The State Maternal and Child Health/Title V Agencies Support Breastfeeding: Surveillance and Programs

Introduction

The Association of Maternal and Child Health Programs (AMCHP) is a national resource, partner, and advocate for state and territorial public health leaders and others working to improve the health of women, children, youth, and families. Our members come from the highest levels of state government and include directors of maternal and child health programs, directors of programs for children with special healthcare needs, and other public health leaders. AMCHP members directly serve more than 35 million people and strive to improve the health of all women, infants, children, and adolescents, including those with special healthcare needs, by administering critical public health education and screening services and coordinating preventive, primary, and specialty care. AMCHP builds successful programs by disseminating best practices, advocating on their behalf in Washington, providing technical assistance, convening leaders to share experiences and ideas, and advising states about involving partners to reach our common goal of healthy children, healthy families, and healthy communities.

Among its partners, AMCHP works closely with the Maternal and Child Health Bureau (MCHB), Health Resources and Services Administration, U.S. Department of Health and Human Services, the agency that administers the provisions of Title V. Title V (which was authorized as Title V of the Social Security Act in 1935) is the nation's oldest Federal program to improve the health of all mothers and children. It was converted to a Block Grant in 1981; states receive funding through Title V based on a formula.

Public Health Surveillance of Breastfeeding

Surveillance/monitoring is an essential public health service. Breastfeeding surveillance data that are collected by state health departments and reported to the federal government can help inform programs and policy. The Centers for Disease Control and Prevention sponsors an immunization survey (www.cdc.gov/nis/) that includes breastfeeding questions. Many states include breastfeeding questions on the Pregnancy Risk Assessment Monitoring System (PRAMS) surveys of postpartum women (www.cdc.gov/prams/cponder.htm). Some states have a question about breastfeeding initiation on their birth certificates and newborn metabolic screening tests. Breastfeeding data from many of these sources can be found on health departments' websites and in the MCHB Title V Information System (perfdata.hrsa.gov/MCHB/TVISReports/). The latter includes reports from each state on the percentage of mothers who breastfeed their infants at 6 months of age in their state. Many states use National Immunization Survey and/or PRAMS data for this report.

According to findings by Kogan et al., ¹ there is significant variation in both breastfeeding initiation and breastfeeding at 6 months by state of residence. There are also regional variations: Western and northwestern states had the highest rates, and southern states had the lowest. Additionally, Kogan et al. ¹ found that children living in states without legislation that supports and protects breastfeeding enacted before their birth were more likely to not be breastfed than those living in states with multiple laws.

State Health Department Breastfeeding Programs

Title V develops health systems to promote maternal and child health, and breastfeeding is part of this preventive care model approach. Examples of such programs, which are often administered in partnership with other programmatic areas in the health department, include:

The development of a web-based training course on breastfeeding to help healthcare workers better understand the potential impact that they have on the health of the community and to educate them on the basics of successful breastfeeding

The Public Health Division of the Oregon Department of Human Services is an example of a state agency that has shown national leadership in the development of programs to support breastfeeding. The state has among the highest breastfeeding initiation, duration, and exclusivity rates in the country. The Public Health Division has collaborated with numerous stakeholders to collectively address a supportive environment for breastfeeding (legislation that passed in 1999), worksite support for breastfeeding (legislation, tools, and recognition for businesses and to some degree child care, peer counseling [Special Supplemental Nutrition Program for Women, Infants and Children (WIC), nonprofit or volunteer groups]), and breast pump provision through WIC. Their job has been made easier by public support for breastfeeding. The law relating to expression of breastmilk at work, which passed in 2007 and went into effect January 1, 2008, is the strongest in the country guaranteeing workplace accommodation for breastfeeding mothers. The law applies to pumping breastmilk, addresses time and space needs, and provides a remedy for noncompliance. It covers 70% of the Oregon workforce and applies to full- and part-time workers.

Examples of programs in Oregon include:

Providing leadership through convening a meeting of interested stakeholders to address newborn hospital support for breastfeeding in Oregon.

Summary

State maternal and child health programs face many obstacles to increasing breastfeeding rates, including shrinking state budgets, siloed funding streams in public health, lack of designated breastfeeding staff at the state level beyond the WIC program, lack of designated maternal and child health nutrition staff in some states, public and private insurance programs that do not reimburse lactation consultants, and low adoption rates for Baby-Friendly hospitals. However, states also have many successes in comprehensive surveillance efforts that enable states to monitor breastfeeding rates and use data to inform programs and policies and in the development of numerous and creative partnerships to promote breastfeeding. It is only through these partnerships that we will reach our ultimate goal of improving the health of women, infants, and families.