NPM-4a: Percent of infants who are ever breastfed

 

This Performance Measure was achieved. The Performance Objective was 89.0% and the Annual Indicator was 91.4%.

 

NPM-4b: Percent of infants breastfed exclusively through 6 months

 

This Performance Measure was NOT achieved. The Performance Objective was 29.0% and the Annual Indicator was 27.3%.

 

Annual Report FY22:

 

Program Activities:

 

NPM-4.1 and NPM-4.2 are linked to NOMs 9.1 - Infant mortality, 9.3 - Postneonatal mortality, and 9.5 - Sudden Unexpected Infant Death (SUID) mortality. Utah is ranked 8th of 51 for breastfeeding initiation, which corresponds to a significantly higher prevalence (91.4%) compared to 83.2% in the U.S. overall in 2019. Utah is also ranked 21st out of 51 for exclusive breastfeeding through six months of age, which corresponds to 27.3% compared to 24.9% for the U.S. overall.

The policies, procedures, and practices a new birthing parent encounters in the first hours and days after childbirth can help or hinder their future breastfeeding success.  Implementing evidence-based strategies, like those described by the World Health Organization’s Ten Steps to Successful Breastfeeding, can significantly improve parents’ confidence to reach their breastfeeding goals. Parent exposure to these ten steps significantly increases the likelihood that their infant will ever be breastfed and be exclusively breastfed until six months of life.

The Stepping Up for Utah Babies (SUUB) program works with birthing facilities across the state to implement the Ten Steps to Successful Breastfeeding through quality improvement methods. When a birthing facility meets the certification requirement of all ten steps, they are designated and recognized as a Breastfeeding Friendly Facility. Once this designation is met, the facility is recognized on the SUUB website and is given a certificate of achievement to display in the facility.

From the program’s inception in 2015 to the end of FY22, 24 (53%) Utah birthing facilities have been trained on the program and have successfully implemented a total of 210 steps. During FY22 specifically, two birthing facilities completed all 10 steps, and three met the requirements to be re-designated as a “Breastfeeding Friendly Facility.” To date, 20 hospital facilities have implemented all 10 steps. Re-designation occurs two years after the birthing facility successfully implemented all 10 steps and requires six months of current data submission that meets specified thresholds.

The Utah Women, Infants, and Children (WIC) program developed a statewide goal for FY22 to increase or maintain the number of International Board Certified Lactation Consultants (IBCLCs) working for local WIC agencies and to increase access and utilization of WIC peer-counselors. These goals support and promote breastfeeding to ensure that every eligible pregnant and breastfeeding WIC participant receives at least one contact from a Utah WIC breastfeeding peer-counselor.

WIC refers eligible pregnant and breastfeeding participants to the WIC breastfeeding peer-counseling program using multiple methods. These methods include using the Nutrition Interview, Referrals, and Participant Care Plan screens in the Utah WIC Program computer system entitled VISION. The VISION system generates a report that easily allows WIC peer-counselors to access a list of pregnant and breastfeeding participants that are eligible to receive services. WIC assigns pregnant and breastfeeding participants to a specific peer-counselor that provides personalized breastfeeding support services. Utah WIC also uses referrals from partner organizations, such as MotherToBaby Utah, local hospitals, health care provider offices, and community breastfeeding organizations.

In FY22, the Utah WIC program encouraged breastfeeding peer-counselors to contact prenatal and postpartum WIC participants in many ways. The best way that WIC improved this outcome is through a policy requiring peer-counselors to document their contacts in the computer system. Another way that WIC encouraged peer-counselor contacts to participants throughout the state is through referrals by community and partner organizations. These included referring prenatal and postpartum WIC participants to the WIC breastfeeding peer-counseling program through local hospitals and health care provider offices, community breastfeeding support groups such as La Leche League, and professional organizations such as MotherToBaby Utah, among others.

Additional goals included providing training and educational opportunities to WIC breastfeeding peer-counselors to increase their knowledge and skills. Each local agency offered at least one training on breastfeeding. USDA has also provided a new WIC Breastfeeding Support curriculum that requires an introductory level of completion for all WIC staff. WIC breastfeeding peer-counselors were required to complete two levels of the four level training series. Many local agencies had their peer-counselors begin working on the curriculum in FY22 and the targeted completion date was April 30, 2023.

