making the most of d’s reastfeeding data and resources€¦ · • annually from 2007-2014 •...
TRANSCRIPT
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Centers for Disease Control and Prevention
National Center for Chronic Disease Prevention and Health Promotion
MAKING THE MOST OF CDC’S BREASTFEEDING DATA AND RESOURCES
Division of Nutrition, Physical Activity, and Obesity
Erica H. Anstey, PhD, MA, CLCMcKing Consulting Corporation
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• I have no financial relationships with commercial interests that pertain to the content presented in this program.
• The information in this presentation is that of the authors and does not necessarily represent the official position of the Centers for Disease Control and Prevention
DISCLOSURES: NONE
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• Describe CDC’s primary breastfeeding surveillance activities and the latest breastfeeding rates
• Explain the National Immunization Survey and breastfeeding rates
• Demonstrate how to use CDC breastfeeding data to examine breastfeeding rates in your states over time
• Describe the Maternity Practices in Infant Nutrition and Care (mPINC) survey and reports
• Share CDC breastfeeding resources
• Q&A
OVERVIEW
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DNPAO STRATEGIC PRIORITIES
Reaching All Americans Across the Lifespan by Supporting
▪ Breastfeeding
▪ Maternal, Infant & Toddler Nutrition
▪ Vitamins & Minerals
Adults & Older
Adults Maintaining
a Healthy Lifestyle
Children & Youth
Growing Up Strong
& Healthy
A Healthy Start
for Infants
▪ Good Nutrition & Healthy Food Environments
▪ Physical Activity & Access to Environments
Designed for Physical Activity
▪ Healthy Weight Management & Obesity
Prevention
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Low rates of breastfeeding add
more than $3 billion a year to
medical costs for the mother and
child in the United States
Only 1 in 4 infants is exclusively breastfed as
recommended by the time they are 6 months old
BREASTFEEDING
Black infants are 15% less
likely to have ever been
breastfed than white infants
1in4
The Problem
Bartick, M. C., Schwarz, E. B., Green, B. D., et al. (2016), Suboptimal breastfeeding in the United States: Maternal and pediatric health outcomes and costs, Maternal & Child Nutrition.
https://www.cdc.gov/breastfeeding/data/nis_data/results.html
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CDC’S STRATEGIES TO SUPPORT BREASTFEEDING
Our GoalWe want to ensure that if a mom wants to breastfeed, she has the supports in place to start and continue to do so
Improve Hospital Support for
Breastfeeding
1 32
Improve Support for Employed Women
Improve Community Support for
Breastfeeding
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NATIONAL OBJECTIVES AND BREASTFEEDING RATES IN THE U.S.
THE STATE OF BREASTFEEDING
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MICH: Maternal, Infant, and Child Health
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U.S. BREASTFEEDING RATES AMONG CHILDREN BORN IN 2009–2016
76.1 76.7 79.2 80.0 81.1 82.5 83.2 83.8
46.6 47.5 49.4 51.4 51.8 55.3 57.6 57.3
24.6 25.3 26.7 29.2 30.733.7 35.9 36.2
0
20
40
60
80
100
2009 2010 2011 2012 2013 2014 2015 2016
Data Source: National Immunization
%
Ever
6 months
12 months
https://www.cdc.gov/breastfeeding/data/nis_data/results.html
Year of birth
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U.S. EXCLUSIVE BREASTFEEDING RATES AMONG CHILDREN BORN IN 2009–2016
35.9 37.1 40.7 43.3 44.4 46.6 46.9 47.5
15.6 17.2 18.8 21.9 22.3 24.9 24.9 25.4
0
20
40
60
80
100
2009 2010 2011 2012 2013 2014 2015 2016
Data Source: National Immunization
% Exclusive3 months
Exclusive6 months
https://www.cdc.gov/breastfeeding/data/nis_data/results.html
Year of birth
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U.S. BREASTFED INFANTS WHO WERE SUPPLEMENTED WITH INFANT FORMULA
23.3 22.819.4 19.1 17.1 15.5 17.2 16.9
35.9 35.4 31.5 29.3 29.2 27.8 28.8 29.1
43.3 42.837.9 35.4 34.9 33.8 34.5 33.5
0
20
40
60
80
100
2009 2010 2011 2012 2013 2014 2015 2016
Data Source: National Immunization
%
Before 2 days
https://www.cdc.gov/breastfeeding/data/nis_data/results.html
Year of birth
Before 3 months
Before 6 months
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MORE BIRTHS ARE OCCURRING IN HOSPITALS THAT SUPPORT BREASTFEEDING
26%
2%
0% 10% 20% 30%
Percentage of Babies born in
Baby-Friendly facilities in the US,
2007-2018
2018
2007500 Baby-Friendly
Facilities in the
United States!
