Addressing Breastfeeding Disparities in the Black Infant Health - - PDF document

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Addressing Breastfeeding Disparities in the Black Infant Health - - PDF document

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2/6/2017 Addressing Breastfeeding Disparities in the Black Infant Health Program Niambi Lewis, MSW Robin Qualls, BSN, MPH California Breastfeeding Summit Anaheim, CA January 25, 2017 California Department of Public Health Maternal, Child

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California Department of Public Health Maternal, Child and Adolescent Health Division

Addressing Breastfeeding Disparities in the Black Infant Health Program

Niambi Lewis, MSW Robin Qualls, BSN, MPH California Breastfeeding Summit Anaheim, CA January 25, 2017

Acknowledgements

  • The BIH State Team
  • Dr. Paula Braveman and University of California San

Francisco Center for Health Disparities

  • Maternal Child and Adolescent Health Division-

Maternal and Infant Health Branch

  • Maternal Child and Adolescent Health Division-

Epidemiology, Evaluation, and Data Operations Section

  • Dr. Ifeyinwa V. Asiodu, California Breastfeeding Coalition

Board Member, Day 1 Chair

2

Funded by: Title V Federal Funds and State General Funds

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Black Infant Health (BIH) Program Goal

  • To improve health among African-

American mothers/babies

  • To reduce the Black/White

disparities

  • To facilitate and increase women’s

empowerment

3

Istock.com/thegift777

Health Disparity

“The differences in health status among distinct segments of the population, including differences that occur by gender, age, race or ethnicity, education or income, disability or functional impairment

  • r geographic location, or the combination
  • f any of these factors.” 1

1 Portrait of Promise: The California Statewide Plan to Promote Health and Metal Health Equity

4

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BIH Program

  • Started in 1989 to address health disparities (black/white

gap) and higher incidences in the African-American community of:

  • Pre-term birth
  • Infants small for gestational age
  • Infant mortality
  • Sudden Infant Death Syndrome (SIDS)
  • Sexually Transmitted Diseases
  • Hypertension
  • Diabetes
  • Obesity

5

Infant Mortality Rate by

Race/Ethnicity, 2000-2013

12.8 12.6 12.7 12.3 12.0 12.7 11.5 11.5 12.1 10.6 9.5 10.5 9.8 10.6 4.8 5.0 5.1 4.5 4.6 4.7 4.4 4.6 4.1 4.1 4.1 4.1 3.8 3.8 5.3 5.0 5.2 5.2 5.2 5.3 5.1 5.1 5.2 5.0 4.9 4.9 4.7 5.1 2 4 6 8 10 12 14 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Year African-American White Hispanic California

2 2 California Birth and Death Statistical Master File, California Department of Public Health, Center for Health Statistics and Informatics. Prepared by the Epidemiology, Assessment and Program Development Branch, Maternal, Child and Adolescent Program, Center for Family Health

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The BIH Program spans 15 jurisdictions where

  • ver 90% of African-

American live births

  • ccur.

3 California Birth Statistical Master Files, 2006-2008, Non-Hispanic African-American resident mothers, age 18 years or older, excluding foreign-born

  • mothers. Analysis by CDPH MCAH EAPD.

7

3

Service Criteria for Enrollment

  • Self-Identified African-American woman
  • At least 18 years of age
  • Less than 26 weeks pregnant at the

time of enrollment

8

Used with permission from City of Long Beach Black Infant Health Program

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Intervention Rationale

  • “Singular Core Model”

(Empowerment/Social Support) to promote:

  • Empowerment
  • Social Support
  • Stress Reduction
  • Health Education

9

Istock.com\studio1one 4 4 The Black Infant Health Program: Comprehensive Assessment Report and Recommendations

Intervention Components

  • Case Management/Life Planning
  • Group Sessions

10

Used with permission from San Francisco Black Infant Health Program Used with permission from WIC Works Image Gallery,) https://wicworks.fns.usda.gov/topics-z/image-gallery