The Healthy Environments Active Living (HEAL) program oversees a home-grown program called Teaching Obesity Prevention (TOP Star) in Early Child Care and Education Settings (ECEs).The HEAL program began to work with Head Start to implement TOP Star in facilities in 2020. Head Start provides services to support early development and positive health outcomes for children from lower income families. Existing Head Start curriculum has limited content on breastfeeding, so during FY22, the HEAL program created a training curriculum on breastfeeding for ECEs, specifically for Head Start providers. This training was developed to help Head Start providers be better equipped to help families achieve higher breastfeeding rates. Training modules are online and provide continuing education credits for staff. Trained breastfeeding consultants provide assistance to Head Start staff. Many early child care resources are included, such as breastfeeding lesson plans, handouts, and materials. In the past, much of the focus has historically been on facilities in the four main urban counties of Utah, but HEAL has recently reached out to providers in the rural areas of the state.

 

Accomplishments / Successes:

The SUUB program has seen consistent success since the program’s implementation in birthing facilities across the state. Twenty-four out of 45 (53%) birthing facilities are participating, with 20 facilities meeting all 10 steps. During September 2021, SUUB staff were able to provide initial program training for Fillmore Community Hospital and Delta Community Hospital, both of which are small, rural facilities.

In the spring of 2022, a shortage of infant formula occurred that affected families across the country. SUUB staff created educational materials, including fact sheets and answers to frequently asked questions, for parents, caregivers, and clinicians to help them navigate the shortage. These included information on safe alternatives to feed infants, tips on how to find formula, and infant feeding resources. During April 2022, Stepping Up staff partnered with the HEAL program and released a podcast episode available to the public that focused on breastfeeding education and information about the formula shortage.

One significant success in the WIC program was the ability of WIC clinics to begin providing in-person breastfeeding services as COVID-19 restrictions eased. This allowed breastfeeding peer-counselors the ability to contact eligible WIC participants in-person, at the hospital, and at home. This was in addition to contacts made via telephone and texting. Additionally, several local agencies were successful in making at least three breastfeeding peer-counseling contacts per participant, helping move the needle on our current ESM goal of at least three contacts per participant.

Local agencies also focused on improving breastfeeding peer-counseling outreach to WIC participants in order to ensure that all eligible parents were receiving breastfeeding peer-counseling services. Outreach included creating and strengthening community partnerships with local hospitals and health care providers, at community events, Early Intervention, La Leche League, the Mountain West Mother’s Milk Bank, other community breastfeeding support groups, and home visiting programs, among others.

Improving collaboration and partnerships with community programs and organizations helps increase the number of women referred to the WIC breastfeeding peer-counseling program and subsequently the number of women who are contacted by a WIC breastfeeding peer-counselor. Weber-Morgan Health Department had an especially successful outreach program by hosting their first WIC Breastfeeding Fair to celebrate World Breastfeeding Week. However, the most significant successes reported by local agencies are testimonials from WIC participants about how participating in the WIC breastfeeding peer-counseling program helped them to initiate breastfeeding and to meet their breastfeeding duration goals.

In FY22, 74.5% of all eligible pregnant and breastfeeding WIC participants received at least one breastfeeding contact by a WIC breastfeeding peer-counselor, which was a significant increase from FY21, which was 41%. Due to the global pandemic of COVID-19, which was at its height throughout 2020 and 2021, many peer-counselors in the state of Utah were deployed to other efforts throughout their local health departments. During FY22, many peer-counselors were able to receive laptops and began to work remotely, which allowed significant increases for their work and caseload. The state WIC office also required that peer-counselors document their contacts in a consistent manner in the VISION system. The number of employed WIC breastfeeding peer-counselors also increased from 29 to 31 between FY21 and FY22.

