1 jonathan e. fielding, md, mph, mba director of public health and health officer l.a. county...
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Jonathan E. Fielding, MD, MPH, MBA
Director of Public Health and Health Officer
L.A. County Department of Public Health
Public Health Breastfeeding Public Health Breastfeeding Policy InitiativePolicy Initiative
Breastfeeding MattersBreastfeeding MattersApril 7, 2010April 7, 2010
Chronic Disease & Health Disparities
• Health disparities are associated with:
• Poverty• Education• Race/Ethnicity
• Breastfeeding has a role to play in disease prevention and addressing health disparities
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Breastfeeding evens the playing field
Breastfeeding is a natural "safety net" against the worst effects of poverty...It is almost as if breastfeeding takes the infant out of poverty for those first few months in order to give the child a fairer start in life and compensate for the injustice of the world into which it was born.
James P. Grant
Former Executive Director UNICEF
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Why is breastfeeding important?
Exclusive and extensive breastfeeding reduces the risk for many diseases.
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Breastfeeding: Important for BabiesRisk Differences for Various Disease
-23%
-42%
-64%
-40% -39%
-19%
-36%
-24%
-70%
-60%
-50%
-40%
-30%
-20%
-10%
0%
Ris
k D
iffe
ren
ce
Acute Chronic
Source: Ip, AHRQ, 2007
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Breastfeeding Reduces the Risk of Childhood Obesity
• Leptin, ghrelin, adiponectin play a role• Infants self-regulate at the breast• Different maternal behavior• Reduced risk for early growth acceleration• Other variables• Reduces the risk of obesity by 4% for each month of exclusive breastfeeding
Ip, AHRQ, 2007Dewey, JHL, 2003Miralles, Obesity, 2006
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Breastfeeding Reduces the Risk of Childhood Obesity
• Exclusive BF for 3 to 6 months is associated with reduced risk for childhood overweight
• Not a panacea, but the start of our obesity prevention efforts
• BF promotion has become an important component in larger efforts to reduce childhood obesity
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Breastfeeding: Important for MothersRisk Differences of Various Disease
-28%
-21%
-12%
-30%
-25%
-20%
-15%
-10%
-5%
0%
Ris
k D
iffe
ren
ce
Ip, AHRQ, 2007
Breastfeeding =Optimal Infant Nutrition
Good public health outcomes are associated with: extensive breastfeeding exclusive breastfeeding
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Public Health Breastfeeding Policy Initiative
Increase exclusive and extensive BF ratesBaby Friendly Hospital designation
LAC DHS committed, bringing along others
Evidence based approachBuy-in from the topConvening regional quality improvementCollaborative approachMultidisciplinary team
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California Any and Exclusive In-Hospital Breastfeeding: 1994-2007
43%43%44% 44% 43% 44% 44% 44% 43% 43% 43% 42% 42% 42%
87%87%86%86%86%85%84%84%83%82%80%79%77%77%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Exclusive Breastfeeding Any Breastfeeding
11Data Source: California Department of Public Health, Genetic Disease Screening Program, Newborn Screening Database 1994-2007 Prepared by: California Department of Public Health, Maternal, Child and Adolescent Health Program Note: Includes cases with feeding marked ‘BRO’ (Breast Only), ‘FOO’ (Formula Only), or ‘BRF’ (Breast & Formula)
The “GAP” is Growing
87%83%
43%
24%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
California Average LA County Average
Any BF Exclusive BF
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Percent Any/Exclusive In Hospital Breastfeeding: 2007
Gap
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Maternity Care Policy & Practices
• The maternity care experience exerts unique influence on both breastfeeding initiation and later infant feeding behavior
• Breastfeeding is an extremely time-sensitive relationship
• Experience with breastfeeding in the first hours and days of life significantly influence an infant’s later feeding
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Evidence-Based Interventions• Significant evidence that changes in
maternity care at the institutional level can increase breastfeeding initiation, exclusivity, and duration
• CDC recommends bringing key decision makers together to address the importance of evidence-based breastfeeding practices
Source: Shealy 2005
Works Cited• California Department of Public Health, Maternal, Child and Adolescent Health Program.
“California Department of Public Health, Genetic Disease Screening Program, Newborn Screening Database, 1994-2007.” Available at: http://www.cdph.ca.gov/DATA/STATISTICS/Pages/BreastfeedingStatistics.aspx
• Dewey KG. Is breastfeeding protective against child obesity? J Hum Lact 2003;19(1):9-18.
• Ip S, Tufts-New England Medical Center. Evidence-based Practice Center., United States. Agency for Healthcare Research and Quality. Breastfeeding and maternal and infant health outcomes in developed countries. Rockville, MD: U.S. Dept. of Health and Human Services, Public Health Service, Agency for Healthcare Research and Quality; 2007.
• Miralles O, Sanchez J, Palou A, Pico C. A physiological role of breast milk leptin in body weight control in developing infants. Obesity (Silver Spring) 2006;14(8):1371-7.
• Shealy KR, Li R, Benton-Davis S, Grummer-Strawn LM. The CDC Guide to Breastfeeding Interventions. Atlanta: U.S. Department of Health and Human Services. Available at: http://www.cdc.gov/breastfeeding/pdf/breastfeeding_interventions.pdf
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