PRAMS Data To Action Success Stories
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Oregon: Using PRAMS Data for Legislation to Support Breastfeeding in the Workplace
Problem Overview
Many women discontinue breastfeeding when they return to work because of barriers in the workplace including inflexibility in work hours, lack of privacy for breastfeeding or expressing milk, and lack of storage for expressed breastmilk.1 Oregon PRAMS data from 1999 showed that while more than 90% of Oregon women initiated breastfeeding, many stopped by the time their infant was 3–4 months old. The American Academy of Pediatricians, American College of Obstetricians and Gynecologists, American Academy of Family Physicians and many other health organizations recommend that babies be exclusively breastfed for the first 6 months of life. Among the women who stopped breastfeeding, 37% said they did so because they were planning on going to work or school and they anticipated difficulty in continuing to breastfeed.
Program Activity Description
Interested in developing ways to increase breastfeeding in Oregon, an Oregon Public Health Division staff study group identified barriers using Oregon PRAMS data and worked with building managers to identify and refurbish space that allowed state employees to breastfeed at work. In 2007, the study group took their findings to the state legislature and helped create Oregon House Bill 2372, known as “Rest Periods for Expression of Breast Milk,” which requires large employers to provide time and space for breastfeeding. Subsequently, through the sponsorship by Oregon’s U.S. Senator, Ron Wyden, features of the Oregon law were incorporated into the Patient Protection and Affordable Care Act, 2010.
Program Activity Outcomes
The Oregon Bureau of Labor and Industries created guidelines that have been implemented statewide. The regulations require employers of 25 or more employees to allow women at least a 30-minute break period every 4 hours and a private area, other than a public restroom, to express milk. PRAMS data shows an increase in the proportion of women who exclusively breastfed for at least 9 weeks from 9.3% in 2007 to 12.2% in 2008.
1 U.S. Department of Health and Human Services. The Surgeon General’s Call to Action to Support Breastfeeding. Washington, DC: U.S. Department of Health and Human Services, Office of the Surgeon General; 2011.
Vermont: Using PRAMS Data for Legislation to Support Breastfeeding in the Workplace
Problem Overview
Vermont women enrolled in the Special Supplemental Nutrition Program for Women, Infant and Children (WIC) have lower rates of breastfeeding initiation and duration than women not enrolled in the program, despite nearly 70% of Vermont WIC enrollees stating during their prenatal WIC visits that they intended to breastfeed their infant. 2004–2006 Vermont PRAMS data indicate WIC participants’ breastfeeding initiation rates are 15% lower than their non-WIC counterparts. In addition, the WIC participants’ rates for continuing to breastfeed at 4 and 8 weeks postpartum are more than 20% lower than their non-WIC counterparts.
Program Activity Description
In 2008, USDA Food and Nutrition Service announced a Special Project grant to allow states to develop innovative programs that support the National WIC food package policy and provide replicable, transferable breastfeeding interventions. Vermont PRAMS surveillance data provided evidence for the client- and provider-based intervention designed to target breastfeeding rates among women enrolled in WIC and in 2009 the Vermont WIC program successfully obtained grant funding.
The Vermont grant researched the following question: if mothers who intend to breastfeed are screened for predictors of success, offered education and support, and connected with breastfeeding resources, will a higher percentage of women exclusively breastfeed at 4 weeks postpartum? The goals for the program include a 10% increase in exclusive breastfeeding at 4 weeks postpartum and to assess the Vermont WIC program’s reputation in the community as a credible, effective and sincere partner in breastfeeding promotion and support. The project is taking place in 3 of Vermont’s 12 Local Health Clinic sites, which serve 33% of the state’s yearly resident births.
Client-based “You Can Do It” materials, some of which were developed using PRAMS respondent’s comment data, are being distributed at three prenatal client visits and all enrolled mothers are given access to the study’s enrollee-only website. Further, WIC’s Peer Counseling Program provides additional support for all study participants during the prenatal and early postpartum periods. Provider “WIC Can Help” materials and training modules are delivered to the provider practice and district office WIC staff visit practitioner’s offices to provide additional support.