Comparing breastfeeding rates for Utah WIC participants to the state of Utah as a whole, finds breastfeeding initiation rates lower among women participating in the WIC program. The State of Utah had a 91.4% initiation rate, compared to 86% among WIC participants. The Utah WIC Program’s prevalence for exclusive breastfeeding at six months increased from 18% to 23% between FY21 and FY22, an increase of 5% in one year, which we consider a success. However, exclusive breastfeeding through six months remains higher for the state overall at 27.3%
 

The HEAL program performed outreach to obtain professionals to volunteer and restart the Utah Breastfeeding Coalition (UBC), which has been inactive since 2018. This included recruiting members, the board of directors, and committee chairs. States are supported and strongly encouraged by the U.S. Breastfeeding Committee, the CDC, and USDA to have a state breastfeeding coalition to work on a statewide collaboration to support, protect and promote breastfeeding. MCH leveraged HEAL's state Registered Dietician, IBCLC representative to support the reinvigoration of the UBC.

 

UBC's collaboration with DHHS is significant because it can leverage other lactation and non-traditional partners that extend beyond DHHS's reach to provide synergy to achieve similar goals, such as sharing statewide breastfeeding resources and unified message campaigns and other significant work that complement DHHS work. Specific to MCH's work, UBC plays a significant role in promoting and supporting the SUUB program, where MIHP does not have the reach, access, or capacity. By leveraging other experienced and expert professionals across the state, DHHS has more leverage and work power to accomplish a broader continuum of support across services and programs that would otherwise not be possible.

A known disparity includes low rates of breastfeeding among lower wage ($20 per hour or less) working women. HEAL successfully applied for funding for the past three years to help worksites with a high percentage of women with low wages establish or enhance their lactation accommodations. This will help in reaching longer duration and exclusivity in breastfeeding rates.

HEAL’s TOP Star in ECEs program has made good progress to expand its reach to 12 of the 13 local health departments in Utah with one-third of this curricula focused on breastfeeding. HEAL has also made great strides in creating a Spanish curriculum with many resources.

During FY22, 41 worksites across the state established or enhanced their lactation accommodations (or at a minimum added a breastfeeding policy). Through local health department contracts and Association of State and Territorial Health Officials grant funding, HEAL has been able to provide training and funding to support these worksites in their endeavors.

 

Summary of successes and accomplishments on “Moving the Needle” in relation to NPM-4a and NPM-4b:

• Utah Women, Infants, and Children breastfeeding peer-counselors were able to utilize multiple modes of communication and partnerships with community partners to increase the number of women who were contacted by a WIC breastfeeding peer-counselor.
• MIHP provided SUUB training to small, rural birthing facilities in the state.
• SUUB and WIC staff provided education and guidance to the state during the nationwide infant formula shortage.
• The HEAL program reached a significant number of worksites throughout the state to help them implement or improve their lactation accommodations for employees.

 

Challenges / Gaps / Disparities Report:

 

During FY22, the COVID-19 pandemic continued to prove a challenge to SUUB program activities. During the pandemic, birthing facilities were forced to react to the rapidly changing health directives and policies enacted by federal, state, local, and birthing facility officials. Projects surrounding the implementation of the SUUB program were temporarily halted for birthing facility staff to focus on protecting their patients from COVID-19. Additionally, all training and in-person meetings were canceled due to social distancing requirements, travel restrictions, safeguarding birthing facility staff, and SUUB staff's overall safety.

During FY22, an urban birthing facility that had been trained in Stepping Up practices and was working towards achieving the ten steps to a Breastfeeding Friendly certification, closed their labor and delivery unit for financial reasons.

Despite the increased number of eligible participants who received at least one WIC breastfeeding peer-counseling contact, there were barriers to meeting the goal of three contacts in FY22. The COVID-19 pandemic interrupted the operations of WIC clinics. This included not seeing participants in-person and being unable to host in-person breastfeeding classes or support groups. Additionally, many peer-counseling staff members were asked to help with local agency COVID-19 tasks, such as contact tracing, which may have affected their availability for contacting prenatal and postpartum WIC participants.

 

Local agencies stated that several peer-counselors left their jobs with WIC during FY22 to find jobs with better pay and benefits. The turnover in employed peer-counselors exacerbated the difficulty of peer-counselors’ abilities to make breastfeeding contact to participants. This was especially difficult in rural areas that contain fewer WIC clinics over a large geographic area. Breastfeeding peer-counselors in these rural areas were not able to see all participants in-person at every clinic or make hospital and home visits. Additionally, some agencies were under a hiring freeze related to strict COVID-19 precautions. Agencies’ breastfeeding peer-counseling budgets were also reduced, making it difficult to fill open breastfeeding peer-counselor positions. Breastfeeding peer-counselor recruitment and retention remains an ongoing concern within the Utah WIC breastfeeding peer-counseling program.