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Case Management/Life Planning

  • Participants receive individual, complementary

case management during and after pregnancy

  • Referrals for identified services (e.g., medical,

dental, social)

  • Guidance on family planning
  • Identification of strengths & problem-solving

skills

  • Assistance with setting short and long term-

goals

11

Group Sessions

  • Weekly group session topics:
  • Cultural Heritage as a Source of Pride
  • Healthy Pregnancy, Labor and Delivery
  • Nurturing Ourselves and Our Babies
  • Prenatal, Postnatal and

Newborn Care

  • Stress Management
  • Healthy Relationships
  • Celebrating Our Families

12

Used with permission from Fresno County Black Infant Health Program

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LHJ Staffing Requirements

  • BIH Coordinator
  • Community Outreach

Liaison

  • Mental Health

Professional

  • Public Health Nurse
  • Family Health Advocate
  • Group Facilitator
  • Data Entry Personnel

13

Used with permission from Santa Clara County Black Infant Health Program

Breastfeeding Data Findings

14

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Breastfeeding (BF) Data Collected in BIH

  • BF disparity rates for AA women in California
  • BIH program data collected
  • BF intention
  • BF initiation
  • Women receiving WIC services
  • Quarterly and Annual Reports
  • Anecdotal participant success stories of BF practices

www.istock.com/lostinbids

Methods

  • For breastfeeding disparity rates
  • California Maternal and Infant Health Assessment Data 2013-

2014

  • BIH Program Data
  • Extracted from Efforts to Outcomes (ETO) data system on

November 1, 2016.

  • Cohort of analysis: Women enrolled between July 1, 2015 to

June 30, 2016

  • Comparison of responses to breastfeeding intention

questions at

– Assessment 1 - Enrollment (N = 938) – Assessment 2 - 33 to 36 weeks gestation (N = 410)

  • Women enrolled in WIC question asked during baseline

assessment at enrollment.

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The 2013-2014 MIHA Survey reported: Intended to breastfeed-

  • 85.7% of African-American women
  • 91.7% in Hispanic women
  • 94.6% in White women

Health Knowledge: Breastfeeding

6 BIH data extracted from ETO on November1, 2016. Recruitment Cohort Period: July 1, 2015 – June 30, 2016. Preliminary data of participants that were assessed at baseline and follow-up (approximately 33-36 weeks of pregnancy)

5

5 California Maternal and Infant Assessment 2013-2014

The 2013-2014 MIHA Survey reported: Intended to exclusively breastfeed-

  • 57.5% of African-American women
  • 57.2% in Hispanic women
  • 81% in White women

Health Knowledge: Breastfeeding

6 BIH data extracted from ETO on November1, 2016. Recruitment Cohort Period: July 1, 2015 – June 30, 2016. Preliminary data of participants that were assessed at baseline and follow-up (approximately 33-36 weeks of pregnancy) 5 5 California Maternal and Infant Assessment 2013-2014

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2/6/2017 10 BIH participant intended length of breastfeeding:

Health Knowledge: Breastfeeding

6 BIH data extracted from ETO on November1, 2016. Recruitment Cohort Period: July 1, 2015 – June 30, 2016. Preliminary data of participants that were assessed at baseline and follow-up (approximately 33-36 weeks of pregnancy)

Planned Breastfeeding Length At Initial Enrollment into Program N=826 Follow-up At 33-36 Weeks Gestation N=385 Less than 6 months 16% 12% 6 to 11 months 35% 42% 12 months or longer 33% 38% Not sure yet 16% 8%

6

BIH Participants Receiving WIC Services

6 BIH data extracted from ETO on November1, 2016. Recruitment Cohort Period: July 1, 2015 – June 30, 2016. Preliminary data of participants that were assessed at baseline and follow-up (approximately 33-36 weeks of pregnancy)

