Update on PM annual objectives:
NPM 4A: Percent of infants who are ever breastfed. The NPM 4A annual objective for reporting year 2021 is 90.5%.
NPM 4B: Percent of infants breastfed exclusively through 6 months. The NPM 4B annual objective for reporting year 2021 is 28.0%.
ESM 4.1: Percent of births insured by Medicaid in Baby-Friendly hospitals. The ESM 4.1 annual objective for reporting year 2021 is 38.7%.
For the upcoming reporting period, MCH Block Grant dollars will continue to support breastfeeding efforts implemented by the early childhood obesity prevention team at CDPHE. The funding will cover staff time (0.25 FTE) to execute a large portion of the state’s breastfeeding strategies, including the provision of funding for activities to support the Colorado Baby-Friendly Hospital Collaborative. MCH will continue to leverage funding from the CDC 1807 State Physical Activity and Nutrition grant to pay for staff time (0.25 FTE) and technical assistance, hospital incentives and recognition awards. Additional breastfeeding FTE (and associated strategy work) will be funded through the WIC program (0.45 FTE) and the state-funded Cancer, Cardiovascular and Pulmonary Disease grant program (0.05 FTE). The funded strategies and associated outcomes are summarized below.
The 2021-2025 MCH priority to promote positive child and youth development includes a focus on building nutrition security through increased access to breastfeeding supportive environments in communities facing the greatest racial/ethnic disparities. Within this priority, work will focus on development of breastfeeding supportive policies and environments in hospitals, medical offices, workplaces, child care programs, youth programs, and community resource centers. Hospitals and medical offices serving a high proportion of Medicaid patients, workplaces with hourly and lower-income workers, community resource centers serving minority populations, and publicly funded county jail systems will be specifically targeted to remove known barriers to breastfeeding and improve health equity practices and breastfeeding support.
CDPHE emphasizes implementation of evidence-based breastfeeding supportive maternity care practices in Colorado, as data shows hospital practices impact not only initiation but also breastfeeding exclusivity and duration rates beyond the hospital setting. For instance, Colorado Pregnancy Risk Assessment Monitoring System (PRAMS) survey results show the importance of hospital support on breastfeeding duration. Survey data indicates that mothers who report receiving at least five of the Ten Steps to Successful Breastfeeding (the foundation of Baby-Friendly) during their hospital stay have two months longer breastfeeding duration compared to mothers who do not report receiving at least five of the Ten Steps.
Implementing the Baby-Friendly Hospital Initiative’s Ten Steps improves breastfeeding prevalence and increases breastfeeding support throughout local communities with a health equity, population health impact. Based on the previous successes of the Colorado Baby-Friendly Hospital Collaborative, the MCH program will track and report on an evidence-informed strategy measure (ESM) that captures the percent of births insured by Medicaid in Baby-Friendly hospitals. The Collaborative has seen success assisting hospitals to achieve Baby-Friendly designation since its creation in 2013, when only three hospitals in Colorado were designated, increasing to 14 designated hospitals in 2020. Shifting the ESM from tracking the number of Baby-Friendly hospitals to the percent of births insured by Medicaid in Baby-Friendly hospitals will help the program track impact on equitable access to a birth experience that includes best-practice breastfeeding support across different populations by socioeconomic status.
The impacts of COVID-19 are still unknown regarding hospital capacity and interest in advancing breastfeeding supportive maternity care practices, especially Baby-Friendly designation. The information gleaned through the Colorado Hospital Breastfeeding Summit, held in September 2020, will be used to determine new directions for the Collaborative in coming years. In coordination with advice, input and technical assistance from the Advisory Committee and the Baby-Friendly Expert Contractor, the early childhood obesity prevention team at CDPHE will continue to provide technical assistance to staff at the member hospitals through webinars, one-on-one communication, and a full-day annual networking workshop. The team will continue to collect and track hospital data to monitor quality improvements in Baby-Friendly designated hospitals and the overall impact on breastfeeding rates. Hospitals with maternity services that are not currently members will be actively recruited to join, receive technical assistance to implement the Ten Steps, and recognized statewide for policy implementation of at least six of the Ten Steps. Additionally, teams plan to explore development of state-level policies that incentivize and promote breastfeeding supportive practices in hospitals, including working with hospital systems on the adoption of Baby-Friendly policies, with an additional focus on hospitals that serve larger numbers of pregnant people enrolled in Medicaid.
Workplaces, child care professionals and healthcare providers play critical roles in supporting breastfeeding families in Colorado. Research shows if a mother feels supported by her employer, child care and healthcare providers, she is more likely to both initiate breastfeeding and continue exclusively breastfeeding longer, thus receiving more health benefits for mother and child. The early childhood obesity prevention team at CDPHE will continue to work with local public health agencies, the Colorado WIC Program, the Colorado Breastfeeding Coalition, local breastfeeding coalitions and newly engaged partners around the state to increase breastfeeding friendly policies and environments at community locations to support breastfeeding families. Previously created breastfeeding-friendly trainings, toolkits and resources will be used to support local communities’ efforts and provide recognition and incentives, as available, to worksites, child care programs, medical offices and public spaces upon adoption of breastfeeding supportive policies and environments.
Breastfeeding initiatives will emphasize increasing support for communities of color and those with the highest health and breastfeeding disparities, especially the Spanish speaking and African American communities in Colorado. To reach communities with the highest disparities and increase breastfeeding rates in communities of color, lactation support should be provided by individuals within that community. A main objective is to increase the number of individuals of color to receive advanced lactation training and develop community-based peer counselor programs and support services. Spanish speaking lactation trainings and resources, especially for child care providers, will continue to be developed and disseminated statewide.
Pregnant and breastfeeding youth and incarcerated individuals have high health disparities and frequently lack lactation support. Technical assistance guidance and resources will be created and disseminated to support youth programs, including those associated with local school districts. Model policies created previously with the Denver Sheriff Department for inmate lactation support, which include providing access to a breast pump, private space, lactation consultation and milk storage and transport to the baby, will be shared with publicly funded juvenile detention systems and local jail jurisdictions throughout the state to improve breastfeeding support for some of the most vulnerable and overlooked members of the population.
Work within the breastfeeding national performance measures impacts other priorities, as it lays a foundation for healthy, supportive child and family development while working to reduce racial disparities, improve nutrition security and positively impact social emotional wellbeing. Research shows community level breastfeeding initiatives to develop supportive policies and environments increase breastfeeding support and access to care, while also influencing social connections and mental health. Strategies can be combined with other policy and environment work within a community to increase acceptance and adoption of supportive practices.
See the cross-cutting population domain for information on the new priority associated with this NPM - promote positive child and youth development.
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