There were also mixed messages during the COVID-19 pandemic about the safety of breastfeeding and COVID-19. Some mothers and babies were separated after birth due to these concerns. Combating these mixed messages was difficult and caused some residual concern about COVID-19 transmission, which may have influenced some WIC participants’ choice not to breastfeed during FY22.

There were also difficulties in obtaining accurate data about WIC breastfeeding peer-counseling contacts. The Utah WIC computer system, VISION, pulls data from participant records to provide information about the number of breastfeeding peer-counseling contacts made for each local agency and clinic. However, when obtaining the data for FY22, some agencies were either missing breastfeeding peer-counseling contact data or breastfeeding peer-counseling contacts were duplicated. This was due to a VISION update that created errors in collecting breastfeeding data, affecting the accuracy of the data collected. To prevent future data inaccuracies, the Utah WIC program is working with the developers of VISION to correct this issue and is creating a new report to pull breastfeeding peer-counseling contact data accurately. The goal is to have the new report updated and in use for FY24.

The HEAL program has also experienced challenges implementing the TOP Star program in worksites. Worksites often have priorities other than lactation accommodations for breastfeeding. Offering funding, even small amounts, can dramatically encourage interest in establishing workplace breastfeeding policies and accommodations.

An additional challenge occurred when the TOP Star curriculum contracted vendor did not meet expectations and was deficient in fulfilling the scope of work. This prevented the program from publishing the planned English and Spanish online modules. Creative in-house efforts were made to complete the work.

Birthing facilities in the state of Utah are diverse in size. There are many large facilities in urban areas, as well as small facilities in rural areas. Staff has observed that small, rural facilities often struggle to implement SUUB practices, due to their limited number of staff and resources. However, Stepping Up staff have begun to see success in rural facilities, and have gained knowledge from birthing facility staff on how to best help other rural facilities become successful in the program.

Data from the state of Utah shows that women who are eligible for WIC, but do not participate have higher rates of breastfeeding initiation and exclusive breastfeeding through six months compared to women who are participating in WIC. This may be related to social perceptions of WIC as “an infant formula program” as opposed to a breastfeeding promotion and support program. Additionally, women who are not participating in WIC, but are eligible for participation, may be utilizing other community programs or organizations instead. Differences in breastfeeding initiation and exclusivity between women who participate in WIC and women who are eligible but do not participate highlight the need for improved education about WIC as a breastfeeding support program. More outreach is needed to other community breastfeeding organizations that can refer women to WIC and its breastfeeding peer-counseling program. These solutions would help to meet the ESM goal of increasing the number of contacts that pregnant and breastfeeding WIC participants receive from a WIC breastfeeding peer-counselor, which could improve breastfeeding rates and decrease breastfeeding disparities throughout the state of Utah.

Utah WIC's ever-breastfed prevalence rate decreased by one percentage point to 86% between FY21 and FY22. This decrease may have been influenced by COVID-19 protocols within local agencies that limited the availability of breastfeeding peer-counselors to contact WIC participants.

An emerging issue for the HEAL program is the lack of resources in Spanish for TOP Star participants. As the program grows, it will be critical to create materials that are accessible to Spanish speaking participants.

 

Based on Federally Available Data, Utah is ranked 8th out of 51 for children who were ever breastfed, which corresponds to a significantly higher prevalence (91.4%) compared to the U.S. overall (83.2%) in 2019. However, breastfeeding initiation is lower for unmarried mothers (79%) compared to mothers who are married (89.9%).

 

Utah is also ranked 21st out of 51 for children who are exclusively breastfed through six months.

 

Agency Capacity/Family Partnerships/Collaboration:

The success of the SUUB program immensely benefits from the program’s many partners. The most important partners are the staff and administration that work to implement the Ten Steps to Successful Breastfeeding in their facilities. Their commitment and dedication to the program positively influence the state’s breastfeeding initiation and continuation rates. Second, partnerships with the WIC and HEAL programs are important to the program’s success. Their teams provide SUUB staff with expert advice and additional tools that are shared with participating birthing facilities to assist in implementing the steps. They are integral in many ways, especially in helping families achieve exclusive breastfeeding through six months of the infant’s life. This work would not be possible without their partnerships.