Are you currently receiving any WIC services for yourself or your children? Total=901

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Local Collaboration Efforts

  • Collaboration occurs during prenatal and

postpartum series

  • Sites collaborate with local agencies to

support breastfeeding by:

  • Having nurses available to support

breastfeeding efforts and attend groups

  • Partnering with local Women, Infant and

Children (WIC) programs

  • Partnering with coalitions to obtain current

breastfeeding information

21

State Collaboration Efforts

  • Partnerships with
  • WIC
  • March of Dimes
  • Alameda County

Breastfeeding Coalition

22

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Breastfeeding Topics for BIH Sessions

Session Topic Information Session 3

  • Advocating for Services: breastfeeding support

Session 6

  • Infant feeding (will review in detail)

Session 7

  • Review from session 6
  • Safe Sleep Video: breastfeeding plan

Session 8

  • Lifestyle Quiz Questions (True/False)
  • Breastfeeding and formula-feeding are equally

good for your baby. (FALSE)

  • Breastfeeding is good for your baby but not good

for you. (FALSE) Session 9

  • Paternal breastfeeding support

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Breastfeeding Resources

  • Each group session is accompanied

by a facilitator guide and participant handbook

  • The participant handbook contains:
  • More information and resources
  • Breastfeeding infographics
  • BIH staff utilize MCAH-BIH BF

resources to provide to participants

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Source: http://womenshealth.gov/itsonlynatural/

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Black Infant Health Group Session 6

Kwanzaa Principle Kujichagulia

To define ourselves, name

  • urselves, create ourselves and

speak for ourselves.

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Istock.com/raycan Istock.com/imageegaml

This activity will help us learn more about infant feeding and where to find support Pregnancy, birth and breastfeeding were sacred in many African tribes, and mothers were nurtured and supported for weeks after giving birth

Birth was an important time—not just for women, but for the entire village Breastfeeding was viewed as part of the overall birth process Breastfeeding was always part of the bonding process

Baby’s First Food In Africa

26

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In BIH, breastfeeding is considered normal infant feeding and not a lifestyle choice We also believe in SELF-DETERMINATION— you know what is best for YOU! Watch Growing a First Food Movement

https://www.youtube.com/watch?v=Zhx-R6p1xAQ

What’s something NEW you learned?

Baby’s First Food In Africa

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What’s recommended: Breastfeed your baby for at least one year, and exclusively breastfeed your baby (breast milk only) for the first 6 months The more closely you can follow these recommendations, the greater the benefits—but any breastfeeding is good for both the health of you and your baby

Breastfeeding

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http://www.istockphoto.com/RuslanDashinsky

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Breastfeeding Intention vs. Breastfeeding Practice

What stands out to you in this table?

Women in every group have higher rates of intention than practice African Americans have the lowest rates

  • f both intention and

practice

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Benefits and Challenges

Benefits

Short-term

 Provides the best nutrition for your baby  Protects your baby from life threatening ailments (e.g., respiratory infections, gastrointestinal infections, SIDS/SUID)  Faster weight loss for you

Long-term

 Your baby is less likely to develop childhood

  • besity and other diseases like asthma and

diabetes  You may be at lower risk for developing breast cancer, ovarian cancer, or diabetes

Challenges

 Pain  Latching problems  Lack of family or community support  Limited access to lactation consultant  Lack of breastfeeding role models

Brainstorm the BENEFITS and CHALLENGES of breastfeeding  Watch Overcoming Breastfeeding Challenges

http://www.womenshealth.gov/itsonlynatural/overcoming-challenges/breastfeeding-challenges.html?from=breastfeeding

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Source: http://womenshealth.gov/itsonlynatural/

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Breastfeeding improves overall health for both you and your baby!

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Breastfeeding Quiz

Instructions: Thumbs up for TRUE Thumbs down for FALSE

  • 1. Breastfeeding helps prepare the baby’s digestive system

for handling solid food.

