Safe infant sleep and breastfeeding are significant protective factors against infant mortality. From 2010-2019 (the most recently available data), breastfeeding initiation, for all races, increased from 80.1 percent to 89.8 percent. During this period, the gap between the breastfeeding percentages for non-Hispanic black and white infants decreased. However, the breastfeeding initiation percentages for non- Hispanic black infants are still the lowest of the racial/ethnic groups examined. In 2019, the percentage was 78.1 percent for non-Hispanic black, 86.4 percent for non-Hispanic white, and 90.3 percent for Hispanic infants. According to the CDC, the 2017 percentage of exclusive breastfeeding at three months in Florida (41.1 percent) is lower than in the nation (46.9 percent).

In Florida, sudden infant death syndrome (SIDS) consistently ranks in the top four leading causes of post-neonatal infant death. In 2019, the resident SIDS death rate was approximately 0.3 per 1,000 live births in Florida. However, black infants experience rates that are consistently two times higher than the rates among other ethnic groups. (0.7)

The FDOH engaged in several activities through a variety of public-private partnerships to improve rates of breastfeeding initiation and duration. With Title V funding, the Florida Healthy Start Coalitions and the county health departments partner to provide needed services including prenatal care, support services, and breastfeeding education and support to all participating pregnant women. Services provided to pregnant women encourage breastfeeding in the early postpartum period. These services also provide anticipatory guidance and support to prevent breastfeeding problems and address barriers to breastfeeding. Breastfeeding education and services provided to postpartum women promote the continuation and exclusivity of breastfeeding and enable women to overcome any perceived or actual breastfeeding problems.

Florida’s WIC Program provides peer counseling and breastfeeding support to women who qualify for WIC. The FDOH plans to explore alternative breastfeeding support options for women who need breastfeeding support and do not qualify for WIC.

Safe Sleep Initiatives

Florida continued the Florida Safe Sleep Hospital Certification Project, a partnership with county health departments to recruit birthing hospitals to complete the requirements needed to achieve Safe Sleep Certification from the Cribs for Kids Organization. There are currently 23 hospitals certified through the Safe Sleep Certification program.  These hospitals have completed steps including implementing a Safe Sleep policy. Annual reports are submitted to Cribs for Kids on educational activities and staff compliance. The top eight counties in Florida with elevated sleep related death rates have been identified.  The FDOH reached out to them directly to engage them in enhanced safe sleep activities.  

To help reduce SUID-related deaths, the American Academy of Pediatrics (AAP) published updated safe sleep recommendations in 2016 promoting supine positioning, the use of a firm sleep surface, room-sharing, no bed sharing, and breastfeeding among others. Health care providers and community partners, such as Healthy Start staff, continue to promote and educate infant caregivers on these recommendations during direct interactions.

In January, 2020, a promising safe sleep initiative, Sleep Baby Safely, was implemented by the Child Abuse Death Review Committee in Duval County. This initiative was supported with funding from the Title V Maternal and Child Health Block Grant. Sleep Baby Safely includes training at all birthing hospitals and facilities, providing labor and delivery nurses and hospital birthing staff a framework for providing face-to-face safe sleep education to the new parents of each baby born. The initiative also ensures that along with face-to-face education, each new parent is also provided a Welcome Baby Bag including a onesie, infant sleep sack, nightlight, diaper tote, and outlet covers, all imprinted with the ABCs of safe sleep messaging (Alone, Back, Crib), as well as a Safe Sleep baby book and other sleep-related educational materials. Prior to the implementation of this initiative, Duval County reported an average of 2-3 infant deaths associated with unsafe sleep practices each month. During the first 8 months of implementing this initiative, there has been one incident of sleep-related infant death in Duval County. While the loss of one child to unsafe sleep is too many, the significant decrease in infant death across the county demonstrates the exceptional efficacy of this initiative.

The FDOH continues to participate in the National Institute for Children’s Health Quality’s (NICHQ) five-year project from July 2017 to July 2022, “National Action Partnership to Promote Safe Sleep Improvement and Innovation Network (NAPPSS-INN): Making Safe Infant Sleep  and Breastfeeding a National Norm. ”Within this role,  Florida’s data was analyzed to identify birthing hospitals that could have the greatest impact on improving breastfeeding and safe sleep behaviors and  these birthing hospitals were invited to participate. After interested hospitals completed competitive applications, one birthing hospital participated in the first phase of the project and another hospital in the second phase. Florida’s Community of Practice was created to include a group of leaders from public and private sectors in the state. The group included members from the Executive Office of the Governor, March of Dimes, the Florida Perinatal Quality Collaborative, the Florida SIDS Alliance, and the American College of Obstetrics & Gynecology. Under this leadership,  an asset map and SMART objectives were completed for the group to follow in their respective work.

As a component of Florida’s Healthy Babies Initiative, all 67 county health departments are given Title V funding specifically to address factors that contribute to infant mortality in their communities.  This includes safe sleep. County health departments submitted action plans that were reviewed by subject matter experts in the program offices through a lens of identifying proposed strategies and best practices that could be applied and have statewide impact. The most commonly proposed strategies and themes identified in the counties’ local plans were breastfeeding, smoking reduction among pregnant women, safe sleep, and increased WIC access and utilization.  Multiple safe sleep programs in Florida communities provided safe sleep information, cribs, pack and plays, and infant onesies with safe sleep messages this past year, 

The FDOH conducted a health problem analysis of contributing factors to SIDS and developed a logic model at the state level to address these risk factors with outcome measures to assess strategy effectiveness. These two documents have been instrumental in the development of a state work plan to address SIDS.

Breastfeeding Initiatives

Florida’s Enhanced Breastfeeding Project is addressing health inequities to mitigate breastfeeding disparities among vulnerable populations including rural, minority, and low socioeconomic communities. There are several county health departments implementing two to three evidenced-based strategies within their local communities as part of the project. Qualitative review of hospital success stories and anecdotal evidence have shown that the BSBF project has also served as a catalyst for community engagement. New breastfeeding support groups in rural areas and local breastfeeding coalitions have been established as a result of the project.

Duration of breastfeeding is an identified concern, with known contributing factors including lack of breastfeeding support in the workplace. Having access to proper equipment, such as an electric breast pump for mothers returning to work, is essential to breastfeeding success. A statewide commitment to give babies the best start is evidenced by efforts from Florida’s Agency for Health Care Administration. As of June 20, 2016, Florida Medicaid’s Durable Medical Equipment Fee Schedule covers breast pumps, demonstrating a commitment to promote the best nutrition and the best start for Florida’s babies.

MCH epidemiology staff housed in the MCH Section perform analysis of FDOH programs impacting the MCH population. One study showed the receipt of breastfeeding peer counseling services are associated with increased breastfeeding initiation and duration. Additionally, the study showed that non-Hispanic black participants are less likely to initiate breastfeeding and continue to breastfeed at 6 months. To address this issue, the MCH program has updated Florida’s Healthy Start Standards and Guidelines and provider competencies to include the importance of personal, social, and cultural factors when providing breastfeeding education to clients.

Data from the 2019 Florida Pregnancy Risk Assessment Monitoring System (PRAMS) show that the percent of Florida women who initiate breastfeeding is higher, at 89.8 percent, than the Healthy People 2020 goal of 81.9 percent. However, duration drops quickly to 64.2 percent at 4+ weeks and to 54.8 percent at 12+ weeks. This survey is a valuable tool for recognizing trends and identifying a focus for breastfeeding promotion efforts. Survey data can be found at: http://www.floridahealth.gov/statistics-and-data/survey-data/pregnancy-risk-assessment-monitoring-system/