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2/6/2017
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California Department of Public Health Maternal, Child and Adolescent Health Division
Addressing Breastfeeding
Disparities in the Black
Infant Health Program
Niambi Lewis, MSW
Robin Qualls, BSN, MPH
California Breastfeeding Summit
Anaheim, CA
January 25, 2017
Acknowledgements • The BIH State Team
o Dr. Paula Braveman and University of California San
Francisco Center for Health Disparities
o Maternal Child and Adolescent Health Division-
Maternal and Infant Health Branch
o Maternal Child and Adolescent Health Division-
Epidemiology, Evaluation, and Data Operations
Section
• Dr. Ifeyinwa V. Asiodu, California Breastfeeding Coalition
Board Member, Day 1 Chair
2 Funded by: Title V Federal Funds and State General Funds
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Black Infant Health (BIH)
Program Goal
• To improve health among African-
American mothers/babies
• To reduce the Black/White
disparities
• To facilitate and increase women’s
empowerment
3
Istock.com/thegift777
Health Disparity
“The differences in health status among
distinct segments of the population,
including differences that occur by gender,
age, race or ethnicity, education or
income, disability or functional impairment
or geographic location, or the combination
of any of these factors.” 1
1 Portrait of Promise: The California Statewide Plan to Promote Health and Metal Health Equity
4
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BIH Program
• Started in 1989 to address health disparities (black/white
gap) and higher incidences in the African-American
community of:
o Pre-term birth
o Infants small for gestational age
o Infant mortality
o Sudden Infant Death Syndrome (SIDS)
o Sexually Transmitted Diseases
o Hypertension
o Diabetes
o Obesity
5
Infant Mortality Rate by Race/Ethnicity, 2000-2013
12.8 12.6 12.7
12.3 12.0
12.7
11.5 11.5
12.1
10.6
9.5
10.5
9.8
10.6
4.8 5.0 5.1
4.5 4.6 4.7 4.4
4.6
4.1 4.1 4.1 4.1 3.8 3.8
5.3 5.0
5.2 5.2 5.2 5.3 5.1 5.1 5.2
5.0 4.9 4.9 4.7
5.1
0
2
4
6
8
10
12
14
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
De
ath
s p
er
1,0
00
Liv
e B
irth
s
Year
African-American
White
Hispanic
California
2
2 California Birth and Death Statistical Master File, California Department of Public Health, Center for Health Statistics and Informatics.
Prepared by the Epidemiology, Assessment and Program Development Branch, Maternal, Child and Adolescent Program, Center for Family Health
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The BIH Program spans
15 jurisdictions where
over 90% of African-
American live births
occur.
3 California Birth Statistical Master Files, 2006-2008,
Non-Hispanic African-American resident mothers,
age 18 years or older, excluding foreign-born
mothers. Analysis by CDPH MCAH EAPD. 7
3
Service Criteria for Enrollment
• Self-Identified African-American woman
• At least 18 years of age
• Less than 26 weeks pregnant at the
time of enrollment
8
Used w
ith p
erm
issio
n f
rom
C
ity
of
Long B
each B
lack I
nfa
nt
Health P
rogra
m
2/6/2017
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Intervention Rationale
• “Singular Core Model”
(Empowerment/Social Support) to promote:
o Empowerment
o Social Support
o Stress Reduction
oHealth Education
9
Istock.com\studio1one
4
4 The Black Infant Health Program: Comprehensive Assessment Report and Recommendations
Intervention Components
• Case Management/Life Planning
• Group Sessions
10
Used with permission from San Francisco Black Infant Health Program
Used with permission from WIC Works Image Gallery,)
https://wicworks.fns.usda.gov/topics-z/image-gallery
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Case Management/Life Planning
• Participants receive individual, complementary
case management during and after pregnancy
• Referrals for identified services (e.g., medical,
dental, social)
• Guidance on family planning
• Identification of strengths & problem-solving
skills
• Assistance with setting short and long term-
goals
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Group Sessions
• Weekly group session topics:
o Cultural Heritage as a Source of Pride
o Healthy Pregnancy, Labor and Delivery
o Nurturing Ourselves and Our Babies
o Prenatal, Postnatal and
Newborn Care
o Stress Management
o Healthy Relationships
o Celebrating Our Families
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Used with permission from Fresno County Black Infant Health Program
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LHJ Staffing Requirements
o BIH Coordinator
oCommunity Outreach
Liaison
oMental Health
Professional
o Public Health Nurse
o Family Health Advocate
oGroup Facilitator
oData Entry Personnel
13
Used with permission from Santa Clara County Black Infant Health Program
Breastfeeding Data
Findings
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Breastfeeding (BF) Data
Collected in BIH
• BF disparity rates for AA women in California
• BIH program data collected
o BF intention
o BF initiation
o Women receiving WIC services
• Quarterly and Annual Reports
o Anecdotal participant success stories of BF practices
www.istock.com/lostinbids
Methods
• For breastfeeding disparity rates o California Maternal and Infant Health Assessment Data 2013-
2014
• BIH Program Data o Extracted from Efforts to Outcomes (ETO) data system on
November 1, 2016.
o Cohort of analysis: Women enrolled between July 1, 2015 to
June 30, 2016
• Comparison of responses to breastfeeding intention
questions at
– Assessment 1 - Enrollment (N = 938)
– Assessment 2 - 33 to 36 weeks gestation (N = 410)
• Women enrolled in WIC question asked during baseline
assessment at enrollment.
