A12 Reaching and Supporting Populations with Lower Rates of Breastfeeding_Hiltrud Dawson

Prevent More to Treat Less – June 4, 2014

Reaching and Supporting Populations with Lower Rates of Breastfeeding Dr. Susan Hayward Debbie Silvester Hiltrud Dawson

CFPC Conflict of Interest

Disclosure of Commercial Support Presenter Disclosure Presenters: • Dr. Susan Hayward • Debbie Silvester • Hiltrud Dawson Relationships with commercial interests: • • • •

Grants/Research Support: Speakers Bureau/Honoraria: Consulting Fees: Other:

None None None None

Who we are…

The Best Start Resource Centre: www.beststart.org • Provides services to support service providers working in maternal health and early child development – – – – –

Information Consultations Resources Training Networking opportunities

• A program of Health Nexus www.healthnexus.ca • Funded by the Ministry of Children and Youth Services

Some Services of the Best Start Resource Centre • Resources – – – – –

Child Development Breastfeeding Perinatal Mood Disorders Reproductive Health Preconception Health

• Training – Regional Workshops – Webinars

• Other Projects – Module on obesity in children – Prenatal key messages – BFI strategy for Ontario (in partnership with TEGH and PCMCH)

Learning Goals • Learn how primary research, data analysis, and information from service providers in primary health care and public health was used to identify populations with lower rates of breastfeeding. • Learn how primary research, data analysis, and information from service providers in primary health care and public health was used to identify breastfeeding challenges and effective strategies to reach and support populations with lower rates of breastfeeding. • Learn how the Best Start Resource Centre and representatives from primary health care and public health are working together to develop a strategy to reach and support populations with lower rates of breastfeeding.

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Objectives 1. Discuss breastfeeding as a key population health promotion strategy 2. Understand the purpose of the breastfeeding community project and its application in specific communities 3. Apply the concepts to practice by discussing examples

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Benefits of Breastfeeding The WHO, UNICEF, CPS and CCFP recommend exclusive breastfeeding until 6 months then combined with complimentary foods up to two years and beyond. Experts feel breast milk is the physiological norm and ideal nutrition for babies.

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Breastfeeding • Provides the correct quantity, quality and absorption of nutrients • Is easily and efficiently digested • Provides immunity and protection against infection via immunoglobulins, WBS and other immune factors • Matures the small intestine 8

Breastfeeding Benefits for Baby • Provides protective antibodies to baby to prevent bacterial meningitis, bacteremia, diarrhea, respiratory tract infections, otitis media, urinary tract infections, and inflammatory bowel disease • Decreases diabetes, asthma and obesity • Decreases SIDS

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Benefits of Breastfeeding cont’d • Increases neurocognitive scores • New research finding oligosaccharides in breast milk which provides optimal brain development for the baby • Helps overall growth and development • Provides good oral motor skills

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Benefits of Breastfeeding cont’d • Creates a strong bond between mother and baby • Comforting and relaxing for both baby and mother • Always ready at the right time and temperature • Breast milk changes for child’s different nutritional needs as it grows 11

Breastfeeding Benefits – For Mother • • • • •

Decreased postpartum hemorrhage Increased postpartum weight loss Delays fertility postpartum Decreased breast and ovarian cancer Decreased heart disease and type 2 diabetes

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Economical Benefits • • • •

Cost effective Decreased medical costs to governments Healthcare costs 3x less if breastfed Better infant health, so decreased absenteeism for employees, decreased insurance claims and increased productivity • Ideal nutrition in an emergency

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From a Primary Care Perspective ‌ • Breastfeeding is the ideal preventative medicine.

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Snapshot – One Community in Ontario

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Windsor-Essex County

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Breastfeeding Only at Hospital Discharge BORN Ontario Perinatal Reports

LHIN #1 Erie St. Clair

Ontario

• 2008

56.4%

61.3%

• 2009/2010

45.3%

59.8%

• 2011/2012

49.5%

63.25% Live term infants

Erie St. Clair LHIN Breastfeeding Rates BORN Ontario – Perinatal Health

Windsor

Chatham

Lambton

Erie St. Clair LHIN

Ontario

83%

78.4%

82.8%

81.4%

89.6%

Report 2008 South West Ontario Public Health Region

Intent to Breastfeed

Method of Feeding at Hospital Discharge Combination

42.8%

9.8%

13.5%

22.0%

25.2%

Formula only

19.9%

26%

18.7%

21.5%

13.5%

Breastfeeding only

37.2%

64.2%

67.8%

56.4%

61.3%

Live term infants

Validation Research • Who are the populations with lower rates of breastfeeding in Ontario?

• What are their barriers to breastfeeding?

• Which strategies have been found to be effective in promoting and supporting breastfeeding initiation, exclusivity and duration for these populations.

