Abstract
In Maryland, we have about a third of low-income children overweight or obese between the ages of 2 and 4, it remains a problem through childhood, and about 60% of Maryland adults are overweight or obese. Of course, Maryland is not alone. It's a national challenge.
We have room to improve to meet the 2020 breastfeeding objectives. We are somewhat close on ever-breastfed, but we are about 15 points behind on breastfed at 6 months and about 20% off breastfed at 1 year.
We participate in the PRAM [Pregnancy Risk Assessment Monitoring System] study, which is a representative study of moms. About 62% breastfeed for 8 weeks or more, and it goes down from there. In terms of characteristics of the 20% of mothers who never breastfeed in Maryland, they generally tend to be younger and less educated.
You're all very familiar with the Surgeon General's Call. I'll just tell you my own experience with this. I was a resident at Boston Medical Center when the hospital really made a commitment to breastfeeding, and I really saw that all across the hospital. That's how I trained. I don't know how many of you met Bobbi Philipp, who is the pediatrician that really championed that. But really I learned a lot from her, not just about breastfeeding in general, but also about how you change a culture and make things different within an institution.
Moving on to a couple of steps that we're taking in Maryland. In 2010, tax exemption for supplies for breastfeeding and pumping was established. WIC [Special Nutrition Program for Women, Infants, and Children] has made a major commitment to breastfeeding in Maryland, which included establishing breastfeeding coordinators, supporting peer counseling, and hiring 20 lactation consultants, and there has been a dramatic increase within the WIC population. That's probably driving the improvement in Maryland overall. Our WIC program, which is internal to the Department of Health, is really the lead for breastfeeding.
Our state education department has worked to establish breastfeeding support in childcare settings, including feeding standards, professional development, and ensuring onsite accommodations for breastfeeding within childcare. We have a program where we support healthy workplaces, and breastfeeding is a part of that. There are hundreds of businesses that participate and get information from us about breastfeeding.
On June 1, the Governor announced that there would be a model breastfeeding policy for the state agencies and that would be tracked in the State of Maryland. That is one of the items that we are looking forward to being engaged in.
Then you have hospitals. We clearly have recognized from the suboptimal hospital breastfeeding scores that we need to make improvement in this area. I think the hospitals recognize that as well.
What we did was put out draft policy recommendations for hospitals and asked for public comment. The Maryland Hospital Association was supportive of some action but took the position that whatever we did, we should not require hospitals to achieve “Baby-Friendly” status. That was the Hospital Association's position, although there were a number of comments saying we should support Baby-Friendly. We received over 130 comments, we will probably be coming out with another draft approach, and we'll have to figure out how we position Baby-Friendly either by itself or with other recommendations.
One of the things I've learned is that the regulatory process is a journey. It's not just the end. In the course of a regulatory process, you can do quite a lot of education. So when we went out and posted our draft recommendations, there was a flurry of news stories, and a whole bunch of hospitals called us and said they were going for Baby-Friendly and just wanted to let us know.
People said, “Well, why don't you just adopt them and enforce them?” Well, these things are a balance. Sometimes you eventually get there. But I think every time we do this, we're going to get closer. We're going to increase the understanding a bit of where we are and where we need to go. You have to be true to where you're going, but you don't have to immediately rush there. You can build quite a lot of support for smart policy along the way.
Disclosure Statement
No competing financial interests exist.