The program also shares a beneficial partnership with the two most prominent healthcare systems in the state, Intermountain Health and the University of Utah. Intermountain Health strongly encourages all of their hospitals to participate in the SUUB program, tracks their progress, and recognizes their achievements and certifications. The University of Utah is the largest birthing facility in the state and the only Baby-Friendly Facility in the state; however, they are supportive of the SUUB program and have also received a designation of being a Breastfeeding Friendly Facility.

The Utah WIC Program partners with several organizations including the state-wide Utah Department of Health and Human Services (DHHS) organizations, such as Early Intervention; local health agency organizations, such as home visiting programs and Nurse Family Partnership programs; county-wide events, such as county fairs and Baby Animal Days; local organizations, such as La Leche League and the Mountain West Mother’s Milk Bank; local hospitals; and local health care providers, including pediatricians, obstetricians, and International Board Certified Lactation Consultants.

Improving outreach and partnership between the WIC breastfeeding peer-counseling program and other organizations continues to be a high priority. Local agencies have continued to network and collaborate with partners by providing referral cards to the WIC breastfeeding peer-counseling program, attending other organizations’ events, utilizing social media, and working with organizations and coalitions to provide education and training about breastfeeding, among other efforts. Local agencies have also improved relationships with local hospitals, which has created more opportunities for WIC breastfeeding peer-counselors to provide hospital visits to mothers and has improved referrals to the WIC breastfeeding peer-counseling program from hospital staff members.

The HEAL program has long-term collaborations focused on lactation training and support in place with the Utah Breastfeeding Coalition, Mountain West Mother’s Milk Bank, and the University of Utah Baby Friendly Hospital Initiative. The Utah DHHS Early Childhood Utah Advisory Council, Weber State University, and Brigham Young University support the program’s breastfeeding educational components. Worksite partners include the Association of State and Territorial Health Officials (ASTHO) and the Utah Worksite Wellness Council. Established community based partnerships include Centro de la Familia de Utah, Boys & Girls Clubs of Greater Salt Lake, Utah Private Child Care Association, Refugee Health, Utah Adverse Childhood Experiences Program, and the Utah Society for Environmental Education. HEAL also received ASTHO funding for breastfeeding support three years in a row. This funding provided grants to 100+ worksites to ensure they were compliant with the federal lactation accommodation law.

Report of ESMs related to NPM-4a and NPM-4b

 

ESM 4.1: The proportion of live births that occur in facilities that have met all requirements set by the SUUB program to become a “Breastfeeding Friendly Facility.”

 

Goal/Objective:

Increase the percentage of babies born in hospitals participating in the SUUB program.

 

Significance of ESM 4.1:

Hospital policies and practices significantly affect whether a woman feels confident enough to reach her breastfeeding goals. The SUUB program encourages and recognizes hospitals that offer an optimal level of care for lactation based on the World Health Organization (WHO)/United Nations Children’s Fund (UNICEF) Ten Steps to Successful Breastfeeding. To be designated as a “Breastfeeding Friendly Facility,” facilities must meet the requirements set by the Stepping Up program for each of the Ten Steps. By fully implementing all Ten Steps, the participating hospitals can help new mothers successfully start and continue breastfeeding.

 

ESM 4.1 Progress Summary:

The policies, procedures, and practices a new birthing parent encounters in the first hours and days after childbirth can help or hinder their future breastfeeding success.  Implementing evidence-based strategies, like those described by the World Health Organization’s “Ten Steps to Successful Breastfeeding,” can significantly improve people’s confidence in reaching their breastfeeding goals.

 
The SUUB program is a free, Utah-centric program that works with birthing facilities to implement the “Ten Steps to Successful Breastfeeding” through quality improvement methods, such as working to implement two steps at a time. When the birthing facility meets the certification requirement of all ten (10) steps, they are designated and recognized as a “Breastfeeding Friendly Facility.”