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The 2013-2014 MIHA Survey reported: Intended to breastfeed- • 85.7% of African-American women • 91.7% in Hispanic women • 94.6% in White women
Health Knowledge: Breastfeeding
6 BIH data extracted from ETO on November1, 2016. Recruitment Cohort Period: July 1, 2015 – June 30, 2016. Preliminary data of participants that were assessed at baseline and follow-up (approximately 33-36 weeks of pregnancy)
5
5 California Maternal and Infant Assessment 2013-2014
The 2013-2014 MIHA Survey reported: Intended to exclusively breastfeed- • 57.5% of African-American women • 57.2% in Hispanic women
• 81% in White women
Health Knowledge: Breastfeeding
6 BIH data extracted from ETO on November1, 2016. Recruitment Cohort Period: July 1, 2015 – June 30, 2016. Preliminary data of participants that were assessed at baseline and follow-up (approximately 33-36 weeks of pregnancy)
5
5 California Maternal and Infant Assessment 2013-2014
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BIH participant intended length of breastfeeding:
Health Knowledge: Breastfeeding
6 BIH data extracted from ETO on November1, 2016. Recruitment Cohort Period: July 1, 2015 – June 30, 2016. Preliminary data of participants that were assessed at baseline and follow-up (approximately 33-36 weeks of pregnancy)
Planned
Breastfeeding Length
At Initial Enrollment
into Program
N=826
Follow-up
At 33-36 Weeks
Gestation
N=385
Less than 6 months 16% 12%
6 to 11 months 35% 42%
12 months or longer 33% 38%
Not sure yet 16% 8%
6
BIH Participants Receiving WIC Services
6 BIH data extracted from ETO on November1, 2016. Recruitment Cohort Period: July 1, 2015 – June 30, 2016. Preliminary data of participants that were assessed at baseline and follow-up (approximately 33-36 weeks of pregnancy)
Are you currently receiving any WIC services for yourself or your children?
Total=901
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Local Collaboration Efforts
• Collaboration occurs during prenatal and
postpartum series
• Sites collaborate with local agencies to
support breastfeeding by:
oHaving nurses available to support
breastfeeding efforts and attend groups
o Partnering with local Women, Infant and
Children (WIC) programs
o Partnering with coalitions to obtain current
breastfeeding information
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State Collaboration Efforts
• Partnerships with
oWIC
oMarch of Dimes
o Alameda County
Breastfeeding
Coalition
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Breastfeeding Topics for BIH
Sessions
Session Topic Information
Session 3 • Advocating for Services: breastfeeding support
Session 6 • Infant feeding (will review in detail)
Session 7 • Review from session 6
• Safe Sleep Video: breastfeeding plan
Session 8 • Lifestyle Quiz Questions (True/False)
• Breastfeeding and formula-feeding are equally
good for your baby. (FALSE)
• Breastfeeding is good for your baby but not good
for you. (FALSE)
Session 9 • Paternal breastfeeding support
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Breastfeeding Resources
• Each group session is accompanied
by a facilitator guide and participant
handbook
• The participant handbook contains:
o More information and resources
o Breastfeeding infographics
• BIH staff utilize MCAH-BIH BF
resources to provide to participants
24 Source: http://womenshealth.gov/itsonlynatural/
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Black Infant Health
Group Session 6
Kwanzaa Principle Kujichagulia To define ourselves, name
ourselves, create ourselves and
speak for ourselves. 25
Istock.com/raycan
Istock.com/imageegaml
This activity will help us learn more about infant
feeding and where to find support
Pregnancy, birth and breastfeeding were sacred in
many African tribes, and mothers were nurtured and
supported for weeks after giving birth
Birth was an important time—not just for women, but for the
entire village
Breastfeeding was viewed as part of the overall birth process
Breastfeeding was always part of the bonding process
Baby’s First Food In
Africa
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In BIH, breastfeeding is considered normal
infant feeding and not a lifestyle choice
We also believe in SELF-DETERMINATION—
you know what is best for YOU!
Watch Growing a First Food Movement https://www.youtube.com/watch?v=Zhx-R6p1xAQ
What’s something NEW you learned?
Baby’s First Food In
Africa
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What’s recommended: Breastfeed your
baby for at least one year, and exclusively
breastfeed your baby (breast milk only) for
the first 6 months
The more closely you can follow these
recommendations, the greater the
benefits—but any breastfeeding is good for
both the health of you and your baby
Breastfeeding
37
http://www.istockphoto.com/RuslanDashinsky
2/6/2017
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Breastfeeding Intention vs.
