New York City Breastfeeding Initiative NY Statewide Breastfeeding Coalition Meeting August 1, 2013 Lorraine C. Boyd, MD, MPH, Medical Director Bureau of Maternal, Infant an Reproductive Health NYC Department of Health and Mental Hygiene 1 Making Breastfeeding the Norm Requires All CBOs DPHOs FBOs Hospitals WIC Advocacy Newborn Home Visiting Educational Materials Nurse Family Partnership Media Campaigns NYC Leadership Council Worksites for Wellness 2 DOHMH History of Breastfeeding Promotion, Support and Protection Sponsored CLC Partnered with NYS to courses for NFP, Baby Launched remind hospitals about NBHV & Hospitals Friendly Received Public Health state regulations on to increase BF Hospitals joint funding Detailing formula distribution knowledge Project from United campaign to Surveyed with Beth Hospital community Israel Developing a community BF Fund to and hospitalpractices Medical BF campaign & policy Δ Created DOHMH promote BF based Center & in all NYC workplace lactation in Staten providers maternity NYU room and breast Island Created BF toolkit for Faith facilities Medical pump loaner Center Based Organizations program Latch On NYC 2005 2006 2007 2008 2009 2010 2011 2012 2013 Funded 11 HHC maternity facilities to develop standard policies and procedures consistent with BFHI and other experts Began efforts to work Awarded Communities Putting with private hospitals by Prevention to Work (CPPW) sponsoring a breakfast Obesity funding for 13 for CEOs hospitals Awarded CPPW First NYC Hospital designated Baby Friendly : Mentoring Grant for 10 LHD/communities Harlem Hospital Center CTG Grant Cohort 1 Awarded CTG Gant CTG Grant Cohort 2 Second NYC hospital designated: NYU Medical Center 3 1
Breastfeeding Initiation, Duration and Exclusivity, NYC 2009 2011 Percent of New Mothers 100 90 80 70 60 50 40 30 20 10 0 90 88.8 89.4 Ever Breastfed 68.6 68.8 69.0 Any Breastfeeding at 8 weeks 27.9 24.6 25.7 Exclusive Breastfeeding at 8 weeks 2009 2010 2011 Source: NYC PRAMS, 2010, 2011. Non significant at P < 0.05% Limited to women whose infants were living with them at time of PRAMS survey. 4 Mothers Reasons for Stopping Breastfeeding, NYC 2011 Experience % I thought I was not producing enough milk 46.4 Breast milk alone did not satisfy my baby 41.6 My baby had difficulty latching or nursing 27.1 It was too hard, painful, or too time consuming 19.6 I went back to work or school 15.0 My nipples were sore, cracked or bleeding 14.5 I had too many other household duties 11.9 I thought my baby was not gaining enough weight 11.7 I got sick and was not able to breastfeed 10.3 I felt it was the right time to stop breastfeeding 8.7 My baby was jaundiced 4.8 Source: NYC PRAMS, 2011 5 DOHMH 2012 Opinion Poll Population based survey of 2000 adult men and women in New York City to look at community perceptions of obesity Three breastfeeding questions: 91% of respondents agreed that breastfeeding is healthier for babies than formula 50% of respondents agreed that, mothers should breastfeed in private places only. Most likely to disagree: Parents with children <12 yrs and college grads 68% of respondents agreed with the statement, I am comfortable when mothers breastfeed their babies near me in a public place. Most likely to disagree: 65+ and HS or less education 6 2
Community Breastfeeding Initiatives and Resources Home Visiting Programs Nurse Family Partnership Newborn Home Visiting Program Faith Based Advocacy Project 127 places of worship City wide information line: 311 Breastfeeding materials, videos, links Referrals to supports (WIC, LCs, etc.) Mobile Milk Workplace Lactation Programs DOHMH Employee Lactation Program Partner with other city agencies: DHS Worksites for Wellness Infant Mortality Reduction Initiative (IMRI) Partner with community based organizations for breastfeeding outreach and education Partner with other groups NYC Leadership Council NYS Breastfeeding Coalition WIC Program AAP 7 NYC Nurse Family Partnership An evidence based home visiting program Committed to improving the health and welfare of first time