Increasing Breastfeeding Rates in South Hampton Roads Rebecca Berryman, Allita De Oliveira Braga, Ayesha Howard, Gibtsawit Kidane, Leizle Ortiz, Kimberly Pullen, Emily Redden, Rosa Shu

Breastfeeding in the U.S. Currently 79.2% of women initiate breastfeeding Only 18.8% continue to exclusively breastfeed for six months Healthy People 2020 goal for breastfeeding 81.9% 23.7% This presentation will demonstrate why breastfeeding is important, and why programs such as “Breastfeeding Welcome Here” and “La leche league” are so important and essential in reaching the Healthy People 2020 goals for breastfeeding.

Breastfeeding Benefits Infant: Contains antibodies Changes as the child grows Lower risk for: Ear infections Diarrhea Respiratory infections SIDS Asthma Obesity Mother: Lower risk for: type two diabetes breast and ovarian cancers postpartum depression Increased weight loss Decreased cost Bonding Society: Less environmental waste There are many benefits to breastfeeding. Breast milk contains antibodies which pass from the mother to the baby and help to protect them from infection. Breast milk also changes as the baby grows according to their needs at that stage of development. Babies who are breastfed have a lower risk for ear infections, diarrhea, respiratory infections, SIDS (sudden infant death syndrome), asthma, and obesity. Benefits for the mother include lower risk for type two diabetes, breast and ovarian cancers, and postpartum depression. Other benefits include increased weight loss for breastfeeding mothers as well as decreased cost. The environment also benefits from decreased waste because less bottles, nipples, and other supplement accessories are thrown away.

Aggregate Description Aggregate: Mothers and Women of Childbearing Age Able to Breastfeed Our program did not work directly with the aggregate but rather the local businesses in order to facilitate support and a welcoming environment for breastfeeding mothers. State the health problems of the aggregate, utilizing the nursing diagnosis format, identified during the assessment phase. Rosa Shu (Only 18.8% of 6 month old infants are exclusively breastfeed) Dissatisfaction or difficulty a mother, infant, or child experiences with the breastfeeding process formula too much water/ diluted & doesnt contain

Assessment Health Problem: Low Breastfeeding Rates Mother and child are missing the immediate and long term health benefits of breastfeeding Nursing Diagnosis Deficient knowledge Related to Breastfeeding Ineffective Breastfeeding Related to Unsatisfactory Process Less than optimal nutrition Rosa Less than Body Requirement

Breastfeeding Welcome Here Projects Breastfeeding Welcome Here Increasing visual cues cute pic em

Projects Business Case for Breastfeeding Policies for employees

Projects Breastfeeding Friendly Childcare Policies for breastfeeding mothers

Healthy People 2020 Objective: Increase the proportion of infants who are ever breastfed

Measurable Goals Sign up 40 businesses for BFWH Survey 50% of businesses participating in BFWH Begin advertising at Old Dominion University Increase the number of lactation rooms at Tidewater Community College by one Increase the number of lactation rooms at Old Dominion University by one Increase the number of Breastfeeding Friendly Childcare training participants and centers sign up 40 businesses between August 2014 and April 2015 for the breastfeeding welcome here program survey half or greater of the local businesses participating in the breastfeeding welcome here program who joined before August 2014 and evaluate changes in their business after joining the program begin advertising for lactation rooms and breastfeeding awareness at Old Dominion University increase the number of lactation rooms at Tidewater Community College by one Increase the number of lactation rooms at Old Dominion University by one increase the number of childcare centers participating in the Breastfeeding Friendly Childcare training

Primary Intervention: Education EDUCATION IS KEY! social norms, lack of knowledge, limited information Want to create spaces for breastfeeding mothers to feel comfortable in The primary intervention is to spread knowledge about the necessity and benefits of breastfeeding to those who have a direct effect on the aggregate: this includes local business owners and their employees. It is apparent these parties base their beliefs and views on their own knowledge of the issue. A perception of social disapproval of breastfeeding in public is one of the main reasons why women may cease breastfeeding early (Marsden, Abayomi, 2012). Therefore, the need for intervention is determined by considering these parties may have an understanding of “the opposing side” and may benefit from further education.

Interventions CINCH: Breastfeeding Welcome Here! Project Partner with local businesses Sign a pledge include standards of project, staff training, visibility of logo CINCH: BFWH Project -Breastfeeding Welcome Here! Project partners with employers -Goals: increase awareness about breastfeeding **Increase social acceptability with knowledge!!

Interventions Accomplishments IHOP mother given towel to cover baby’s head contacted and signed pledge “Breastfeeding Sit-in” Assistant Dean: Breastfeeding rooms at ODU Article in Health Sciences Newsletter -IHOP -situation where mother was given a towel to cover up her baby’s head; became local news story -called IHOP to set up a teaching session (??) -“Breastfeeding Sit-in” -trained staff, mothers sat and breastfed their children -IHOP partnered with BFWH! Project -Assistant Dean: ? -advertisement for ODU placed on FB on ODU nursing page and in March Health newsletter

Interventions Goals: increase awareness about breastfeeding **Increase social acceptability with knowledge!! By serving as an advocate, and targeting local businesses, the ultimate goal of spreading education is to increase breastfeeding mothers’ self-efficacy and gradually normalize the view of breastfeeding in society.

