According to the 2018 Breastfeeding Report Card, 77.4 % of babies born in Delaware were “ever breastfed or fed breast milk” ; lower than the national estimate of 83.2%.  Within this measure, there are disparities by both race/ethnicity and household income level.  As is the case nationally, rates of breastfeeding are lowest for Black, non-Hispanic infants, as well as infants in low-income households. These disparities are mirrored in the data for longer-term breastfeeding, with the overall rate dropping to just 20.5% of infants who are breastfed exclusively for 6 months; lower than the national average of 24.9%.

As per the PRAMS 2019 data the percent overall prevalence of ever breastfed among those who delivered was 87.3% and currently breastfeeding/at the time of survey was 59.0%.  As per the PRAMS data, the 2019 prevalence of ever breastfed among non-Hispanic black was 80.5% as compared to 84.0% among non-Hispanic white, and 89.8% among Hispanics. Similarly, the 2019 prevalence of currently breastfeeding (or at the time of survey) among non-Hispanic blacks was 41.4% as compared with 59.9% among non-Hispanic whites, and 57.0% among Hispanics.

The percentage of women who ever breastfed increased by eight-percentage points from 79.2% (95%CI: 76.4-81.9) in 2012 to 87.3% (95%CI: 84.9-89.7) in 2019. Similarly, the percentage of women who indicated currently breastfeeding increased by 11 percentage points from 48.8% (95%CI: 45.2-52.5) in 2012 to 59.0% (95%CI: 55.3-62.8).  

This data shows the need for improvements in overall breastfeeding initiation but also improvement in the disparities that exist in Delaware. In addition, the input gathered through our needs assessment process showed overwhelming support from partners to address this area.  Through a survey of MCH stakeholders, breastfeeding was ranked as the number one national performance measure for our Title V program to address in the perinatal/infant domain, and 72% indicated that there was a strong desire among stakeholders to address the issue.

The following activities have been accomplished this past year with the use of Title V funding and through partnerships with entities such as the DHMIC, WIC and the Breastfeeding Coalition of Delaware (BCD).

According to the Ripples Group findings in the Final Quarter Report of 2020, WIC WOW Data System:

• Breastfeeding Initiation rates in the WIC population increased to 57% versus 53% in 2019
• Duration at 3 months increased in all clinics, with an average of 42% versus 33%    in 2019
• Duration at 6 months averaged 32% in all counties versus 25% in 2019
• Exclusivity rates decreased to an average rate of 23.5% versus 28% in 2019

The Delaware WIC Program continues to partner with Christiana Health Care Systems, The Latin American Community Center, Nemours Pediatrics, Westside Family Health, The Breastfeeding Coalition of Delaware, The Perdue Chicken Plants of Milford and Georgetown and The Delaware Healthy Mother and Infant Consortium to strengthen our breastfeeding services in the heart of the community.  

According to Ripples findings in the final quarter report of October 2020 a participant contacted by a peer counselor is 81% more likely to be breastfeeding at 3 months and 88% more likely to be breastfeeding at 6 months. Exclusivity rates among WIC mothers remains 5% higher when mothers are contacted by a peer counselor.

WIC offices closed March 2020 and remain closed to date due to Covid-19 precautions.  Participants are contacted by phone for scheduling appointments certifications and recertifications.   WIC benefits are loaded remotely and the WIC no show rate as a result of the WIC waiver for Physical Presence remains at an all-time low of 11%.

The virtual breastfeeding classes remain successful. The classes are offered the first and third Wednesday of each month at 11am and 5pm.

One clear need in our state is to enhance the supports that are available to women in the early days and months after birth, when breastfeeding is being initiated and becoming a routine. Over the past several years DPH has worked on expanding state breastfeeding capacity - promoting the transformation of Delaware hospitals into Baby Friendly hospitals and improving access to professional and peer support for breastfeeding in the community. Four out the six birth facilities in the state have received baby friendly designation including our largest birthing hospital. The other two birthing facilities are interested, with one of them starting the process this past year.  In the most recent CDC Maternity Practices in Infant Nutrition & Care, Delaware scored an 83 which slighting higher than the national average of 79.  The BCD will continue to provide support to birthing facilities to maintain certification or as they work to achieve the certification.   