https://www.cdc.gov/nccdphp/dnpao/data-trends-maps/index.html
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MICH: Maternal, Infant, and Child Health
†Source: https://www.cdc.gov/breastfeeding/data/nis_data/results.html
57.3%
25.4%
16.9%
Current†
36.2%
47.5%
83.8%
51.0%
26.1%
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Breastfeeding rates are
rising overall, but
disparities remain:74.0
82.9 86.6
0
20
40
60
80
100
NH Black
Infants
Hispanic
Infants
NH White
Infants
Breastfeeding Initiation Rates by Race and Ethnicity in the U.S. – 2016
Percent Ever Breastfed
DISPARITIES EXIST IN BREASTFEEDING RATES BY RACE AND ETHNICITY
https://www.cdc.gov/breastfeeding/data/nis_data/results.html
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Breastfeeding rates are
rising overall, but
disparities remain:
20.7 20.429.1
0
20
40
60
80
100
NH Black
Infants
Hispanic
Infants
NH White
Infants
Exclusive Breastfeeding Through 6 mo., by Race and Ethnicity in the U.S. – 2016
DISPARITIES EXIST IN BREASTFEEDING RATES BY RACE AND ETHNICITY
https://www.cdc.gov/breastfeeding/data/nis_data/results.html
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USING NATIONAL AND STATE LEVEL BREASTFEEDING DATA
BREASTFEEDING RATES
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• Household, population-based estimates of vaccination coverage among children & teens
• Breastfeeding questions added in 2001
• Telephone interviews with parents or guardians in 50 states, D.C., and some U.S. territories
• Breastfeeding data are obtained by maternal recall when children are between 19 to 35 months of age
• From 2002-2008 - landline sampling frame
• Starting in 2009 - dual-frame sample (landline or cellular)
• National and state estimates
• Initiation, duration, exclusivity
• Demographic characteristics
NATIONAL IMMUNIZATION SURVEY (NIS)
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1. Was [child] ever breastfed or fed breast milk?
2. How old was [child's name] when [child's name] completely stopped breastfeeding or being fed breast milk?
3. How old was [child's name] when (he/she) was first fed formula?
4. This next question is about the first thing that [child] was given other than breast milk or formula. Please include juice, cow's milk, sugar water, baby food, or anything else that [child] may have been given, even water. How old was [child's name] when (he/she) was first fed anything other than breast milk or formula?
NIS BREASTFEEDING QUESTIONS
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WHAT IS THE DENOMINATOR FOR THE BREASTFEEDING RATES?
NIS breastfeeding rates are among all infants born in the year specified EXCEPT for % of breastfed infants introduced to formula, which is among only breastfed infants
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• Why are there differences in breastfeeding rates by state from year to year?
• Sample sizes are relatively small, so there is a wide margin of error around state-level estimates
• Statistical tests of change show the differences by state from one year to the next – these are generally not significant
• States should look at trends in rates over several years
NATIONAL IMMUNIZATION SURVEY (NIS)
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• Why does the NIS data seem so behind and out-of-date?
• 2019 rates are among children born in 2016, which includes data from the 2017 and 2018 survey years
• To capture breastfeeding duration, the data are obtained by maternal recall when children are between 19 to 35 months of age
• We analyze the data by birth year rather than survey year, which has more public health relevance
NATIONAL IMMUNIZATION SURVEY (NIS)
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USING NATIONAL AND STATE LEVEL BREASTFEEDING DATA
BREASTFEEDING RATES
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• Provides state-by-state data
• breastfeeding initiation, duration, & exclusivity
• formula before 2 days of age
• births at Baby-Friendly hospitals
• Annually from 2007-2014
• Every other year starting in 2014
• Annual data is available online for some indicators
• Helps public health practitioners, policy makers, health professionals, and community members
BREASTFEEDING REPORT CARD
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PUTTING THE BREASTFEEDING REPORT CARDTO USE
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• DNPAO provides interactive state-by-state and national data via clickable maps, charts, and tables
• Provides the most recent health and behavior data, including breastfeeding
• Rates
• mPINC scores
• Births at Baby-Friendly facilities
• Export data & save visualizations
• NOTE: 2016 data will be available soon
BREASTFEEDING DATA, TRENDS, AND MAPS
https://www.cdc.gov/nccdphp/dnpao/data-trends-maps
Select a topic to see nationwide maps, charts, and tables
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PUTTING DATA, TRENDS, AND MAPS TO USE
https://www.cdc.gov/nccdphp/dnpao/data-trends-maps/index.html
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USING MPINC STATE REPORTS
MATERNITY CARE PRACTICES
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• Assessment of maternity care practices in the usual care of healthy, term infants and their healthy mothers.
• Biennial census (from 2007-2015) of all hospitals and birth centers that provide maternity care services.