  • 2. Babies who are breastfed have more frequent doctor visits.
  • 3. Breastfeeding saves less than $100 per month.
  • 4. Moms who breastfeed lose weight faster.
  • 5. Breastfeeding is good for the environment.
  • 6. Breastfeeding moms sleep less at night.

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Source: http://womenshealth.gov/publications/our-publications/breastfeeding-guide/BreastfeedingGuide- AfricanAmerican-English.pdf

Used with permission from wicworks.fns.usda.gov

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Infant Feeding Plan

Whether you choose to breastfeed or formula feed, we want you to be successful. What do you need to be successful?

 Before your baby is born, tell your partner, family, and friends how you plan to feed your baby  If you choose to breastfeed; ask for support from family and friends, connect with other breastfeeding mothers and discuss any problems with a lactation consultant  Tell your doctor that you want to breastfeed, and make sure it’s part of your Birth Plan  Breastfeeding experts are available to answer your questions

  • - just ask!

 Complete your Infant Feeding Plan

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Reminder

Read Chapter 6 Remember that labor and delivery and infant feeding require support—please ask us for help! If you have questions about any of the topics we covered today, please ask one

  • f us

Session 7 will cover information to help you when you bring your baby home HAVE A GREAT WEEK!

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How You Can Help Site Support

  • Train staff at BIH sites to become lactation

experts

  • Provide additional workshops (between group

sessions)

  • Present during breastfeeding session
  • Availability of lactation expert available during

postpartum sessions/home visits

35

Microsoft ClipArt

How You Can Help Referral Assistance

  • Refer eligible women to BIH
  • Talk to community partners about BIH
  • Develop formal and informal agreements
  • Assist with distributing BIH messaging

materials

36

Microsoft ClipArt

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How You Can Help Community Engagement

  • Identify Breastfeeding champions at the

state and local level

  • Establish local Breastfeeding coalitions
  • Conduct presentations with community

partners

  • Identify success stories
  • Celebrate successes!

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Microsoft ClipArt

For More Information

  • State BIH Page
  • http://www.cdph.ca.gov/programs/BIH/Pages/

default.aspx

  • BIH Coordinator Directory
  • http://www.cdph.ca.gov/programs/bih/Pages/

BlackInfantHealthCoordinatorDirectory.aspx

  • Black Infant Health Profile
  • http://www.cdph.ca.gov/programs/bih/Docum

ents/Profile%20BIH.pdf

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References

1. (2015, August). Portrait of Promise: The California Statewide Plan to Promote Health and Mental Health Equity. (Rep.). Retrieved January 12, 2017, from Report to the Legislature and the People of California by the Office of Health Equity website: http://www.cdph.ca.gov/programs/Documents/Accessible- CDPH_OHE_Disparity_Report_Final.pdf 2. Data sources: 2011-2013 California Birth and Death Statistical Master File, California Department of Public Health, Center for Health Statistics and Informatics. 3. California Birth Statistical Master Files, 2006-2008, Non-Hispanic African-American resident mothers, age 18 years or older, excluding foreign-born mothers. Analysis by CDPH MCAH EAPD. 4. (2007, July). The Black Infant Health Program: Comprehensive Assessment Report and Recommendations (Rep.). Retrieved http://www.cdph.ca.gov/programs/bih/Documents/MO-BIH- ComprehensiveAssessmentReport-April-2008.pdf 5. California Maternal and Infant Health Assessment 2013-2014 6. BIH data extracted from ETO on November1, 2016. Recruitment Cohort Period: July 1, 2015 – June 30, 2016. 39

Thank You

Niambi Lewis, MSW

California Department of Public Health Niambi.Lewis@cdph.ca.gov

916 650-6405 Robin Qualls, BSN, MPH

California Department of Public Health Robin.Qualls@cdph.ca.gov

916 650-0385

40