* Poor women receive less support for breastfeeding

Breastfeeding has substantial benefits for infants in terms of promoting healthy weight, reducing infections and boosting cognitive ability. The American Academy of Pediatrics recommends that mothers breastfeed exclusively for the first six months of life, and organizations such as the World Health Organization and U.S. Centers for Disease Control and Prevention have urged hospitals to implement policies to promote the exclusive breastfeeding of newborns.

In California, however, there is wide disparity in how well hospitals support breastfeeding, according to a new report from the UC Davis Human Lactation Center and the California WIC Assn. The report rates nearly every hospital in the state on two measures: the average number of women breastfeeding their newborns while in the hospital and the average number of women who are breastfeeding exclusively (that is, with no supplemental formula or other fluid). Breastfeeding exclusively in the hospital creates the best chance for sustained breastfeeding at home. The report found a concentration of low-performing hospitals in Southern California compared with elsewhere in the state and showed the breastfeeding gap is greatest at hospitals serving ethnic, low-income women and babies.

"Breastfeeding should not depend on where you are born," says Karen Farley of the California WIC Assn. "Our report shows that virtually all of the hospitals with the lowest exclusive breastfeeding rates reported here serve low-income and minority women -- the very population most affected by poor health outcomes such as diabetes and obesity."

Overall, 87% of new mothers in California start breastfeeding during the hospital stay but less than half of them leave the hospital exclusively breastfeeding. The report cites Coastal Communities Hospital, in Orange County, where 88.4% of women initiate breastfeeding at birth but only 2.4% leave the hospital breastfeeding exclusively. Other low-performing hospitals on the exclusive breastfeeding measure include: Pacific Alliance Medical Center in L.A., Pacifica Hospital of the Valley, Bellflower Medical Center, Los Angeles Metropolitan Medical Center, Valley Presbyterian Hospital, Beverly Hospital in Montebello, St. Francis Medical Center in Lynwood, Garfield Medical Center in Monterey Park and California Hospital Medical Center. All those hospitals are in Los Angeles County.

Hospitals that performed well have policies in place to support breastfeeding women, according to the report. For example, the staff is trained to help nursing mothers, the hospitals prohibit free formula samples and mother and baby are allowed to stay together to promote nursing. High-performing hospitals in Southern California include St. John's Hospital, which has a breastfeeding exclusively rate of 68.7%; St. Joseph's Hospital in Orange, at 63.8%; St. John's Pleasant Valley Hospital in Ventura County, at 72.4%; and Rancho Springs Medical Center/Tenet in Riverside County at 71.6%.

The full report and county by county statistics can be accessed at the WIC website.

- Shari Roan

Photo credit: Spencer Weiner/Los Angeles Times

* Updating this blog item: Under the state labor code, employers are required to provide a break time and space to accommodate an employee who wants to express breast milk for her baby. A training session entitled "The Business Case for Breastfeeding" will be held on Sept. 22 in Los Angeles to help employers establish worksite lactation programs. The training session is offered by the Breastfeeding Task Force of Greater Los Angeles and the Los Angeles Collaborative for Healthy Active Children.

For more information on the training session, see this website at the L.A. County Public Health Department. You can find information on breastfeeding in the workplace at this site.

-- Shari Roan

Comments

[Laure]

You also have to remember that poorer women are also more likely to have to go straight back to work, and are less likely to be able to pump milk (no time or place to pump). This is one big reason why poorer women don't breastfeed at the same rates as middle- to upper middle-class women.

[Karen Peters]

The highest-scoring hospitals by exclusive breastfeeding have implemented policies and practices that support breastfeeding women, such as, training all staff in skills necessary to help breastfeeding women, making sure breastfeeding is started soon after the baby is born, giving breastfeeding newborns only breast milk while in the hospital unless there is a medical need for something else, eliminating formula marketing to their patients and allowing mom and baby to stay together and breastfeed whenever they want to do so.

We know what hospital policies work to support breastfeeding mothers and it is the responsibility of all hospitals to take action to implement those policies.

Karen Peters
Executive Director
Breastfeeding Task Force of Greater Los Angeles

[Julie]

Poorer communities suffer higher rates of diabetes, obesity and other chronic diseases. Breastfeeding is truly an equalizer. No matter what your socioeconomic status or where you live you can breastfeed your baby to give him/her the best start in life. Support in the hospital is imperative in giving moms the opportunity to provide the best for their babies - location should not determine whether mothers and babies are provided this support or not.

[Michelle]

Eliminating barriers to breastfeeding in the workplace is essential for working mothers if they are to meet the current CDC, WHO and AAP recommendations on breastfeeding. Currently, the State of California supports Workplace Lactation Accommodation with Labor Code 1030. To comply with this legislation, employers are required to provide a break time and space to accommodate an employee desiring to express breastmilk for her baby. Unfortunately, many worksites in Los Angeles do not have policies that support breastfeeding moms and returning to work.

