantly predicts health outcomes for mothers and babies for things like Sudden Infant Death Syndrome, breast and ovarian cancer, diabetes, asthma and more- all things experienced disproportionately by people of color. This is a huge gap in care, and entities ranging from community grassroots organizations up to the Surgeon General are increasingly acknowledging and working to address this.
While disparities in breastfeeding rates are often cited by medical organizations and in the media, rarely do we discuss the root causes of these differential health outcomes born by women and their families. Dr. James Collins and colleagues have shown the impact of racism on maternal child health outcomes, specifically low-birth weight and pre-term babies in the African American community. Institutional racism and white privilege impact the breastfeeding care that women and their babies receive as well. Institutional racism is a term first coined by Stokely Carmichael to refer to the “collective failure of an organization or system to provide an appropriate and professional service to people because of their color, culture, or ethnic origin.” Solid Ground, one of WithinReach’s community partners, defines institutional racism as:
The systematic distribution of resources, power and opportunity in our
society to the benefit of people who are white and the exclusion of people
of color. Present-day racism was built on a long history of racially distributed
resources and ideas that shape our view of ourselves and others. It is a
hierarchical system that comes with a broad range of policies and institutions
that keep it in place.
White privilege refers to the [perhaps unspoken or unacknowledged] privileges that white people have in a racist society that affords more value to white people than people of color- it is the flip side of racism. While we often hear about ‘underserved’, ‘underprivileged’ or ‘disadvantaged’ communities, the flipside is rarely acknowledged: that other communities (namely white, middle and upper class) are over-served, over-privileged and over-advantaged.
Impact: The 2013 Inequity in Breastfeeding Support Summit
In 2012, community breastfeeding activists, including representatives from the Native American Breastfeeding Coalition of Washington, Mahogany Moms Breastfeeding Coalition and WithinReach’s Breastfeeding Coalition of Washington, got together in an effort to address the institutional barriers faced by women of color seeking breastfeeding support. Out of these conversations, the Inequity in Breastfeeding Support Summit was born. The purpose of this Summit was threefold: to collaborate, educate and act together as a community of breastfeeding supporters to counter institutional racism in support services for new families, that are significantly centered on the needs and experiences of white women. Our long-term aims as a result of this Summit are to increase the cultural competence of breastfeeding supporters, increase the proportion of breastfeeding counselors who are women of color, and increase the organizations that provide culturally relevant breastfeeding support to women of color.
Cynthia Good-Mojab, a Summit planning committee member and speaker, acknowledged that “this Summit has been a yearlong, collaborative labor of love. We stand on the shoulders of giants. Long before and concurrent with our efforts to create this Summit, others have made far more significant contributions to the ongoing movement to dismantle racism and other forms of oppression.”
On June 21-22, over 200 people came together from across Washington State and the country- mothers and babies, community members, breastfeeding peer counselors, public health professionals, health care providers and more. The day started out with a blessing from Emma Medicine White Crow honoring the Duwamish people for their land that the city of Seattle and the Summit were held on. Day one was focused on what systemic racism looks like and how it impacts families. Leaders in maternal child health such as Dr. Maxine Hayes, Kathi Barber and Sheila Capestany, laid the historical groundwork for disparities in breastfeeding rates and the access to breastfeeding support that mothers have. Kathi Barber led us through a history of the African American experience starting with women’s treatment during slavery, how many women were removed from their children and unable to nurse them and bringing us to present day, showing how this collective history has contributed to where our society is today with regard to breastfeeding.
Day two was focused on solutions that prioritize supporting moms and babies of color. Six breakout sessions focused on topics ranging from grassroots community breastfeeding support programs to heterosexist language in breastfeeding support to the role of social media in creating ally communities. A three-hour action planning session got participants discussing solutions and the role they can play in ensuring all mothers and babies are receiving quality care. The end result: the synopsis of dozens and dozens of voices answering one question: What key actions can we take to advance racial equity in breastfeeding support at the individual, family, community and societal level? The two days ended with each participant, speaker and planning committee member saying just one word about how they were feeling or what they were left with. Comments ranged from uplifted, humbled and doubtful to motivated, skeptical and inspired. The Summit likely didn’t meet the needs of all participants, but it did build upon the groundswell of work happening around the country to name and address institutional factors that create unequal care for mothers and children. To read one student midwife’s reflection of her experience at the Summit, visit Robin Gray-Reed’s post from her blog The Mindful [Student] Midwife.
Action: Next steps in moving forward
This Summer, WithinReach intern Rebecca Allen and the Summit planning committee will drive the development of a Community Action Report. We hope this document will serve as a blueprint of steps to take for all communities interested to work in achieving equity in breastfeeding support and maternal child health outcomes. To learn more or get involved visit the Inequity in Breastfeeding Support Summit Facebook page.