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Four Strategies • Literature review • Key informant interviews • Needs assessment of service providers • BORN data

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Literature Review • 78 Articles from 2003 – 2013 • Mostly Canadian – – – –

Published studies Survey results Literature reviews Survey results

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BORN Data • Breastfeeding status at discharge from hospital • Mostly consistent with literature • Surprising variables between LHINS Exclusive breastfeeding at discharge in Ontario 2011/2012

ONTARIO

number

percent

69,332

63.5 22

Key Informant Interviews • 26 telephone interviews • Service providers working with prenatal and breastfeeding women ( 1-40 years’ experience) Roles

Organization type

Front-line

Public health

Supervisor/manager

Community health

Educator/program planner

Primary care NGO Hospital 23

Service Provider Needs Assessment • 349 survey respondents • From similar backgrounds as key informants • Need for face-to-face or web-based, easy to access, culturally appropriate information, education and resources

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Breastfeeding Community Project • To gather information about, understand, reach and support populations with lower rates of breastfeeding • To work at a community level to address populations with lower rates of breastfeeding • To promote the use of effective and promising strategies when working with these target populations 25

Role of the Advisory Committee • Public health – nurses, lactation consultants • Primary care – physicians, midwives, nurses, nurse practitioners, and lactation consultants • Representatives from other key stakeholder organizations • Best Start Resource Centre

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Key Informant Interviews • AC helped to develop the list of key informants to get input from multiple, credible sources in a variety of settings in Ontario Questions asked: – What works to increase breastfeeding rates?

– What barriers exist to improving breastfeeding rates?

– How can issues be addressed that affect populations with lower rates of breastfeeding

• Objective: Focus on breastfeeding community projects 27

My Role as Physician • AC members passionate about increasing breastfeeding rates in Ontario • Breastfeeding medicine has been part of my practice for last 12 years • In order to increase rates, we need to increase support for mothers, babies and health care professionals • Worked at the Doctor’s Breastfeeding Clinic and obtained fellowship with the Academy of Breastfeeding Medicine 28

Impact • Developed Queen Square Breastfeeding Clinic as part of FHT over last two years 28,000 patients pregnant & postpartum women

17 doctors

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Why We Applied for a Grant Windsor Essex County’s Baby Friendly Initiative committee (WEBFI) includes representative from: • • • • • • • •

Health Unit La Leche League Private Doulas Private Prenatal Educators Parents of Multiple Births Association (POMBA) Victorian Order of Nurses Local Birthing Hospital Building Blocks for Better Babies: local Canadian Prenatal Nutrition Program (CPNP) • Ready-Set-Go: local Community Action Program for Children (CAPC)

Why We Applied for a Grant 1. Lower breastfeeding rates Windsor Ontario 83% 89.6% 37.2% 61.3%

Intent to Breastfeed¹ Breastfeeding only at hospital discharge¹ Exclusive breastfeeding at 6 months² 14.7%

25%

¹BORN Ontario 2008 ²Canadian Community Health Survey 2007-2012

Why We Applied for a Grant 2. Inconsistent breastfeeding messages to women and their families 3. Limited community breastfeeding supports 4. Limited financial and human capacity to provide community breastfeeding education and supports.

Examples in Your Work • What have you done to promote breastfeeding? (or another population health issue) • How has it been addressed by public health, primary care?

• How has the issue led to a working together of public and primary health practitioners?

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Primary Care and Public Health Working Together • Breastfeeding requires many levels of support and knowledge.

• Integration of the allied health professionals to optimize care provides the ideal environment to improve breastfeeding rates.

• Volunteers providing peer support should not be overlooked.

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Queen Square Breastfeeding Clinic provides breastfeeding support • Nurses and lactation consultants overseen by physician • Early access to mothers and babies • Seen within a few days of birth • Teaching basics – latch, feeding frequency – can prevent more complicated issues

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The Doctor’s Breastfeeding Clinic • Example of public health, lactation consultants and physicians working together and supporting each other • Physicians, midwives and public health nurses refer challenging cases • Providing patient-centered care focusing on optimizing breastfeeding • Medical interventions available if required • Approach confirms importance of breastfeeding 36

Supporting Breastfeeding • • • •

Other models available Adapt models to the needs of the community Need to increase services Find balance between support and providing expert services when needed • New supports – Breastfeeding community projects – New Bilingual Online Ontario Breastfeeding Services directory at www.ontariobreastfeeds.ca – Telehealth Ontario 24 hour breastfeeding support 37

www.ontariobreastfeeds.ca

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Breastfeeding App Project • Partnership between: – Building Blocks For Better Babies – University of Windsor – Windsor-Essex County Health Unit

• Local breastfeeding committee, WE BFI, is providing content expertise

Purpose • Women with lower rates of breastfeeding will have: – Access to reliable evidence-based breastfeeding information at the tips of their fingers – anytime, anywhere – Access to local and provincial breastfeeding supports • New: TeleHealth 24/7 Breastfeeding Support • New: Bilingual Ontario Online Breastfeeding Services

Project Activities • Develop app content – Focus groups at BBBB • • • •

50% are less than 26 yrs, 12% less than 20 yrs 40% earn less than $1900/month 46% have no high school diploma 62% are newcomers

• Build app • Focus test the app • Launch January 2014 with a local campaign

Other Project Examples • • • •

Peer support Prenatal education Community education Service provider education

• www.beststart.org/breastfeeding_community_project

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Exiting News!

• Second round of small grants in 2015 • Call for proposals coming in fall 2014 • Eligibility and other criteria will be on Breastfeeding Community Projects webpage in early fall

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Resources • Populations with Lower Rates of Breastfeeding: A Summary of Findings – coming soon • www.beststart.org/projects/breastfeeding_ community_project • www.ontariobreastfeeds.ca • Telehealth Ontario – new 24 hour support for breastfeeding

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Questions and Answers

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Dr. Susan Hayward Queen Square Family Health Team drhayward@queensquaredoctors.ca Debbie Silvester Windsor-Essex County Health Unit dsilvester@wechu.org Hiltrud Dawson Best Start Resource Centre h.dawson@healthnexus.ca www.beststart.org

Thank you!

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