TN Breastfeeding Updates. Celebrating Successes, Addressing Opportunities

Transcription

1 TN Breastfeeding Updates Celebrating Successes, Addressing Opportunities Morgan McDonald, MD - Assistant Commissioner May 4, 2018

2 Objectives Emphasize critical component of breastfeeding to population health Provide an overview of state progress in breastfeeding metrics Highlight statewide breastfeeding initiatives Engage partners in addressing gaps and next steps for breastfeeding support

3 Mandate

4 TDH Statement: Population Health Consistent with its mission, the Tennessee Department of Health aims to improve population health the outcomes related to physical, mental, and social well-being for all Tennesseans. In doing so, the Department: Recognizes the important contributions of the natural environment, built environment, health policies and social determinants of health, as well as access to and provision of quality health care. Partners with and engages stakeholders to assure that health is a consideration in policy and programming efforts across sectors. Anchors its efforts in the guiding questions outlined in the State Health Plan: Are we creating and improving opportunities for optimal health for all? Are we moving upstream? Are we learning from or teaching others?

5 Where to Intervene? Counseling and Education Stop smoking, sleep on back Clinical Interventions Treatment for asthma, obesity Long-Lasting Protective Interventions Changing the Context to make individuals default decisions healthy Increasing Population Impact Immunizations, Breastfeeding Fluoridation, smoke free laws Socioeconomic Factors Education, poverty, housing

6 Health/Development Life Course Model Risk Factors Optimal Trajectory The deaths of 823,000 children and 20,000 mothers each year could be averted through universal breastfeeding, along with economic savings of US$300 billion. -The Lancet, 2016 Health Promotion Factors Age Your Mother s/father s Life Your Life Next Generation Adapted from the Life Course Toolkit by CityMatCH. Available at:

7 Life Course: Benefits of Breastfeeding Mother Decreased risk of breast and ovarian cancers Decreased risk of cardiovascular disease Decreased risk for developing Type II Diabetes Breastfed Infant Improved GI functioning (gastric emptying, decreased risk of NEC) Decreased risk of infection (GI, respiratory, otitis media, UTI, sepsis) Reduced long-term risk of obesity, diabetes, leukemia Patient s Offspring Family savings from formula expenditures Societal savings on healthcare costs

8 Overview of Breastfeeding Progress in Tennessee

9 Key Stats Breastfeeding in Tennessee 79.8% of Tennessee infants born in 2016 were breastfed 1 20% relative increase since 2010 (66.6%) Among infants born in 2014, Tennessee breastfeeding duration rates are above national estimates 2 Breastfeeding at 6 months: 57.0% (US, 55.3%) Breastfeeding at 12 months: 35.8% (US, 33.7%) Data Sources: 1 Tennessee Department of Health, Division of Policy, Planning, and Assessment, Birth Statistical System. Prepared April 2018 by Tennessee Department of Health, Division of Family Health and Wellness. 2 Centers for Disease Control and Prevention, 2015/2016 National Immunization Survey (NIS): 2014 Birth Cohort. Accessed on April 30, 2018.

10 Percent Breastfeeding Rates among Tennessee Newborns, Data Source: Tennessee Department of Health, Division of Policy, Planning, and Assessment, Birth Statistical System. Prepared April 2018 by Tennessee Department of Health, Division of Family Health and Wellness. Analysis restricted to births to TN resident women but excludes infants missing breastfeeding data. Missing overall is 3.7% but varies by year, from 2.3% to 5.6%.

11 Percent Breastfeeding Rates among Tennessee Newborns, : Overall and by Race/Ethnicity 100 Non-Hispanic White Non-Hispanic Black Hispanic or Latino Tennessee Data Source: Tennessee Department of Health, Division of Policy, Planning, and Assessment, Birth Statistical System. Prepared April 2018 by Tennessee Department of Health, Division of Family Health and Wellness. Analysis restricted to births to TN resident women but excludes infants missing race/ethnicity or breastfeeding data.

12 Breastfeeding Rates among Tennessee Newborns in 2015: By County TENNESSEE = 78.2% Rates varied widely across the state 13 of 95 counties had breastfeeding initiation rates at or above Healthy People 2020 goal (81.9%) Data Source: Tennessee Department of Health, Division of Policy, Planning, and Assessment, Birth Statistical System. Prepared April 2018 by Tennessee Department of Health, Division of Family Health and Wellness. Analysis restricted to births to TN resident women.