The Breastfeeding Task Force of Greater Los Angeles in partnership with the Los Angeles Collaborative for Healthy Active Children is offering a training titled "The Business Case for Breastfeeding", on September 22, 2008 from 8:30 am to 12:00pm. This training will provide attendees with the tools and resources necessary to promote the adoption of family-friendly policies by employers.

The training is FREE, and will take place at the LA County Department of Public Health. 3530 Wilshire Blvd, Suite 800, Los Angeles, 90010. Please call (213) 351-7866 for more information or visit www.breastfeedla.org .

[Lindsey]

Workplace lactation accomodation is required by law in the state of California. There are statistics that show that most women who deliver their children in the hospital intend to breastfeed, a great many more intend to exclusively breastfeed than the real numbers reflect... so why isn't it working out? The health risks of formula feeding are very real, and yet women are not receiving the support they need from health professionals to provide human milk to their newborns. Los Angeles is not the only county with poor and working mothers, and yet our numbers of breastfed infants are startlingly lower than other counties and over half of the worst performing hospitals are here in this county. It's time for our community to wake up and take responsibility for the health of our babies and the health of our future and it all begins in the hospital.

[Bonnie]

Thank you for this wonderful article. Hospitals do need to support breastfeeding for mothers. Many hospitals have begun to implement programs to increase exclusive breastfeeding. Support from the media and the reports coming from UC Davis have
made a difference and the hospitals are paying attention.

[Deborah Myers]

It is a common misconception that low income mothers do not exclusively breastfeed because of an early return to the workplace. If it that is the case for an individual mother, it can be readily addressed through education and supportive policies and practices in the hospital. Mothers who wish to introduce formula in order to supplement breastfeeding once they return to work need to initiate exclusive breastfeeding in order to build and maintain a milk supply so that they can "combo" feed later, if that is their informed decision. It's a matter of physiology, not dogma. However, common hospital practices such as separating mothers and newborns after delivery for up to several hours, routinely placing a supply of formula bottles in bassinettes, and assessing feedings by ounces consumed and not the quality of the latch, preclude all but the most knowledgeable and determined mothers from exclusively breastfeeding.
Deborah Myers, MS, CNS, CLE
Nutritionist

[Terri]

This problem needs to be addressed in a holistic, multi-level approach. The importance of exclusive breastfeeding and it's benefits need to be part of school health curriculums, preconception care, prenatal care, and community messaging. In short, it needs to become normalized in our community. Hospital staff should not be the first ones to speak with a woman about the importance of breastfeeding but instead should provide the support, encouragement and further education to what the mother already knows because she has received this information throughout her life span. Community support/ public health assistance needs to be readily available should the discharged mother need further help or support once she returns home...and this assistance needs to be available to all regardless of socio-economic status.

[Laure]

It would be interesting to see if undocumented workers were included in this study of how many women do/don't exclusively breastfeed. I know people are saying that there are laws requiring a workplace to provide space and break-time, but undocumented workers would not be protected by these laws.

I know the law states that a place must be provided to pump milk, but what about women who work in restaurants or fast-food places? I can't believe there is a place (besides the toilet stall) that would be available.

Also, there is a exemption in the labor code that states "An employer is not required to provide break time under this chapter if to do so would seriously disrupt the operations of the employer." I wonder how many employers use this to go around the law.

I agree that we need to change our overall attitudes about breastfeeding. I think a lot of people still see pumping time as time away from doing work, which is extremely short-sighted.

[Ellen Steinberg]

The statistics show that 87% of mothers in California want to breastfeed. Exclusive breastfeeding is the gold standard in infant nutrition, providing the baby with the best start in life. So why do only 24% of Los Angeles County mothers leave the hospital exclusively breastfeeding? As a consultant to hospitals that wish to improve their breastfeeding services, I have seen that the answer is in the breastfeeding policy. When breastfeeding-supportive policies are written, implemented and enforced, the hospital breastfeeding rates increase. Birth hospitals have a duty to provide the best care for their patients, regardless of income or ethnicity. Hospitals that care for wealthier women have needed to discard their outdated policies to meet their demand for breastfeeding education and support. Lower income women do not have a strong voice, so the hospitals where they give birth have been slow to change. Every baby deserves to receive the health benefits that only mother’s milk can provide!

Ellen Steinberg, RN, LCCE, IBCLC
International Board Certified Breastfeeding Consultant
President, The Breastfeeding Task Force of Greater Los Angeles

[Jessy Melowicz Barbour]

Thank you for this article. Knowledge is power, not just for the mothers, but fathers and children as well. There are so many pressures to not breast feed, to stop breast feeding before the child is ready. The more scientific facts that are offered on the health benefits will hopefully stop demonizing this amazing ability mothers' have to feed, comfort, connect and fulfill their children's needs. All staff, including doctors need to do their homework and stop living in the Puritanical ages. Sadly the US is still geared toward parenting based on the industrial revolution: public school system, separating mother from child as soon as possible so she can work, etc. It is time for a change!!!

[QHAmom]

FREE 24-hour breastfeeding help is available FOR ANY MOTHER toll-free in the US from the LLL Breastfeeding Helpline-US at 877-4-LALECHE (877-452-5324).