The BCD has surveyed the Delaware lactation support community to establish a lactation support resource list as well as to determine where there were gaps in support. As a result, of the survey, it was determined that Delaware lacks diversity within peer and professional breastfeeding support.  The BCD created scholarships to a more racially and ethnically diverse candidate pool to help us broaden our reach within peer and professional support.   Scholarships were awarded to two individuals of color in 2020 to attend coursework towards becoming an Internationally Board-Certified Lactation Consultant.

DPH, the BCD, and the DHMIC formed a breastfeeding work group to identify opportunities to leverage each other’s resources and expertise to promote breastfeeding. Posters, tip sheets, and educational materials that were developed by the BCD were uploaded to the resource page of the Delaware Thrives website, dethrives.com. This website serves as the electronic hub for DHMIC’s education and social media efforts and can significantly increase the dissemination and availability of these materials.  In addition, key messages for women in the prenatal, immediate post-partum, and post-discharge stages were developed and have been added to the website to drive web traffic to the resources. 

The ninth annual Black Breastfeeding Week will take place Wednesday, August 25 through Tuesday, August 31. This year’s theme is, “The Big Pause: Collective Rest for Collective Power.” which focuses on helping Black women give their minds and body the rest they need after 16 months of a pandemic, and to use the “pause” to reenergize, reprioritize, and regain the control and power they must promote healthier lives for their children — starting with breastfeeding.

Statewide virtual events are planned for Black Breastfeeding Week on behalf of DHMIC with partners from WIC and the Breastfeeding Coalition.  Virtual events include the following four events:

• Wednesday, August 25 at 6:00 p.m. The Connect: The Connect: Black Maternal Health Virtual Pop-Up
  Wednesday, August 25, 6 to 8 p.m.
  Join us for featured guests, virtual happy hours and workshops dealing with topics like advocating as a Black man, Breastfeeding programs as safe havens and successful legislative initiatives.
• Friday, August 27 at 6:00 p.m. Chocolate Milk: The Big Latch for Black Families - Black Mothers in Power hosts a movie showing of “Chocolate Milk: The Big Latch for Black Families” at Penn Cinema Riverfront 14 + IMAX in Wilmington, Delaware. Following the movie, a panel of lactation specialists and doulas will provide education and information to all registrants.
• Sunday, August 29 at 11:30 a.m. Nemours Cares Community Baby Shower - Nemours Cares Community Baby Shower will be providing expectant mothers the opportunity to receive education and support on August 29. These expectant mothers are provided resources from multiple community experts as well as essential items to assist with becoming a new mom. To continue support beyond the baby shower, some mothers will also be provided a postpartum doula for additional support with topics such as breastfeeding, postpartum depression, etc. Please RSVP by August 18 to 302-218-8941.
• Monday, August 30 at 6:30 p.m. Lift Every Voice - A listening session, Revive. Restore. Reclaim! where participants will be able to share their experiences, thoughts, and ideas.
• Tuesday, August 31 at XX p.m. It Takes a Village Part II - Learn from state leaders how you can help support breastfeeding, why black breastfeeding week is important, and how breastfeeding relates to black maternal health.

Title V funding was used to support staff within DPH’s home visiting program to earn and maintain the IBCLC (International Board-Certified Lactation Consultant) credential in the past.  However, DPH has decided to no longer offer evidence-based home visiting internally and all home visiting have been contracted out.  We continue to offer this opportunity to nurse home visitors in our MIECHV program as well as nurse home visitors funded by sources such as state general funds.  Home visitors were also provided with supplies to support their breastfeeding clients, such as nipple shields and this will support will continue. 

DE WIC built a cross-functional team that includes WIC program staff, local clinic staff, birthing hospital leadership, and community peer counselors to meet quarterly to review the latest breastfeeding rates and develop big and small strategies to enhance the peer counselor role and breastfeeding supports across the state. In coordination with the team, the WIC program does an annual survey of participants to identify issues and inform participant-driven strategies. Some initiatives that the Delaware program has successfully implemented include a major push to inform moms of their breastfeeding rights, increased breastfeeding awareness by state employees in co-located facilities and integrating the peer counselors into the WIC clinics to support groups and foster one-on-one interactions.  The team has recently begun looking at service patterns and seeing where targeted intervention can improve supports. The WIC team is also exploring the use of telehealth with our WIC Breastfeeding Peer Counselors in providing virtual breastfeeding classes to our WIC moms.