• Redesigned in 2018
• Hospitals only
• Online only
• Data are currently being analyzed
MPINC SURVEY OVERVIEW
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• Hospital demographic information
• Skin-to-skin
• Rooming-in
• Feeding Practices
• Feeding Education
• Staff Competency
• Management procedures
• Policies
• Emerging topics (e.g., Neonatal Abstinence Syndrome)
MPINC SURVEY – TOPICS INCLUDED
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• Benchmark Reports• Customized report for each participating
hospital
• Compares hospital practice to other hospitals in U.S., state, of similar size
• Stimulates improved practice
• Hard copies mailed to administrators and managers
MPINC BENCHMARK REPORTS
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• State Reports• Summarize strengths &
areas in need of improvement.
• Comprehensive frequency tables by state & facility type
• Emailed to state-level organizations & others
MPINC STATE REPORTS
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• Use the mPINC survey to guide quality improvement work
• Set benchmarks
• Define data collection processes (review and analyze frequently)
• Get leadership and administration buy-in
• Identify opportunities for improvement
• Aim to improve equitable care
• Use Plan-Do-Study-Act, or PDSA models, to make incremental changes
• Help hospitals meet Joint Commission Perinatal Care Core Measure breastfeeding requirements
MAKING USE OF MPINC DATA
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MPINC TOTAL SCORES – 2007-2015*
CDC Survey ofMaternity Practices in Infant Nutrition and CaremPINC
63 6570
7579
0
10
20
30
40
50
60
70
80
90
100
2007 2009 2011 2013 2015
%
*Please Note: 2018 mPINCscores will not be comparable to previous scores.
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• Examine differences in breastfeeding rates by various socio-demographic factors
• Examine trends in breastfeeding rates over time
• Use the data to make comparisons you haven’t seen before and find your story
• Compare to the peer state your legislators talk about by name
• Encourage hospitals to integrate maternity care into related quality improvement efforts & track quality measures to drive improvement
• Identify low-hanging fruit and make small, incremental changes
• Establish programs that recognize hospital and community efforts that improve breastfeeding rates
• Celebrate successes!
SUMMARY: PUT CDC BREASTFEEDING DATA TO USE
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BREASTFEEDING WEB RESOURCES
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https://www.cdc.gov/breastfeeding/breastfeeding-special-circumstances
BREASTFEEDING WEB RESOURCES
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https://www.cdc.gov/breastfeeding/breastfeeding-special-circumstances
BREASTFEEDING WEB RESOURCES
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https://www.cdc.gov/breastfeeding/breastfeeding-special-circumstances
BREASTFEEDING WEB RESOURCES
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https://www.cdc.gov/features/disasters-infant-feeding/index.html
• Parents/Caregivers
• Breastfeeding
• Formula Feeding
• Emergency Relief Workers
• Healthcare Providers
• CDC Resources
• Other Resources
DISASTER PLANNING
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FACT SHEETS AND REPORTS
https://www.cdc.gov/breastfeeding/resources/index.htm
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MAKE BREASTFEEDING RESOURCES WIDELY AVAILABLE
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Storage and Preparation of Breast Milk handout
Human Milk Storage Guidelines Magnet
https://www.cdc.gov/breastfeeding/recommendations/handling_breastmilk.htm
Also in Spanish!
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HOW TO CLEAN, SANITIZE, AND STORE INFANT FEEDING ITEMS
https://www.cdc.gov/healthywater/hygiene/healthychildcare/infantfeeding/cleansanitize.html
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RESOURCES TO SHARE WITH MOTHERS
https://www.cdc.gov/nutrition/infantandtoddlernutrition/breastfeeding/index.html
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• CDC offers a free Web Content Syndication service that gives public health partners the opportunity to syndicate CDC content directly to their sites without having to monitor or copy updates. Below is a list of breastfeeding content available for syndication.
• Is It Safe for Mothers Who Use Marijuana to Breastfeed?
• Breastfeeding Report Card
• Maternity Practices in Infant Nutrition and Care (mPINC) Survey
• How to Keep Your Breast Pump Kit Clean
• How to Clean, Sanitize, and Store Infant Feeding Items
• Proper Storage and Preparation of Breast Milk
• Infant and Toddler Nutrition Microsite
SYNDICATION
https://www.cdc.gov/breastfeeding/resources/syndicated-content.html
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DNPAO ONLINE RESOURCES
Data Trends and Maps
https://www.cdc.gov/nccdphp/dnpao/data-trends-
maps/index.html
State Community Health Media Center
Collection of free and low-cost, audience-tested
advertising and support materials
https://nccd.cdc.gov/schmc/apps/overview.aspx
DNPAO Facebook Page
Facebook.com/CDCEatWellBeActive
DNPAO Twitter
@CDCObesity
@CDCMakeHealthEZ
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Centers for Disease Control and Prevention
National Center for Chronic Disease Prevention and Health Promotion
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
Division of Nutrition, Physical Activity, and Obesity (DNPAO)
QUESTIONS? THANK YOU!