13 Breastfeeding Rates among Tennessee Newborns in 2016: By County TENNESSEE = 79.8% 17 of 95 counties have breastfeeding rates at or above Healthy People 2020 goal (81.9%) Since 2010, 72 counties have had statistically significant increases in breastfeeding Data Source: Tennessee Department of Health, Division of Policy, Planning, and Assessment, Birth Statistical System. Prepared April 2018 by Tennessee Department of Health, Division of Family Health and Wellness. Analysis restricted to births to TN resident women.

14 Percent Breastfeeding Estimates: Initiation, Duration, and Exclusivity: 2014 Birth Cohort 100 TN US HP 2020 Goal Ever Breastfed Breastfed at 6 Months Breastfed at 12 Months Exclusive Breastfeeding through 3 Months Exclusive Breastfeeding through 6 Months Data Source: Centers for Disease Control and Prevention, 2015/2016 National Immunization Survey (NIS): 2014 Birth Cohort. Accessed on April 30, 2018.

15 Percent WIC Participant Breastfeeding Estimates: United States 2009 vs Birth Cohort Ever BF BF at 6 Months BF at 12 Months Excl. BF through 3 Months Excl. BF through 6 Months Data Sources: 2011/2012 CDC National Immunization Survey (2009 Birth Cohort); 2015/2016 CDC National Immunization Survey (2014 Birth Cohort) Note: National estimates are for children born for respective birth year receiving WIC services.

16 What Can You Do? Normalization of breastfeeding Breastfeeding promotion by providers Encouragement by friends and family Hospital promotion and policies to support breastfeeding Lactation support Lactation support Partner/family support Technical assistance and troubleshooting Cultural acceptance Provider support Worksite lactation support Safe/clean public spaces to breastfeed Partner/family support Community support Clinician Support Worksite lactation support Safe/clean public spaces to breastfeed

17 Breastfeeding Promotion/Support Provider Efforts EMPOWER cohort Free 20 hrs Continuing education* Promotional materials Community Efforts Media campaign Breastfeeding Welcome Here Designated Breastfeeding Experts Peer Counselors Minority father focus groups State Coalition Breastfeeding Hotline 24/7 access to CLC or IBCLC Available to anyone calls/month

18 Lactation Support in Tennessee As of April 2018, there are 718 active Certified Lactation Counselors (CLCs) in Tennessee YEAR CLCs per 1,000 Resident Births National = 4.57 CLCs per 1,000 live births Notes: Map created using 2017 provisional birth data, and is subject to change; CLCs per 1,000 likely overestimated because active CLCs is defined as registered and not necessarily practicing lactation professionals. Also, CLC indicates county of residence. National CLC rate retrieved from CDC Breastfeeding Report Card, Rates shown above calculated different from report. Data Sources: Birth Statistical System; Tennessee Department of Health; Division of Policy, Planning and Assessment. Prepared by Division of Family Health and Wellness. Active CLCs per county obtained from the Academy of Lactation Policy and Practice database as of April 27, 2018.

19 Breastfeeding Welcomed Here Efforts In Tennessee 1,014 businesses have taken Breastfeeding Welcomed Here (BFWH) Pledge since July 2012 YEAR Number of Businesses Missing Pledge Date (n=49) South Central West East Upper Cumberland Davidson Knox Mid-Cumberland Shelby Northeast Sullivan Hamilton Madison Southeast Note: 2018 data include January through March Data Source: Breastfeeding Welcomed Here Tracking Database Number

20 Breastfeeding Welcomed Here Locations, by County Note: 2018 data include January through March Data Source: Breastfeeding Welcomed Here Tracking Database

21 Tennessee s 1,000 th BFWH Site!

22 Call Volume, N Tennessee Breastfeeding Hotline 24/7 access to certified lactation counselor or consultant Available to anyone mothers, other family members, health care providers Total call volume since statewide rollout (January 2014) = 22,875 calls Averaging 525 calls per month (CY2018) www. tn.gov/tbh TN Breastfeeding Hotline: Call Volume 3000 # New Calls to Hotline # Follow-Up Calls Made Jan - Mar Apr - Jun Jul - Sept Oct - Dec Jan - Mar Apr - Jun Jul - Sept Oct - Dec Jan - Mar Apr - Jun Jul - Sept Oct - Dec Jan - Mar Apr - Jun Jul - Sept Oct - Dec Jan - Mar

23 Tennessee Breastfeeding Hotline: Call Volume by Resident County, Missing resident county (n=412) Data Source: Tennessee Breastfeeding Hotline; icarol System.

