Nancy E. Wight MD, IBCLC, FABM, FAAP
In early August 2006 the California WIC Association and UC Davis Human Lactation Center released California hospital any and exclusive breastfeeding rates, along with press releases and a policy brief to make California communities aware of their own hospitals' breastfeeding performances, and garner attention for policies and practices proven to increase exclusive breastfeeding rates. The pattern of infant feeding observed in California -- many women initiating breastfeeding, but few continuing beyond a few weeks -- suggests that while most California women recognize that "breast is best," they are not receiving adequate support to continue exclusive breastfeeding.
In addition, childhood overweight is an urgent health crisis in California. More than 400,000 children under 6 years old are overweight, and this number continues to increase dramatically. 1 breastfeeding is recognized by policy makers and physicians as the first step in preventing childhood overweight. Breastmilk provides infants with all the nutrients they need as well as elements that promote growth and a healthy immune system. 2 The American Academy of Pediatrics recognizes that breastfed infants may be less likely than formula fed infants to become overweight as children or obese as adults. 3 Children who are exclusively breastfed for at least the first few months of life have the lowest risk for becoming overweight. 4,5
More than 83% of California mothers make the important decision to breastfeed their infants, but only 40.5% are breastfeeding exclusively at hospital discharge. 6 The rate of in-hospital exclusive breastfeeding has been virtually stagnant since 1994, even though more women are breastfeeding each year (Figure 1).


Exclusive breastfeeding rates vary widely from county to county. The highest rates tend to be in mountain and coastal counties; the lowest rates are in the central valley and southern California. Although overall, San Diego County mothers initiate any breastfeeding in the hospital at 88.8%, exclusive breastfeeding rates vary widely between hospitals within the county, averaging 57.5%, for a ranking of 29th out of 50 California Counties.
According to state data from the newborn screen report, 3 hospitals in San Diego County have = 80% exclusive breastfeeding rates: Scripps Memorial Hospital Encinitas, Scripps Memorial Hospital La Jolla and Pomerado Hospital. The 3 hospitals in San Diego County with the lowest exclusive breastfeeding rates are: Scripps Memorial Hospital Chula Vista (36.3%), Scripps Mercy Hospital (37.3%), and Fallbrook Hospital (43%). For details of any and exclusive rates for all San Diego County Hospitals, go to: http://www.mch.dhs.ca.gov/programs/bfp/in-hospital-tables.htm or http://www.calwic.org/pk_logged!n8m4home.aspx.
Hospital policies have an enormous impact on the decisions mothers make about infant feeding. 7-9 A 2002 survey of California hospitals demonstrated how breastfeeding-supportive hospital policies and practices such as the WHO "Ten Steps" 10 and the California Department of Health Services Maternal, Child, and Adolescent Health model hospital policies (www.mch.dhs.ca.gov/programs/bfp/toolkit/default.htm) are associated with higher any, and exclusive breastfeeding rates. 11 Two San Diego County hospitals have been certified as "Baby-Friendly" 12: Scripps Memorial Encinitas and UCSD Medical Center. The San Diego County Breastfeeding Coalition is working to help all the hospitals in San Diego County improve their breastfeeding rates, especially exclusive breastfeeding. The overwhelming majority of mothers who chose to breastfeed their infants must receive the support they need to succeed in their goals.

References

  1. Inkelas Mea. The health of young children in California: Findings from the 2001 California Health Interview Survey, Los Angeles and Sacramento: UCLA Center for Health Policy; 2001.
  2. Heinig M. Host defense benefits of breastfeeding for the infant. Effect of breastfeeding duration and exclusivity. Pediatric Clinics of North America. 2001;48(1):105-123.
  3. American Academy of Pediatrics Section on Breastfeeding. Breastfeeding and the Use of Human Milk. Pediatrics. 2005;115(2):496-506.
  4. Arenz S, von Kries R. Protective effect of breastfeeding against obesity in childhood. Can a meta-analysis of observational studies help tro validate the hypothesis? Adv Exp Med Biol. 2005;569:40-48.
  5. Dewey K. Is breastfeeding protective against childhood obesity? J Hum Lact. 2003;19:9-18.
  6. California Department of Health Services Genetic Disease Branch. California In-Hospital Breastfeeding Rates. Statewide, County, and Hospital of Occurance by race/ethnicity, 2004. www.mch.dhs.ca.gov/programs/
    bfp/in-hospital-tables.htm.
  7. DiGirolamo AM, Grummer-Strawn LM, Fein S. Maternity care practices: implications for breastfeeding. Birth. Jun 2001;28(2):94-100.
  8. Gagnon AJ, Leduc G, Waghorn K, Yang H, Platt RW. In-hospital formula supplementation of healthy breastfeeding newborns. J Hum Lact. Nov 2005;21(4):397-405.
  9. Howard CR, Howard FM, Lanphear B, et al. Randomized clinical trial of pacifier use and bottle-feeding or cupfeeding and their effect on breastfeeding. Pediatrics. Mar 2003;111(3):511-518.
  10. WHO/UNICEF. Protecting, promoting and supporting breastfeeding: The special role of maternity services, A joint WHO/UNICEF statement. Geneva: World Health Organization; 1989.
  11. California Department of Health Services WIC Supplemental Nutrition Branch. Maternity and Infant Care Practices Are Related to Exclusive Hospital Breastfeeding Rates in California Hospitals 2006.
  12. Baby Friendly USA. Baby Friendly Hospitals in the US. www.babyfriendlyusa.com. Accessed Oct 2006.

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