Breastfeeding Practice What stands out to you in this table?
Women in every group
have higher rates of
intention than practice
African Americans
have the lowest rates
of both intention and
practice
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Benefits and Challenges
Benefits Short-term Provides the best nutrition for your baby
Protects your baby from life threatening
ailments (e.g., respiratory infections,
gastrointestinal infections, SIDS/SUID)
Faster weight loss for you
Long-term Your baby is less likely to develop childhood
obesity and other diseases like asthma and
diabetes
You may be at lower risk for developing breast
cancer, ovarian cancer, or diabetes
Challenges
Pain
Latching problems
Lack of family or
community support
Limited access to
lactation consultant
Lack of
breastfeeding role
models
Brainstorm the BENEFITS and CHALLENGES of breastfeeding
Watch Overcoming Breastfeeding Challenges http://www.womenshealth.gov/itsonlynatural/overcoming-challenges/breastfeeding-challenges.html?from=breastfeeding
30 Source: http://womenshealth.gov/itsonlynatural/
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Breastfeeding
improves overall
health for both you
and your baby!
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Breastfeeding Quiz Instructions: Thumbs up for TRUE
Thumbs down for FALSE
1. Breastfeeding helps prepare the baby’s digestive system
for handling solid food.
2. Babies who are breastfed have more frequent doctor visits.
3. Breastfeeding saves less than $100 per month.
4. Moms who breastfeed lose weight faster.
5. Breastfeeding is good for the environment.
6. Breastfeeding moms sleep less at night.
41 Source: http://womenshealth.gov/publications/our-publications/breastfeeding-guide/BreastfeedingGuide-
AfricanAmerican-English.pdf
Used with permission from wicworks.fns.usda.gov
2/6/2017
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Infant Feeding Plan Whether you choose to breastfeed or formula feed, we
want you to be successful.
What do you need to be successful?
Before your baby is born, tell your partner, family, and friends
how you plan to feed your baby
If you choose to breastfeed; ask for support from family and
friends, connect with other breastfeeding mothers and discuss
any problems with a lactation consultant
Tell your doctor that you want to breastfeed, and make sure
it’s part of your Birth Plan
Breastfeeding experts are available to answer your questions
-- just ask!
Complete your Infant Feeding Plan
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Reminder Read Chapter 6
Remember that labor and delivery and
infant feeding require support—please
ask us for help!
If you have questions about any of the
topics we covered today, please ask one
of us
Session 7 will cover information to help
you when you bring your baby home
HAVE A GREAT WEEK!
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How You Can Help
Site Support
• Train staff at BIH sites to become lactation
experts
• Provide additional workshops (between group
sessions)
• Present during breastfeeding session
• Availability of lactation expert available during
postpartum sessions/home visits
35
Mic
rosoft
Clip
Art
How You Can Help
Referral Assistance • Refer eligible women to BIH
• Talk to community partners about BIH
• Develop formal and informal agreements
• Assist with distributing BIH messaging
materials
36
Mic
rosoft
Clip
Art
2/6/2017
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How You Can Help
Community Engagement • Identify Breastfeeding champions at the
state and local level
• Establish local Breastfeeding coalitions
• Conduct presentations with community
partners
• Identify success stories
• Celebrate successes!
37
Mic
rosoft
Clip
Art
For More Information
• State BIH Page
o http://www.cdph.ca.gov/programs/BIH/Pages/
default.aspx
• BIH Coordinator Directory
o http://www.cdph.ca.gov/programs/bih/Pages/
BlackInfantHealthCoordinatorDirectory.aspx
• Black Infant Health Profile
o http://www.cdph.ca.gov/programs/bih/Docum
ents/Profile%20BIH.pdf
38
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References
1. (2015, August). Portrait of Promise: The California Statewide Plan to Promote Health and
Mental Health Equity. (Rep.). Retrieved January 12, 2017, from Report to the Legislature
and the People of California by the Office of Health Equity website:
http://www.cdph.ca.gov/programs/Documents/Accessible-
CDPH_OHE_Disparity_Report_Final.pdf
2. Data sources: 2011-2013 California Birth and Death Statistical Master File, California
Department of Public Health, Center for Health Statistics and Informatics.
3. California Birth Statistical Master Files, 2006-2008, Non-Hispanic African-American
resident mothers, age 18 years or older, excluding foreign-born mothers. Analysis by
CDPH MCAH EAPD.
4. (2007, July). The Black Infant Health Program: Comprehensive Assessment Report and
Recommendations (Rep.). Retrieved
http://www.cdph.ca.gov/programs/bih/Documents/MO-BIH-
ComprehensiveAssessmentReport-April-2008.pdf
5. California Maternal and Infant Health Assessment 2013-2014
6. BIH data extracted from ETO on November1, 2016. Recruitment Cohort Period: July 1,
2015 – June 30, 2016.
39
Thank You
Niambi Lewis, MSW California Department of Public Health
916 650-6405
Robin Qualls, BSN, MPH California Department of Public Health
916 650-0385
40