 

From the program’s inception in 2015 to the end of FY22, 24 (53%) Utah birthing facilities have been trained on the program and have successfully implemented a total of 210 steps. Specifically, during FY22, two birthing facilities completed all 10 steps, and three met the requirements to be re-designated as a “Breastfeeding Friendly Facility.”

SUUB program staff will continue outreach to birthing facilities about the SUUB program and how they can become a designated and recognized “Breastfeeding Friendly Facility.” Stepping Up staff remains committed to providing technical assistance, recognition, and additional training opportunities to participating birthing facilities. Stepping Up staff is working on short, on-demand training videos that will be available on the SUUB website. Due to staff capacity, these training videos are still being developed.
 

A challenge of this program has been the training of smaller, rural birthing facilities. The staff has tried traditional contact methods, including calling and emailing birthing facility staff, which has been unsuccessful due to contacting the incorrect person or the emails/calls not being returned. Stepping Up staff has collaborated with Rural Health Programs to identify the correct contact in the rural hospitals. Outreach is ongoing, and we are hopeful that it will lead to more rural birthing facilities participating in the SUUB program.

The success of the SUUB program would not be possible without our many partners including WIC and the HEAL programs. Their teams provide Stepping Up staff with expert advice and additional tools to assist in implementing the steps. We also share an ongoing and beneficial partnership with the two most prominent healthcare systems in the state, Intermountain and the University of Utah. They are both supportive of the SUUB program.

 

ESM 4.3: The number of worksites that have federal lactation accommodations and breastfeeding strategies.

 

Goal/Objective:

Increase the number of worksites that have federal lactation accommodations and breastfeeding strategies.

 

Significance of ESM 4.3:

The U.S. Surgeon General calls for employers to have high-quality employee lactation support programs and policies that work towards reducing breastfeeding barriers for working mothers. Returning to work is a major reason for women to discontinue breastfeeding. Women who are employed in worksites with adequate lactation accommodations have a good chance of increasing their duration of breastfeeding.

 

ESM 4.3 Progress Summary:

A number of local health departments reported progress reaching out to businesses. However, follow-up work was delayed as health department staff were called to work on the COVID-19 response. The work was further delayed when worksites needed to direct their resources towards COVID-19 prevention.

Two podcasts were produced by HEAL during this time, one on the CDC Breastfeeding Report Card and the other on National Breastfeeding Month. Both were published in August 2020.

Future Plans: In October 2021, the HEAL Program received a second opportunity to apply for funding from the Association of State and Territorial Health Officials (ASTHO) to help worksites improve their lactation accommodations; therefore, the performance objective for 2022 is higher than for other years. The project period ran from December 1, 2021 – July 31, 2022, and laid the groundwork for future plans for ESM towards Year 5. HEAL will continue to work with local health departments as they reach out to worksites to help them implement/improve lactation accommodations and breastfeeding policies.
 

Barriers and Challenges: Not surprisingly, worksites closed or went out of business during this project period due to COVID-19 restrictions. Worksites that remained open did not have the resources or interest in improving lactation accommodations. Their priority was on limiting employees’ exposure to COVID-19 and adjusting for employees who were unable to come to work because of illness or because of isolation or quarantine requirements. This situation created a loss of momentum for worksite lactation accommodations.

Partnerships: This work on lactation accommodations has strengthened partnerships with local health departments but relationships can be improved. HEAL is exploring ways to streamline communication and data sharing with the health departments.

 

ESM 4.5: The percentage of eligible pregnant and postpartum WIC participants who received at least three contacts from a WIC Breastfeeding Peer-Counselor.

 

Goal/Objective:

Increase the percentage of eligible pregnant and postpartum WIC participants who received at least three contacts from a WIC Breastfeeding Peer-counselor.

 

Significance of ESM 4.5:

Breastfeeding is the normative standard for infant feeding and nutrition and can result in improved infant and maternal health outcomes. Mothers who receive help and support when they need it are more likely to reach their breastfeeding goals and meet their infant’s complete nutritional needs. A mother’s ability to begin and continue breastfeeding can be influenced by a host of community factors, and programs like WICs breastfeeding peer-counselors can provide important coaching to enable and sustain breastfeeding efforts in WIC clients. Peer-counseling interventions greatly improve breastfeeding initiation, duration, and exclusivity.