24 Tennessee Breastfeeding Hotline: TBH Call Volume per 1,000 Breastfeeding Births Data Sources: 1 Tennessee Breastfeeding Hotline; icarol System. 2 Birth Statistical System; Tennessee Department of Health; Division of Policy, Planning and Assessment. Prepared by Division of Family Health and Wellness. Notes: Numerator is number of TBH calls. Denominator is resident births indicating Y on Is child breastfed? question on birth certificate. Call ratio calculated as follows: Number of TBH calls divided by Tennessee resident breastfeeding newborns multiplied by 1,000. Map created includes 2017 provisional birth data, and is subject to change

25 Baby Friendly Designations Erlanger Hospital - Baroness Campus, Chattanooga (11/14) St. Thomas Midtown Hospital, Nashville (02/16) Erlanger East Hospital, Chattanooga (03/18) Maury Regional Medical Center, Columbia (03/18) Jackson-Madison County General Hospital District, Jackson (03/18)

26 2017 Awardees: Erlanger Baroness Hospital, Chattanooga Hardin Medical Center, Savannah Indian Path Medical Center, Kingsport Laughlin Memorial Hospital, Greeneville Northcrest Medical Center, Springfield Saint Thomas Midtown Hospital, Nashville Tennova Healthcare Cleveland, Cleveland

27 Hospital Toolkit mpinc Care Dimensions

28 Hospital Toolkit Questions within mpinc Care Dimension

29 10 Step Hospital Survey: Barriers and Opportunities

30 Survey Objective and Response Rate Survey Objective To understand Tennessee hospitals implementation of the WHO/UNICEF Ten Steps to Successful Breastfeeding Methods Administered electronically by THA to all TN birthing facilities in the summer and fall of 2017 Response Rate 48/64 (75%) TN birthing hospitals/facilities *Note: Respondents were responding the 10 steps as of the timing of the survey

31 Percent of hospitals Hospital Distribution of 10 Steps Implementation 40% 35% 30% 29% 35% 25% 23% 20% 15% 13% 10% 5% 0% 0-2 Steps 3-5 Steps 6-7 Steps 8-10 Steps Steps Fully Implemented

32 Percent of hospitals Level of Implementation by Step 100% 80% 85% 60% 40% 33% 35% 20% 0% Full Implementation Partial Implementation No Implementation

33 Hospital Breastfeeding Rate 2016 Correlation of 10 Steps Implementation and Breastfeeding 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% R² = # Steps Fully Implemented by Hospital

34 Average # Steps Fully Implemented Differences in Implementation by Region East (10) Northeast (6) Southeast (3) Middle (19) West (10) Hospitals by Region

35 Average # Steps Fully Implemented Differences in Implementation by Number of Births <500 (18) (17) >1500 (13) Hospitals by # Births in 2016

36 Average # Steps Fully Implemented Differences in Implementation by Neonatal Level Level 1 (25) Level 2 (11) Level 3 (10) Level 4 (1) Hospitals by Neonatal Level

37 Average # Steps Fully Implemented Differences in Implementation by Certified Lactation Counselor Density (28) (10) >40 (10) Hospitals by # CLCs in County

38 Percent of Hospitals Barriers Encountered 100% 80% 60% 40% 29% 44% 46% 42% 46% 20% 13% 0% Financial Hospital administration Provider willingness Staff willingness Lactation support in hospital Other barriers identified: Trying to change the culture of breastfeeding has been very hard to do in the community Patient willingness to exclusively breastfeed Mothers coming in asking for formula Turnover of staff and administration Hospital environment not meant for couplet care Lactation support in community

39 Step 10 Barriers 27 hospitals (56%) did not fully implement Step 10: Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic Of those hospitals, the most common barriers listed were: Lactation support in community Staff willingness Lactation support in hospital

40 Summary Improving population health requires us to think differently Beyond health care Upstream efforts Identify gaps Work together to provide solutions Breastfeeding is a primary prevention strategy with the potential to contribute to improved population health In Tennessee, we have seen tremendous improvement in breastfeeding promotion and support Increase in breastfeeding initiation and duration Engagement of new partners in new ways Improvement in hospital policies to support breastfeeding

41 Summary Work remains to be done Racial/ethnic and geographic disparities remain Opportunities to promote breastfeeding prenatally Opportunities to improve breastfeeding duration Availability of lactation support Opportunities for culture change (community, employer, clinical) Breastfeeding promotion is not about the designation, it s about culture change

42 Acknowledgements Jackie Moreland, Tennessee Hospital Association Dr. Elizabeth Harvey, CDC MCH Epidemiologist Rachel Newton, Vanderbilt Medical School Sierra Mullen, Epidemiologist

43 Questions? Morgan McDonald, MD FAAP FACP Assistant Commissioner Director, Division of Family Health and Wellness