Breastfeeding 101: a Public Health Approach

Breastfeeding 101: A public health approach Diana Cassar-Uhl, MPH, IBCLC University of Maryland, College Park, School of Public Health Maternal and Child Health Program, Department of Family Science Spring 2016

How this unit is innovative

The majority of undergraduate students I teach in the state university setting (daytime classes, mostly full-time students, juniors and seniors in their early 20s) are not parents. Their exposure to infant feeding is limited to family experiences and the marketing of breastmilk substitutes in magazines and on television. This educational unit aggressively dispels the narrative that “only good mothers breastfeed” and provides students the platform and structure to critically evaluate the role of personal choice vs. social determinants in health behaviors around infant feeding and other topics. It was developed by an IBCLC and breastfeeding researcher with personal, clinical, scholarly, and policy- related expertise in U.S. breastfeeding, but can be taught by any instructor who possesses an understanding of social determinants/social-ecological health model. The exposure via this unit to a public health approach to breastfeeding equips students with the knowledge and skills to critically examine breastfeeding research and mainstream attitudes surrounding infant feeding behaviors, and advocate for programmatic approaches to breastfeeding promotion and protection in maternal, child, and family health career settings.

Outline of educational offering

Part 1 Breastfeeding: A social ecological context  Advance reading o Center for Social Inclusion. (2015). Removing barriers to breastfeeding: A structural race analysis of first food. Retrieved from http://www.cenderforsocialinclusion.org/removing-barriers-to- breastfeeding-a-structural-race-analysis-of-first-food/ o Li, R., Fein, S. B., Chen, J., & Grummer-Strawn, L. M. (2008). Why mothers stop breastfeeding: Self-reported reasons for stopping during the first year. Pediatrics, 122, S69-76. doi: 10.1542/peds.2008-1315i  Lecture (PowerPoint) and discussion o Status of breastfeeding in the U.S.; disparities o Social-ecological model: barriers and factors that promote breastfeeding at each level . Individual, interpersonal/family, organizational, institutional, community, and societal/policy  Students suggest and discuss factors that promote and discourage the health behavior, based on readings and real-life observations Part 2 Breastfeeding: Research and epidemiology  Advance reading o Cassels, T. (2015). The problem with breastfeeding research that no one is talking about. [Web log post]. Retrieved from http://evolutionaryparenting.com/the-problem-with-breastfeeding- research/  Lecture (PowerPoint) and discussion o Breastfeeding metrics of national behaviors . Initiation, exclusivity, duration o Epidemiologic methods to study associations (not causality) between breastfeeding and outcomes . Infant growth, disease, future weight status, metabolic conditions, allergies, IQ, socialization, maternal health o Research challenges in the study of breastfeeding . Operationalization of variables and group assignments, why they matter  Dose/intensity; breastfeeding vs. breastmilk feeding . Randomization  Ethics of randomization; observational vs. experimental study designs . Social ecology/determinants of health as confounding variables  Sibling studies, strategies to mitigate weaknesses of non- experimental study designs

 Homework assignment (see attachment)