 

ESM 4.5 Progress Summary:

In FY22, the Utah WIC program encouraged breastfeeding peer-counselors to contact prenatal and postpartum WIC participants in many ways. The best way that we have improved this outcome is the required policy for peer-counselors to document their contacts in the computer system entitled VISION. Another way that we have encouraged peer-counselor contacts throughout the state is through referrals by community and partner organizations such as La Leche League and MotherToBaby Utah.

To measure the proposed ESM of all eligible WIC participants receiving at least three breastfeeding peer-counseling contacts throughout the perinatal period, the number of WIC breastfeeding peer-counseling contacts per participant will be documented in VISION and measured. A new data collection report is being created to best gather this data. To achieve the ESM goal, the Utah WIC program will continue encouraging referrals to the WIC breastfeeding peer-counseling program by WIC staff members and will encourage collaboration and partnership with community organizations that can refer to WIC breastfeeding peer-counselors. Additional plans include increasing efforts to recruit and retain WIC breastfeeding peer-counselors, increasing the availability of breastfeeding peer-counselors through providing home and hospital visits when possible, and implementing a new curriculum to improve breastfeeding training to WIC staff members, including breastfeeding peer-counselors.

Improving outreach and partnership between the WIC breastfeeding peer-counseling program and other organizations continues to be a high priority. Local agencies have continued to network and collaborate with partners including providing referral cards to the WIC breastfeeding peer-counseling program, attending other organizations’ events, utilizing social media, and working with organizations and coalitions to provide education and training about breastfeeding among other efforts. Local agencies have also improved relationships with local hospitals, which has created more opportunities for WIC breastfeeding peer-counselors to provide hospital visits to mothers and has improved referrals to the WIC breastfeeding peer-counseling program from hospital staff members.

 

Other activities in the Perinatal/Infant Health domain that contribute to improvement in the National Outcome Measures:

Utah works to adhere to the three-tier framework outlined in the MCH Block Grant guidance. While the focus of most activities is the ESM →NPM→ NOM framework, activities on improving NOMs outside of the NPMs transpire in parallel. The following programmatic activities also work to improve outcomes in this domain.

National Outcome Measures (NOM):

NOM 4: Percent of low birthweight deliveries (<2,500) grams)

NOM 5 - Percent of preterm births (<37 weeks gestation). (Reduce the percent of all preterm deliveries)
NOM 6 - Percent of early term births (37, 38 weeks gestation). (Reduce the percent of early term deliveries)

In FY22 MotherToBaby Utah provided education to women and their providers about medications used during current pregnancies or while planning a pregnancy to treat conditions that could result in preterm birth or low birth weight deliveries such as mental health conditions, cardiovascular conditions, respiratory conditions, and the use of tobacco and other drugs. MotherToBaby Utah provided education to women, their providers, their partners, and other clients regarding the benefits and risks of medications compared to untreated conditions during pregnancy in an effort to help women remain healthy and avoid complications that could result in babies with preterm birth or  lower birth weight.

 

UBDN works to provide education to Utah residents on birth defect prevention and how to strive for a healthy pregnancy, efforts of which include preventing preterm birth and/or low birth weight. UBDN’s health educator participates in health fair events statewide to reach Utah residents who could become pregnant.

 

NOM 8: Perinatal mortality rate per 1,000 live births plus fetal deaths.

 

MotherToBaby Utah provided education to women and their providers about medications used during the perinatal period. Education was provided about the risks of the untreated conditions, such as hypertension, diabetes, tobacco and other substance use, and maternal infections, and the potentially teratogenic medications used to treat those conditions, such as angiotensin converting enzyme (ACE) inhibitors, non-steroidal anti-inflammatory drugs (NSAIDS including aspirin and ibuprofen), and valproate, that could result perinatal complications and/or death.

 

MotherToBaby Utah provided education to women, their providers, their partners, and other clients regarding the benefits and risks of medications compared to untreated conditions during the perinatal period in an effort to help women remain healthy and avoid complications that could result in perinatal deaths.

