Achieving Breastfeeding Equity in California Are hospitals doing enough to support at-risk families?
A Policy Update on California Breastfeeding and Hospital Performance Produced by California WIC Association and the UC Davis Human Lactation Center Los Angeles County: 2018 Data
Breastfeeding: A Health Equity Building on the Foundation of Priority Baby-Friendly Practices Breastfeeding provides short- and long-term health Improvements in hospital policies have resulted benefits that reduce global health care costs.1-4 Breast in increases in breastfeeding rates. From 2010 to milk provides infants with all the nutrients they need 2018, California exclusive in-hospital breastfeeding and other components that promote optimal growth, rates rose from 56.6% to 70.4%, and population development, and immune function.1,2 For mothers, differences were reduced significantly.9 breastfeeding promotes a more rapid recovery from Recent data show that progress has slowed, and childbirth and reduces risk for some cancers and smaller but important disparities persist.9 While chronic diseases.2-4 These benefits are greatest when 1,2 Baby-Friendly and similar policies improve breast milk is fed exclusively. maternity care, not all California women experience To breastfeed successfully, most mothers need these policies and practices the same way.7,10 5,6 support during the hospital stay. Hospital practices To achieve breastfeeding equity in California strongly influence mothers’ abilities to achieve their 6,7 hospitals, we must build on the foundation created breastfeeding goals. Mothers who experience by widespread adoption of Baby-Friendly policies. supportive practices in the hospital are more likely to 1,7 Resources, quality improvement processes, and breastfeed exclusively than those who do not. community partnerships are needed to ensure Ongoing efforts have improved the quality of maternity equitable structures and approaches are in place to care in many hospitals and increased breastfeeding rates meet the needs of California’s diverse families.11 8 and the number of Baby-Friendly hospitals statewide. Continued on page 4 The UC Davis Human Lactation Center used data reported by the California Department of Public Health Maternal, Child and Adolescent Health Program to create the following charts showing in-hospital breastfeeding rates.9 Los Angeles County In-Hospital Breastfeeding Rates, 2018 ANY BREASTFEEDING EXCLUSIVE BREASTFEEDING 96.9 93.1 100 87.5 88.3 92.4 89.3 76.4 70.9 73.0 80 64.0 60 52.9 41.0 40 32.5 30.8
percentage 20 0 ANTELOPE VALLEY BEVERLY CALIFORNIA CEDARS-SINAI CENTINELA EAST LOS ANGELES EMANANTE HOSPITAL HOSPITAL HOSPITAL MEDICAL CENTER HOSPITAL DOCTORS HEALTH QUEEN MEDICAL CENTER MEDICAL CENTER HOSPITAL OF THE VALLEY
hospital (continued) 1 Los Angeles County In-Hospital Breastfeeding Rates, 2018 ANY BREASTFEEDING EXCLUSIVE BREASTFEEDING
92.2 95.1 94.1 92.6 96.6 94.2 100 84.5 80 69.4 73.3 59.8 57.5 59.7 60 34.4 40 30.2 20
percentage 0 FOOTHILL GARFIELD ADVENTIST GLENDALE GOOD SAMARITAN GREATER EL HENRY MAYO PRESBYTERIAN MEDICAL CENTER HEALTH MEMORIAL HOSPITAL MONTE HOSPITAL NEWHALL HOSPITAL GLENDALE HOSPITAL HEALTH MEMORIAL CENTER HOSPITAL hospital
100 96.2 95.9 95.7 94.8 96.8 95.5 96.1 74.8 78.8 80 73.0 71.3 60.0 64.5 60 49.2 40 20 0 percentage HOLLYWOOD HUNTINGTON KAISER BALDWIN KAISER DOWNEY KAISER- KAISER- SOUTH KAISER- SUNSET PRESBYTERIAN MEMORIAL PARK MEDICAL CENTER PANORAMA CITY BAY MEDICAL CENTER HOSPITAL hospital
100 95.7 96.2 90.4 89.3 90.2 93.5 95.4 75.7 77.8 80 67.1 68.3 72.7 57.0 60 45.8 40 20 0 KAISER- WEST LOS KAISER- LAC + USC LAC HARBOR- MARTIN LUTHER MEMORIAL METHODIST