Program Activity Outcomes
As of April 2011, the WIC program had recruited 248 of the 298 clients expected to participate in the program. When Vermont’s WIC Special Project is completed in 2013, the results, resources and evidence-based tools produced will be distributed to all WIC Programs for use, further testing and adaptation.
Louisiana: Supporting a Women’s Decision to Breastfeed
Problem Overview
Approximately 17% of children and adolescents aged 2–19 years are obese and the prevalence among children and adolescents continues to increase.1 Studies show a small but consistent protective effect of breastfeeding on the risk of childhood obesity.2 Recognizing the link between breastfeeding and the prevention of childhood obesity, Louisiana PRAMS (LaPRAMS) collaborated with partners from the American Heart Association (AHA), Louisiana Council on Obesity Prevention and Management (LA Obesity Council) and Louisiana Breastfeeding Coalition to influence policy on breastfeeding practices at the state level.
Program Activity Description
With the overall goal to address obesity among children and adults at different levels, stakeholders and policy makers met to advocate for policy changes that support healthy food choices and physical activity in order to achieve or maintain a healthy weight. One of their initiatives included increasing the number of breastfeeding accommodations in state buildings due to the inadequacy of current workplace lactation spaces. With this initiative in mind, the LA Obesity Council united with the LA Breastfeeding Coalition in June 2009.
With AHA acting as a fiscal agent, collaborators participated in several meetings to determine areas with greatest potential for change. To substantiate the discussions and literature, LaPRAMS was added to the partnership. Analysis of 2007 LaPRAMS data on breastfeeding rates and reasons for not breastfeeding revealed that Louisiana mothers were well below the national average for engaging in breastfeeding practices with their new baby. Furthermore, most mothers perceived work or school as a barrier to initiating or continuing breastfeeding. Using the 2007 PRAMS data, the LA Breastfeeding Coalition developed House Bill 313 and the House Bill 313 Fact Sheet including: background on the importance of breastfeeding, current breastfeeding rates in Louisiana, specific details on House Bill 313 and projected savings as a result of the bill.
Program Activity Outcomes
The LA Obesity Council presented the bill during the 2011 Louisiana Legislative Session where it was successfully passed. House Bill 313 will become effective July 1, 2012, and 10 institutions statewide will have until July 1, 2014, to construct suitable lactation areas for their employees.
The fact sheet presented displayed 2007 LaPRAMS data highlighting breastfeeding rates in Louisiana along with a comparison of state-level findings from PRAMS. This comparison, in conjunction with literature-based evidence and an assessment of the work-place environments as a barrier for breastfeeding increased the reception of the proposed bill.
1 Centers for Disease Control and Prevention. (2011, April 21). Childhood Overweight and Obesity. Retrieved July 25, 2011, from Division of Nutrition, Physical Activity, and Obesity.
2 Arenz S, Ruckerl R, Koletzko B, von Kries R. Breast-feeding and childhood obesity—a systematic review. Int J Obes Relat Metab Disord 2004;28:1247–1256.
New York City: Making Breastfeeding the Norm in NYC
Problem Overview
The New York City Department of Health and Mental Hygiene (DOHMH) set forth an objective to make breastfeeding the norm in NYC by working at individual, community, institutional and policy levels. Take Care New York, launched in 2004, aims to help New Yorkers live longer and healthier lives. “Take Care New York 2008” included a breastfeeding objective to improve maternal and infant health by encouraging healthy breastfeeding for infants. “Take Care New York 2012” took the 2008 objective a step further with the creation of Priority Area #9, focuses on healthy children, and set a target to increase the number of women who exclusively breastfeed their infants for at least 2 months to 45%.1 DOHMN plans to support policies that encourage exclusive breastfeeding for at least 6 months.
Program Activity Description
In 2006, NYC collaborated with the New York City Health and Hospitals Corporation (HHC) to implement the Breast Milk Friendly Hospital Initiative (BMFHI), based on the WHO/UNICEF Baby Friendly Hospital Initiative (BFHI). The BMFHI is a collaborative effort between NYC and 11 public hospitals that includes the training of all nurse, physician, and mid-level health providers in the BFHI principles. Principles include: initiating breastfeeding within 1 hour of life, promoting rooming-in, eliminating formula company incentives and encouraging only breast milk unless medically indicated. NYC PRAMS data from 2007, which were used to inform the program, showed that public hospitals had high prevalence rates of breastfeeding initiation (86%), but low rates of breastfeeding continuation and exclusivity (32% exclusive breastfeeding at 2 months).