low income mothers and their children Emphasizes breastfeeding during the prenatal and postnatal period by CLCcertified nurses Consistently higher rates in initiation than in other low income groups 100% Percentage of mothers who gave birth in 2010 who exclusively 80% breastfed for at least 2 months 60% 45%** NYC NFP* vs. all NYC mothers 40% 25% 20% 19% 31% 33% 0% *Includes only those NYC NFP clients who were still in the program at 6 months postpartum. **Statistically significant difference between NYC NFP and NYC rate. Sources: NYC NFP: Nurse Family Partnership data 2010 births. NYC: PRAMS, 2010 8 Newborn Home Visiting Program Provides home visits to new mothers in the 5 NYC neighborhoods with the highest infant mortality Provides breastfeeding education and support by CLC and IBCLC trained staff during visits Weekly support group sessions with post partum moms Makes referrals for social services, window guards and other housing deficiencies 9 3
Worksite Lactation Programs DOHMH Employee Lactation Program 3 lactation rooms with hospital grade pumps Loaner pump program Support group Q&A calls with IBCLC Brown bag lunches Goal is to support other city agencies to set up lactation rooms 10 Faith Based Organizations (FBOs) In conjunction with DOHMH Office of Minority Health Work with religious organizations to establish breastfeeding friendly rooms Distribute DOHMH materials in 9 languages Presentations to congregants 127 institutions awarded for their work Speaker s Bureau trainings in development 11 Community Based Organizations ~30 organizations working to improve maternal and child health outcomes & infant mortality Key role in developing and teaching a citywide breastfeeding curriculum for pregnant and parenting women and men Provide other conferences and events for community residents to learn about breastfeeding Bronx BF Coalition & Health Link Caribbean Women s Health Association Northern Manhattan Perinatal Partnership Queens BF Alliance & Council Northern Manhattan Perinatal Partnership Lactation Lounge 12 4
Breastfeeding Education Resources Lactation Education and Management Courses Certified Lactation Counselor (CLC) : 1000+ trained Train the Trainer for the 20 hour course : 75+ trained Community Breastfeeding Educator IMRI breastfeeding curriculum training Breastfeeding Patient Materials Grand Rounds and Conferences for Providers 13 New: Prenatal Curriculum Trimester based Short lessons for visit by visit teaching Can be adapted for group teaching Developed based on ABM protocols, BFHI goals, expert opinion, and known educational tools and approaches Evaluated by 5 NYC hospitals over 3 4 months http://www.nyc.gov/html/doh/downloads/pdf/ms/mother guide.pdf 14 Curriculum Overview First Trimester: Starting the conversation Second Trimester: How breastfeeding works Third Trimester: Getting ready to breastfeed 15 5
Sample Pages 16 Breastfeeding Advocacy, Research and Policy Activities NYC Breastfeeding Leadership Council NYS DOH NYC DOHMH Breastfeeding Taskforce NYS Breastfeeding Coalition Academy of Breastfeeding Medicine Data/Research: PRAMS, birth and hospital records Focus groups Infant formula survey CLC follow up survey Hospital Breastfeeding Report Manuscripts 17 Latch On NYC: Voluntary Commitment by Maternity Hospitals Hospital based initiative to support a mother s decision to breastfeed Participating hospitals have agreed to: Enforce NYS hospital regulations not to supplement breastfeeding infants with formula unless medically indicated Limit access to infant formula by hospital staff Discontinue the distribution of promotional or free infant formula Prohibit the display and distribution of infant formula promotional materials in any hospital location 18 6