So why are these projects so important?

Current Research Association of Child Care Providers Breastfeeding Support with Breastfeeding Duration at 6 Months Highlights the importance of support and the foundation of our project Support at 3 months Some current research that we found that supports our project is: Support from care providers at the 3 month period was a big indicator of whether the mothers continued breastfeeding or not. Mothers returning to the labor force require support more than other mothers because if the are not given the time to express their milk then they are most likely to discontinue breastfeeding and begin bottle feeding. Which can have significant impacts on both mom and baby.

Current Research Exclusive breastfeeding: motivations and disincentives for nursing mothers in Eldorado do Sul, Brazil Lack of support could lead a mother to discontinue breastfeeding Some more research that really advocates for breastfeeding mother support was conducted in Eldorado do Sul, Brazil. This research looked at the motivations and barriers to breastfeeding continuation. One of the biggest barriers was again support of the breastfeeding mother.

Alternative Interventions Increasing Breastfeeding Rates: Evidence-based practice. Question: “In low income postpartum women, how does telephone breast feeding support compared to standard care affect breastfeeding rates within a 6 month period from delivery of a term newborn?” Method: weekly calls for the first 3 months after giving birth. Findings: A 35% increase in the exclusive breastfeeding rate. Source:

Alternative Interventions Social marketing: Commercials that convey feelings and help with gearing people’s assumptions and opinions about a determined topic, such as breastfeeding. The Centers for Disease Control published that television commercials were the most effective in changing attitudes towards breastfeeding and increased breastfeeding initiation (CDC, n/d). Source:http://www.leicspart.nhs.uk/_OurServicesAZ-BreastfeedingandInfantFeedingsupport.aspx

Interventions: Limitations/ Barriers Changing the norms and traditions Breast feeding is viewed as “Improper” “indecent” Changing personal beliefs Some mothers who formula feed felt offended and defensive Many were not aware of the new breastfeeding law allowing breast feeding in public places Lacking Role models Lack of knowledge Lack of media encouraging breast feeding. Describe barriers encountered during the implementation phase and how they were addressed. Rosa Shu Many moms want to openly breast feed but feel alone or shy. If there were mothers openly breast feeding more mothers would be encouraged to as well Some females stated concerns over their husbands seeing other female breast ome females stated concerns over their husbands seeing other female breast

How Were the Limitations and Barriers Addressed? EDUCATION !!! Teaching the benefits of breastfeeding Acknowledge the aggregate personal feeling and beliefs Peaceful and respectful approach Benefits to their businesses (advertising and attracting customers) Rosa Shu

Evaluation Process Recording responses of business owners for placing sign or rejecting the sign

Evaluation Process Recording responses for day care center education

Evaluation Process Revisited businesses signed before August 2014

Evaluation Goal Met or not met Accomplishment 40 new businesses met 50% of businesses surveyed not met 24% Advertising at ODU School facebook site and Health news letter One lactation room added at TCC and ODU Did not add any extra rooms Increase child care facility participants increased to 15 participants

Limitations of Evaluations Personal belief of breast feeding

Limitations to Evaluation Snow!!! Distances between business

Limitations to Evaluation Decision makers not available and/or not getting a response back Some businesses did not see the benefit -TCC didn’t see benefit

Recommendations Effective communication among the students Make sure signage is properly displayed

Recommendations Make day care teaching more enjoyable Decorate ODU lactation room New lactation room for Health Science building

Recommendation Information given to new coming students Narrow focus to fewer projects greater results

Implications for Community Health Nursing To bring awareness to community To educate the public about benefits

Implications for Community Health Nursing Make environmental cues to encourage breast feeding mothers

References Batan, M., Li, R., & Scanlon, K. (2013). Association of child care providers breastfeeding support with breastfeeding duration at 6 months. Maternal And Child Health Journal, 17(4), 708-713. doi:10.1007/s10995-012-1050-7 Center for Disease Control. n/d. Media and Social marketing. The CDC Guide to Breastfeeding Interventions. Retrieved from http://www.cdc.gov/breastfeeding/pdf/BF_guide_6.pdf Consortium for Infant and Child Health.Breastfeeding welcome here. Retrieved from http://www.cinchcoalition.org/file/BUSINESS%20PACKET%20FINAL.pdf Flannery, V. (2014). Increasing Breastfeeding Rates: Evidence-Based Strategies. International Journal Of Childbirth Education, 29(4), 59-62. Schardosim, J. M., & Rauber Cechim, P. L. (2013). Exclusive breastfeeding: motivations and disincentives for nursing mothers in Eldorado do Sul, Brazil. Investigacion & Educacion En Enfermeria, 31(3), 377-384. Flannery, V. (2014). Increasing Breastfeeding Rates: Evidence-Based Strategies. International Journal Of Childbirth Education, 29(4), 59-62. Schardosim, J. M., & Rauber Cechim, P. L. (2013). Exclusive breastfeeding: motivations and disincentives for nursing mothers in Eldorado do Sul, Brazil. Investigacion & Educacion En Enfermeria, 31(3), 377-38