Further, in 2009, NYC PRAMS breastfeeding data were used to inform aspects of a Public Health Detailing Kit on breastfeeding. The Public Health Detailing Program works with primary health care providers to improve patient care around key public health challenges. As part of the program, DOHMH representatives deliver brief, targeted messages to doctors, physician assistants, nurse practitioners, nurses, and administrators at their practice sites. The Detailing Kits, which contain clinical tools, resources for providers, and patient education materials, are distributed during site visits. Additionally, PRAMS data on why mothers stop breastfeeding was used in developing educational materials for providers as well as a Breastfeeding Guide for mothers.
Program Activity Outcomes
Preliminary data indicate that these programs are on their way in the mission to make breastfeeding the norm in NYC and have been successful in increasing breastfeeding initiation in the hospitals city-wide from 54% to 80%, and exclusive breastfeeding in the hospitals from 15% to 29%, from 2004–2008.
In 2008, NYC implemented a similar initiative in Staten Island. NYC PRAMS data showed lower rates of breastfeeding initiation, continuation and exclusivity in Staten Island as compared to other boroughs. This information was used to secure a $75,000 grant from the United Hospital Fund for each hospital in Staten Island to promote breastfeeding friendly hospital practices and Staten Island University Hospital received a Certificate of Intent to become a Baby Friendly Hospital.
1 Summers C, Cohen L, Havusha A, Slinger F, Farley T. Take Care New York 2012: A Policy for a Healthier New York City. New York Department of Health and Mental Hygiene, 2009. Accessed July 28, 2011.
New Mexico: Supporting Breastfeeding in the Workplace
Problem Overview
PRAMS data from 2003–2004 showed that while 83% of New Mexico mothers breastfed or pumped milk for their infants at least once after delivery, by 9 weeks, only 57% were still breastfeeding. Further, at 2 months postpartum, 60% of women not working or in school were still breastfeeding compared to a prevalence of 52% for those women who returned to school or work.
Program Activity Description
The Special Supplemental Nutrition Program for Women, Infant and Children (WIC) and New Mexico breastfeeding taskforce partners utilized the 2003–2004 PRAMS data to educate legislators about the importance of employer support for breastfeeding. In 2007, a bill was introduced to amend NMSA 1978 requiring New Mexico employers to allow flexible break times for nursing mothers and to provide a physical private location which was not a bathroom for pumping. The New Mexico Department of Health bill analysis indicated that employed mothers are less likely than non-working mothers to start breastfeeding or to continue nursing their infants. Among working mothers, those who were employed by companies with flexible breastfeeding policies were more likely to breastfeed for at least 9 weeks compared to women without such support.
Program Activity Outcomes
The amended bill was passed and signed into effect in March 2007. In 2010, a bill was introduced to support pumping and breastfeeding in education facilities and schools. In addition to the successful bill passage in 2007, the New Mexico WIC program was awarded a $500,000 grant to implement peer counseling programs for breastfeeding mothers. The peer counseling program is designed to train breastfeeding mothers on ways to support other WIC mothers who want to breastfeed their infant using, in part, the USDA Grow and Glow curriculum. Further, the New Mexico Medical-Legal Alliance now monitors employer compliance with the breastfeeding law and offers legal support for women who wish to pump milk but are prohibited by their employer.
In 2007, among women who started breastfeeding, 69% were still breastfeeding at 9 weeks postpartum. The prevalence increased to 73% in 2008. Among all New Mexico working mothers giving live birth from 2004–2008, the percentage of women breastfeeding for at least 9 weeks increased from 49% to 60% and among WIC mothers, breastfeeding at least 9 weeks rose from 49% to 53%.
The New Mexico WIC program reported in their 2010 Annual Report that New Mexico helps lead the nation in exclusive breastfeeding at 3 months.1 Approximately 47% percent of infants were exclusively breastfed for at least three months, compared to the U.S. average of 33%.
1 Centers for Disease Control and Prevention. Breastfeeding Report Card—United States, 2010. CDC National Immunization Survey. Accessed August 1, 2011.
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