Support for Latch On NYC 29 of 40 maternity hospitals have signed on Endorsed by: NYS Department of Health (NYS DOH) Greater New York Hospital Association (GNYHA) NYC Health and Hospitals Corporation (HHC) NYS chapters of the American Academy of Pediatrics (AAP) American Academy of Family Physicians (AAFP) Society for Adolescent Health and Medicine (SAHM) 19 Latch On NYC Hospitals 1. Bellevue Hospital Center* 2. Beth Israel Medical Center 3. Bronx Lebanon Hospital Center 4. Coney Island Hospital* 5. Elmhurst Hospital Center* 6. Flushing Hospital Medical Center 7. Harlem Hospital Center* 8. Jacobi Medical Center* 9. Jamaica Hospital Medical Center 10. Kings County Hospital Center* 11. Lenox Hill Hospital 12. Lincoln Medical & Mental Health Center* 13. Long Island Jewish Medical Center 14. Maimonides Medical Center 15. Metropolitan Hospital Center* 17. Montefiore Medical Center Wakefield 18. Mount Sinai Hospital 19. New York Presbyterian Hospital Columbia University Medical Center 20. New York Presbyterian Hospital Allen Pavilion 21. New York Presbyterian Hospital Weill Cornell Medical Center 22. North Central Bronx Hospital* 23. NYU Langone Medical Center 24. Queens Hospital Center* 25. Richmond University Medical Center 26. Staten Island University Hospital 27. SUNY Downstate Medical Center/University Hospital of Brooklyn 28. Woodhull Medical & Mental Health Center* 29. Wyckoff Heights Medical Center 16. Montefiore Medical Center Jack D. Weiler * NYC Health and Hospitals Corporation (HHC) 20 Latch On NYC: Media Campaign Subway Ads Hospital Posters Online Ads 21 7
Latch On NYC Website http://www.nyc.gov/html/doh/pregnancy/html/after/breast feeding latchon.shtml 22 New York City Breastfeeding Hospital Learning Collaborative (CTG) Five Year Objective, 9/30/2016: Increase the number of NYC Baby Friendly Hospitals by 10 Provide outreach and TA via Hospital Learning Collaborative model: In person learning sessions, conference calls, webinars, tools Aim: increase initiation, exclusivity and duration Total reach over 5 years: 20 of 40 NYC maternity hospitals 23 NYC Breastfeeding Hospital Learning Collaborative Cohort 1 Bellevue Hospital Center* Harlem Hospital Center* Jacobi Medical Center* Lincoln Medical and Mental Health Center* Metropolitan Hospital Center* Montefiore Medical Center Wakefield & Weiler Queens Hospital Center* Richmond University Medical Center SUNY Downstate Medical Center Cohort 2 To be announced, September 2013 * NYC Health and Hospitals Corporation (HHC) 24 8
CTG: Year 1 Accomplishments From September 2012 2013, CTG has: Supported all Cohort 1 hospitals in forming an active improvement team Held 3 in person learning events with representatives from all participating hospitals Held monthly conference calls/webinars to share best practices and engage in peer to peer learning Launched a data portal to collect monthly data on 11 core measures Moved 5 hospitals 7 steps along Baby Friendly s 4 D Pathway Selected hospitals to participate in Cohort 2 CTG: Next Steps for Year 2 From September 2013 September 2014, CTG will: Launch Cohort 2 Conduct mock site visits at 4 hospitals to prepare for Baby Friendly s assessment team Continue to run quarterly inperson learning sessions and hold monthly conference calls/webinars Increase the number of NYC hospitals along the 4 D pathway Thank You! 27 9
NYC Department of Health and Mental Hygiene Bureau of Maternal, Infant and Reproductive Health Key Contacts Lorraine Boyd, MD, MPH Medical Director Telephone: (347)396 4512 Email: lboyd1@health.nyc.gov Amber Ahmad, MPH, CLC Deputy to the Medical Director Telephone: (347)396 4476 Email: aahmad1@health.nyc.gov Deborah Kaplan, R PA, MPH Assistant Commissioner Telephone: (347) 396 4483 Email: dkaplan@health.nyc.gov Virginia Robertson, MD, MScPH Medical Specialist for Provider Education Telephone: (347) 396 4527 E mail: vroberts@health.nyc.gov Lusta Phanord, MA, CLC Administrative Manager Telephone: (347)396 4587 Email: ljean@health.nyc.gov Emily Magid, MPH, MSW, CLC CTG Breastfeeding Manager Telephone: (347) 396 4486 Email: emagid4@health.nyc.gov Marta Kowalska, MPH, CLC Breastfeeding Initiatives Manager Telephone: (347)396 4513 Email: mkowalsk@health.nyc.gov Wendy Agron, CLC Special Projects Coordinator Telephone: (347)396 7874 Email: wagron@health.nyc.gov Breastfeeding link: http://www.nyc.gov/html/doh/pregnancy/html/after/breast feeding.shtml 28 10