Assessing Maternal and Infant Health Providers in Low Income New York City Neighborhoods: An Essential First Step to Make Breastfeeding the Norm

Erum K. Hadi, MPH1, Jane F. Bedell, MD1 , Philip M. Alberti, PhD1 , Matilde Depena, BSc 2, Ruqayyah Abdullah, BSc 11 Bronx District Public Health Office, New York City Department of Health and Mental Hygiene, 2 Lehman College, City

University of New YorkBACKGROUND

Breast milk strengthens infants’ immune systems, reducing their risk for numerous childhood diseases.1 Breastfeeding also decreases maternal risk of cancers, post-partum bleeding and Type II diabetes.2

In New York City (NYC), 86% of mothers initiate breastfeeding, but by 8 weeks post-partum only 67% are still breastfeeding.4

A 20-minute telephone survey of 211 providers in the South Bronx, East and Central Harlem, and North and Central Brooklyn assessed client education services, provider-client discussion of health benefits, pain, intimacy and legal rights, and barriers to breastfeeding support.

METHODS

Data Sources:[1] Breastfeeding and Maternal and Infant Health Outcomes in Developed Countries, AHRQ, April 2007.[2] Breastfeeding and Maternal and Infant Health Outcomes in Developed Countries, AHRQ, April 2007. [3] NYC Pregnancy Risk Assessment Monitoring System (PRAMS) Report, 2007.[4] NYC Pregnancy Risk Assessment Monitoring System (PRAMS) Report, 2007.

RESULTS

PUBLIC HEALTH IMPLICATIONS

HYPOTHESIS

We hypothesized that in low-income neighborhoods there would be a dearth of services associated with breastfeeding initiation and duration (e.g.: education for mothers and providers, peer counseling, lactation consulting and pumps.)

Figure 2: Pediatricians Less Likely to Use or Provide Educational Materials Than

WIC/Social Services and OBGYNs

75%

46%

76%

0%10%20%30%40%50%60%70%80%90%

100%

WIC/ Social Services

(N=43)

Pediatricians (N=61) OBGYN (N=38)

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test w

as sig

nifi

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t (p<

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)

61%

15%

48%

22%

10%

19%

5% 6% 7%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

WIC/Social Services(N=23)

Pediatricians (N=14) OBGYN (N=26)

Pe

rce

nt

Hand Pump Electric Pump Hospital Grade Pump

Figure 3: Very Few Providers Offer Electric Breastfeeding Pumps

LIMITATIONSThe universe of providers remains unknown and therefore generalizations are limited.

Future questionnaires should distinguish between individual providers and their institutions.

Lack of comparison to high-income neighborhoods.

86.4 88.6 86.4 85.5 86.581.3

68.5 69.767.3

57.660.4

73.8

0102030405060708090

100

NYC Bronx Brooklyn Manhattan Queens StatenIsland

Per

cent

Initiation Duration (8 weeks)

Figure 1: Breastfeeding Initiation Vs Duration (8 weeks) by Borough, NYC, 2007

Source: NYC PRAMS, 2006-2007. Initiation = Percent of women who ever breastfed & Duration = Percent of women who breastfeed for 8 weeks or more.

•Over 70% of all providers offered general breastfeeding education to mothers.•WIC/social service agencies were more likely to communicate breastfeeding guidelines and other issues compared with pediatricians and OBGYNs. •Pediatricians were least likely to provide breastfeeding support services.

INTERVENTIONS

•Findings were used to create and publish a resource list of community breastfeeding support service providers.

•Breastfeeding education materials were distributed to pediatricians.

•In addition, the NYCDOHMH is implementing the following interventions to improve breastfeeding support services availability in low income neighborhoods:

•Provision of Certified Lactation Counselor training program to home visiting nurses for the NYCDOHMH programs, as well as hospitals that request such training.

•Provision of breast pumps to qualifying breast feeding mothers through the home visiting programs.

•Collaboration with local hospitals to help implement policies that support breastfeeding practices.

The breastfeeding assessment revealed a need for provider education, increased access to lactation consultants, pump provision and educational materials, especially in pediatric clinical practices.

•Very few providers offered services beyond general breastfeeding education.

•Lactation consulting was offered by only 40% of WIC/social service agencies, 53% of OBGYNS, and 16% of pediatricians.