Increasing Breastfeeding Exclusivity and Duration: New York City's Multilevel Approach

I was delighted to have the opportunity to say a few words on behalf of the New York City Department of Health and Mental Hygiene at the Third Annual Summit on Breastfeeding.

As you know, breastfeeding confers many health benefits—for infants and mothers. That is why the Department encourages every new mother to breastfeed exclusively for the first 6 months. We would like all mothers to continue to breastfeed while adding supplementary foods during the second 6 months. Although we are making progress in New York City, we are not yet where we want to be.

Almost 87% of our new mothers initiate breastfeeding (New York City Pregnancy Risk Assessment Monitoring System [PRAMS], 2008, unpublished data). That is higher than in the United States as a whole, in which 75% of infants start on breastmilk. ¹ However, far too many mothers quickly switch to formula. Only 68% of New York City mothers continue breastfeeding for 8 weeks or longer, and only 36% breastfeed exclusively for 8 or more weeks (New York City PRAMS, 2008, unpublished data). At 6 months, only 13% of mothers in New York City are still exclusively breastfeeding. ¹ These numbers are disturbingly low, so we have developed a strategy to increase not only breastfeeding initiation but also—most importantly—duration and exclusivity.

First, we are working with hospitals to help them achieve the Ten Steps to Successful Breastfeeding, outlined in the 1989 Joint World Health Organization/UNICEF statement, ² required to become officially designated as Baby-Friendly. We now have two Baby-Friendly Hospitals in New York City, and seven additional hospitals are moving along the Baby-Friendly pathway. We know that many New York City hospitals are still providing free formula to breastfeeding mothers. In the New York City PRAMS data, 83% of women who said they had ever breastfed received a gift pack with formula in the hospital.

Second, we have launched a campaign to remind hospitals that State regulations prohibit them from distributing formula discharge packs without a specific mother's request or a doctor's order. We are also working with the New York State Department of Health to track data on infant feeding at hospital discharge.

Third, we are encouraging employers to make breastfeeding easier in the workplace. I am proud to say that the New York City Department of Health and Mental Hygiene is setting an example by being the first New York City government agency to establish a workplace lactation room and breast pump loaner program for our employees. We are helping other City agencies set up workplace lactation programs for their employees.

Let me briefly point out a few other things that we are doing to promote breastfeeding:

Our Newborn Home Visiting Program recruits new mothers from five hospitals in New York City and provides home visits to low-income breastfeeding mothers within 72 hours after discharge from the hospital. During the visits, the public health advisors provide education and instruction on breastfeeding. We reach some 200 mothers for initial home visits each month and another 100 for follow-up breastfeeding support visits. In 2010, we completed more than 5,800 visits (Newborn Home Visiting Program, Bureau of Maternal, Infant and Reproductive Health, New York City Department of Health and Mental Hygiene, 2010, unpublished data).

Finally, our Nurse Family Partnership Program has provided prenatal and postnatal breastfeeding support to more than 2,200 families in high-need communities in all five boroughs (Nurse Family Partnership Program, Bureau of Maternal, Infant and Reproductive Health, New York City Department of Health and Mental Hygiene, 2010, unpublished data).

Overall, breastfeeding is important to us at the New York City Department of Health and Mental Hygiene because it is important to the health of mothers and their infants and to their infants' futures. I hope you can find creative ways to promote breastfeeding in your communities, and we can all succeed together.