percentage ANGELES WOODLAND HILLS MEDICAL CENTER UCLA MEDICAL KING, JR. HOSPITAL OF HOSPITAL OF CENTER COMMUNITY GARDENA SOUTHERN hospital HOSPITAL CALIFORNIA
100 94.2 91.6 97.1 93.6 89.9 88.9 94.6 73.3 78.8 79.7 80 67.4 60 40.2 40 30.1 20 12.4 0 percentage MILLER MONTEREY PARK NORTHRIDGE OLIVE VIEW- UCLA PACIFICA PIH HEALTH PIH HEALTH CHILDREN'S & HOSPITAL HOSPITAL MEDICAL CENTER HOSPITAL OF THE HOSPITAL - HOSPITAL - WOMEN'S MEDICAL CENTER VALLEY DOWNEY WHITTIER HOSPITAL LONG BEACH hospital
(continued) 2 Los Angeles County In-Hospital Breastfeeding Rates, 2018 ANY BREASTFEEDING EXCLUSIVE BREASTFEEDING
90.3 93.5 89.2 97.2 97.6 95.0 94.4 100 83.3 82.6 80 63.9 64.1 54.2 55.0 60 43.5 40 20 0 percentage POMONA VALLEY PROVIDENCE PROVIDENCE PROVIDENCE PROVIDENCE ST. PROVIDENCE PROVIDENCE HOSPITAL HOLY CROSS LITTLE COMPANY LITTLE COMPANY JOHN'S HEALTH SAINT JOSEPH TARZANA MEDICAL CENTER MEDICAL CENTER OF MARY - SAN OF MARY - CENTER MEDICAL CENTER MEDICAL CENTER
hospital PEDRO TORRANCE
100 96.8 95.5 98.0 90.5 96.1 88.6 85.2 84.6 79.9 80.0 80 58.0 60 48.3 52.1
40 29.2 20
percentage 0 RONALD REAGAN- SAN DIMAS SAN GABRIEL SANTA MONICA- ST. FRANCIS ST. MARY TORRANCE UCLA MEDICAL COMMUNITY VALLEY MEDICAL UCLA MEDICAL HOSPITAL MEDICAL CENTER MEMORIAL CENTER HOSPITAL CENTER CENTER MEDICAL CENTER MEDICAL CENTER
hospital
94.9 95.2 95.5 95.5 100 88.7
80 72.9 69.9 55.6 60 52.7 42.6 40 percentage 20
0 USC VERDUGO HILLS VALLEY PRESBYTERIAN WEST HILLS HOSPITAL ADVENTIST HEALTH WHITTIER HOSPITAL HOSPITAL HOSPITAL AND MEDICAL CENTER WHITE MEMORIAL hospital
Los Angeles County Baby-Friendly Hospitals
Twenty-Six Baby-Friendly hospitals: Adventist Health White Memorial, Antelope Valley Hospital, Beverly Hospital, Centinela Hospital Medical Center, East Los Angeles Doctors Hospital, Emanante Health Queen of the Valley, Glendale Memorial Hospital and Health Center, Good Samaritan Hospital, Harbor-UCLA Medical Center, Henry Mayo Newhall Hospital, Hollywood Presbyterian Medical Center, Huntington Memorial Hospital, LAC+USC Medical Center, Memorial Hospital of Gardena, Miller Children’s and Women’s Hospital Long Beach, Northridge Hospital Medical Center, Olive View-UCLA Medical Center, Pomona Valley Hospital Medical Center, Providence Saint Joseph Medical Center, Ronald Reagan -UCLA Medical Center, San Gabriel Valley Medical Center, Santa Monica -UCLA Medical Center, St. Francis Hospital Medical Center, St. Mary Medical Center of Long Beach, Torrance Memorial Medical Center, Valley Presbyterian Hospital
(continued) 3 Achieving Breastfeeding Equity Los Angeles County Exclusive Breast- To regain momentum and further increase in-hospital feeding Rates by Race/Ethnicity, 2018 exclusive breastfeeding, advocates and administrators must ensure that 1) Baby-Friendly and similar optimal policies are White 78.2 adopted by all California hospitals providing maternity care Multiple Race 75.4 and 2) equitable structures and approaches are integrated American Indian 70.7 throughout medical systems to work synergistically with those policies. Other 67 Hispanic 60.1 The California Department of Public Health must provide clear guidance and associated metrics or benchmarks to be Paci c Islander 60.1 used for implementation of SB-402 so that hospital systems African American 57.2 can prepare for surveillance beginning in 2025. Asian 57.2 Administrators and policy-makers must provide resources 50 60 70 80 to remove current barriers to breastfeeding equity. Targeted and sustainable changes will be needed to eliminate percentage persistent disparities and ensure that all mothers in Source: California Department of Public Health Genetic Disease California are able to meet their breastfeeding goals. Screening Program, Newborn Screening Data, 20189 Los Angeles County Breastfeeding and Hospital Performance