 

The Study of the Associated Risks of Stillbirth (SOARS) is an ongoing, state-specific, population-based survey designed to collect information on maternal experiences and behaviors prior to, during, and immediately following pregnancy among mothers who have recently experienced a stillbirth. SOARS was initiated in 2018 in an effort to find out why stillbirths occur and how to prevent future fetal deaths. Using methodology similar to the Pregnancy Risk Assessment Monitoring System (PRAMS), Utah women who recently experienced a fetal death are mailed a survey. Utah continued SOARS data collection in FY22.

 

UBDN works to provide education to Utah residents on birth defect prevention and how to strive for a healthy pregnancy in efforts to prevent infant death. UBDN’s health educator participates in health fair events statewide to reach Utah residents who could become pregnant.

 

NOM 9: Infant Mortality Rate per 1,000 live births.
 

Utah's Perinatal Mortality Review Program reviews deaths to infants due to perinatal conditions. Infant death cases are reviewed by a multidisciplinary committee, which assesses preventability and makes recommendations for prevention.

 

NOM 10: Percent of infants born with fetal alcohol exposure in the last 3 months of pregnancy.

 

MotherToBaby Utah provided education to women and their providers about the risks of alcohol use during pregnancy. They provided information through in-person, telephone, email, chat and text contacts. They provided information through printed brochures, newsletters, social media posts, and television news segments.

 

MotherToBaby Utah and the Division of Substance Abuse and Mental Health received funding to create a campaign to reduce alcohol use in pregnancy and reduce Fetal Alcohol Syndrome/disorder. During FY22, a steering committee composed of staff from UBDN, MotherToBaby Utah, Utah substance use prevention networks, and MCH began meeting bi-weekly to develop a scope of work for a statewide educational media campaign that focuses on the risks associated with drinking alcohol while pregnant. Work continues to contract with a media company that will work with the steering committee to implement the campaign as detailed in the scope of work.

 

NOM 11: The rate of infants born with neonatal abstinence syndrome per 1,000 hospital births.

MotherToBaby Utah provided education to women and their providers about medications used during current pregnancies or while planning a pregnancy to treat mental health conditions and pain. MotherToBaby Utah provided education to women, their providers, their partners, and other clients regarding the benefits and risks, including neonatal abstinence syndrome, of medications for mental health, substance abuse conditions, and pain compared to the risks of untreated conditions during pregnancy to promote healthy outcomes.

 

NOM 12: Percent of eligible newborns screened for heritable disorders with on time physician notification for out of range screens who are followed up in a timely manner.

The Child Health Advanced Records Management (CHARM) Program’s Web Portal provides child specific data in real time from a variety of programs, and presents a consolidated record of newborn hearing, heel-stick (out-of-range screens are included) and critical congenital heart defect (CCHD) screening results. Authorized private and public health care providers continued to use the CHARM Web Portal (CWP) to look up and view a child's health information/screening results, to coordinate care, treatment, and follow-up in a timely manner. Providers also had access to the Medical Home Portal through a link in the CWP to find diagnostic and treatment information for newborn disorders. The Medical Home Portal is a resource for professionals and families who care for children and youth with special health care needs and want to achieve the best possible outcomes for their health, well-being, and success. The CHARM Program also continued to collaborate with the Early Hearing Detection and Intervention (EHDI) and Vital Records (VR) Programs.

 

Through the CHARM system’s data integration with EHDI and VR, when parents apply for a birth certificate for their child at the state or local health department, a hearing screening alert is generated by the CHARM system, if the child did not pass a hearing-screening test, was not screened, or needs to complete the process. When the birth certificate clerk sees the alert in the VR OLIVER system, he/she prints out a letter informing the parents or guardians that their child needs a hearing screening follow-up, and instructs them to contact the EHDI Program. The CHARM Program also prepares a report of these children for the EHDI Program, so staff can follow-up with the parent/guardian about obtaining a hearing test. From July 1, 2021 – June 30, 2022, there were 1,011 hearing alerts generated for children by CHARM and received in the OLIVER system; 641(63.4%) of those children went on to complete a hearing screening test after receiving the alert. This linkage has improved follow-up efforts and care coordination for children that are deaf or hard of hearing. In addition, the CHARM system provided hearing screening alerts through its linkages with other health program databases and through the CWP. Physicians, audiologists and public health providers who use these databases, or the CWP, are notified in real time when a child needs a hearing screening test and follow-up efforts can occur in a timelier manner.