CHAMPS (Communities and Hospitals Advancing Maternity Practices), a multi-year quality improvement program led by Boston Medical Center (BMC) researchers, has resulted in increased breastfeeding rates in Mississippi hospitals and reduced inequities racial lines in breastfeeding initiation.
The results, published in Pediatricsdemonstrate that the implementation of the Baby Friendly Hospital Initiative, a set of practices and goals that promote breastfeeding among new mothers, may lead to higher breastfeeding rates, especially among black women. The CHAMPS program assists and supports Mississippi hospitals in adopting the “Baby-Friendly” approach.
“Expanding access to breastfeeding support in Mississippi is a critical component of health equity for families in the short and long term,” said Anne Merewood, PhD, MPHcorresponding author of the study and director of the Center for Health Equity, Education and Research at BMC.
Breastfeeding outcomes are linked to race and location
Many data demonstrate the benefits of breastfeeding for mother and child. Breastfed children perform better on intelligence tests. They are less likely to be overweight, obeseor develop Diabetes later in life. Nursing women are at a reduced risk of breast and ovarian cancer as well as heart disease.
In Mississippi and many other southern states, breastfeeding rates have historically been lower than in other parts of the country. The state has one of the highest rates of heart disease, obesity, and diabetes. Before CHAMPS began in 2014, Mississippi had the lowest breastfeeding rates in the United States, with an initiation rate of 57.5%, according to data cited in the study. Rates among black mothers were also the lowest in the country.
“Two of the biggest factors that affect breastfeeding outcomes are race or racism and where you live, which the CHAMPS program addresses at the hospital level, providing the necessary information and support to help all new mothers have successful breastfeeding,” said Laura Burnham, MPHassociate director of BMC’s Center for Health Equity, Education, & Research and first author of the study.
Ten steps to successful breastfeeding
The Baby-Friendly Hospital Initiative was launched in 1991 by the World Health Organization and the United Nations Children’s Fund to increase breastfeeding rates around the world. The initiative helps hospitals help mothers gain the skills and confidence to initiate and continue breastfeeding.
For a hospital to be certified as baby-friendly, it must achieve certain goals, including not marketing infant formula to the hospital and adhering to the framework known as the Ten steps to successful breastfeeding.
- Have a written breastfeeding policy that is regularly communicated to all health care staff.
- Train all healthcare staff in the skills needed to implement this policy.
- Inform all pregnant women about the benefits and management of breastfeeding.
- Help mothers initiate breastfeeding within one hour of birth.
- Show mothers how to breastfeed and how to maintain lactation, even if they are separated from their baby.
- Do not give infants any food or drink other than breast milk, unless medically indicated.
- Practice cohabitation – allow mothers and infants to stay together 24 hours a day.
- Encourage breastfeeding on demand.
- Do not give pacifiers or artificial nipples to breastfed infants.
- Promote the creation of breastfeeding support groups and refer mothers to them when they leave the hospital or birthing centre.
From zero “baby-friendly” hospitals to 22
In 2014, the CHAMPS team enrolled 39 of the state’s 43 birthing hospitals in its quality improvement program. The hospitals received intense on-site coaching and technical assistance. Key stakeholders, including local breastfeeding experts and lactation consultants, as well as local and national organizations, also provided support. CHAMPS held 100 training sessions across Mississippi, training 1,837 hospital staff.
As part of its approach to community engagement, the CHAMPS team organized a regional conference, trained mother-to-mother training programs that resulted in 89 “community transformers” and funded the opening of the first Baby Coffee in Mississippi.
An analysis of data collected between January 2015 and December 2019 shows that overall breastfeeding initiation rates increased by 10 percentage points over the course of the program. For black mother-baby dyads, rates increased by 21 percentage points; for white mother-baby dyads, rates increased by 4%. Exclusive breastfeeding rates increased by 11%, with higher monthly increases among black mother-baby dyads.
The results show a significant decrease – from 79% to 11% – in the number of hospitals distributing sample packs of free preparations to patients, and there was a significant reduction in the number of hospitals accepting free preparations from manufacturers. This demonstrates the hospitals’ commitment to earning and maintaining the Baby-Friendly designation.
When CHAMPS was launched in Mississippi, there were no “baby-friendly” hospitals in the state. There are currently 22.
“We know that breastfeeding has tremendous health benefits for both mother and child, and we need to identify sustainable solutions to sustain these efforts in the future,” says Merewood.