County average breastfeeding rates: Any – 93.7% Exclusive – 63.4% County ranked 40th in the state for exclusive breastfeeding Six hospitals among the 15 lowest-scoring in the state: Beverly Hospital, Hollywood Presbyterian Medical Center, Monterey Park Hospital, PIH Health Hospital - Downey, San Dimas Community Hospital, Whittier Hospital Highest performing hospital in the county: Santa Monica-UCLA Medical Center
NOTES: • All nonmilitary hospitals providing maternity services are required to complete the Newborn Screening Test Form [Version NBS-I(D) (12/08)]. • Infant-feeding data presented in this report include all feedings since birth to time of specimen collection, usually 24 to 48 hours since birth. Upon completing the form, staff must select from the following three categories to describe ‘all feeding since birth’: (1) Only Human Milk; (2) Only Formula; (3) Human Milk & Formula. • The numerator for “Exclusive Breastfeeding” includes records marked “Only Human Milk.” The numerator for “Any Breastfeeding” includes records marked “Only Human Milk” or “Human Milk & Formula.” The denominator excludes cases with unknown method of feeding, cases marked NPO and those receiving TPN at time of specimen collection. • Excludes data for infants who were in a Neonatal Intensive Care Unit (NICU) nursery at the time of specimen collection. • Excludes cases that were not collected by facilities listed as “Kaiser” and/or “Regular” maternity hospitals in the newborn screening database. • Data for counties include information for all births occurring in a ‘Regular’ or ‘Kaiser’ facility providing maternity services in that county. Counties and facilities with fewer than 50 births with known type of feeding are not shown.
REFERENCES: 1. Perez-Escamilla R, et al. Impact of the Baby-friendly Hospital Initiative on breastfeeding and child health outcomes: a systematic review. Matern Child Nutr. Jul 2016;12(3):402-417. 2. World Health Organization. Guideline: Protecting, promoting and supporting breastfeeding in facilities providing maternity and newborn services. Geneva; 2017. 3. Bartick MC, et al. Suboptimal breastfeeding in the United States: Maternal and pediatric health outcomes and costs. Matern Child Nutr. Jan 2017;13(1):e12366. 4. Bartick MC, et al. Disparities in Breastfeeding: Impact on Maternal and Child Health Outcomes and Costs. J Pediatr. Feb 2017;181:49-55.e6. 5. Centers of Disease Control and Prevention. Breastfeeding Report Card 2018. https://www.cdc.gov/breastfeeding/data/reportcard.htm 6. Spaeth A, et al. Baby-Friendly Hospital designation has a sustained impact on continued breastfeeding. Matern Child Nutr. Jan 2018;14(1):e12497 7. Patterson JA, et al. The effect of Baby-friendly status on exclusive breastfeeding in U.S. hospitals. Matern Child Nutr. Jul 2018;14(3):e12589. 8. Baby Friendly USA. Baby Friendly Facilities by State. 2018. https://www.babyfriendlyusa.org. 9. California Department of Public Health, Center for Family Health, Genetic Disease Screening Program, Newborn Screening Data, 2018. https://www.cdph.ca.gov/Programs/CFH/ DMCAH/Breastfeeding/Pages/In-Hospital-Breastfeeding-Initiation-Data.aspx 10. Sipsma HL. et al. Differential exposure to hospital breastfeeding support by maternal race and ethnicity: A pilot study. J Midwifery Womens Health 2019;64(6):743-748. 11. Beauregard JL et al. Racial disparities in breastfeeding initiation and duration among US infants born in 2015. MMWR 2019;68:745-748.
January 2020 This project was supported by Kaiser Foundation Hospitals Photograph Sources: California WIC Association, Bill McLeod, www.Istockphoto.com 4