System-based approach reduces racial disparities in breastfeeding

Despite efforts to reduce racial disparities in maternal child heath care, Black women die during pregnancy, childbirth, and the first year postpartum at nearly four times the rate of White women. Black babies are more than twice as likely as White babies to die before they turn one. And breastfeeding rates among Black women are lower than those in White.

Since 2014, the CHAMPS (Communities and Hospitals Advancing Maternity Practices) initiative has been doing something about that.

The W.K. Kellogg Foundation awarded Boston Medical Center (BMC) a $2,125,000 three-year grant for the program which improves maternal child health outcomes through the promotion of Baby-Friendly practices in Mississippi, New Orleans, Texas, and Southern Tennessee. In 2017, CHAMPS secured three more years of funding from the Kellogg Foundation and the Bower Foundation to increase the number of Baby-Friendly hospitals in Mississippi.

CHAMPS Project Director Anne Merewood, PhD, MPH, IBCLC worked mainly as a researcher in breastfeeding for 15 years.

“Eventually, I got fed up doing one more research project to prove that breastfeeding is good for babies,” she says. Instead, she now focuses on “action and implementation.”

In 2017, Dr. Merewood launched CHEER, the Center for Health Equity, Education and Research at BMC which oversees the Baby-Friendly projects as well as a growing body of work in Indian Country.

Dr. Merewood points out that it takes an average of 17 years before research integrates into policy and practice. CHAMPS has made tremendous progress around reducing racial inequities in just three years.

Breastfeeding initiation in the U.S. rose from 80% to 81% between 2012 and 2013, but Mississippi’s rate fell from 59% to 52%, Dr. Merewood notes in her 2016 American Public Health Association (APHA) Annual Meeting presentation CHAMPS Initiative and Improved Compliance with the Ten Steps to Successful Breastfeeding in the South.

In 2013, Mississippi had the lowest breastfeeding rates in the nation, the lowest mPINC score and ranked last on the CDC’s breastfeeding report card.

Also in CHAMPS Initiative and Improved Compliance with the Ten Steps to Successful Breastfeeding in the South, Dr. Merewood reports that prior to CHAMPS enrollment, none of the hospitals reported data by race or correctly defined or charted skin-to-skin or rooming-in.

But between January and December 2015, twenty five of 31 CHAMPS hospitals in Mississippi, Louisiana, Texas, and Tennessee collected and submitted data. The results:

  •         “Average breastfeeding initiation rose from 64% to 72% (all races), and from 50% to 61% (blacks).
  •         Exclusive breastfeeding rose from 32% to 36% (all) and from 10% to 23% (blacks).
  •         Skin-to-skin rose from 42% to 50% in vaginal births, and from 8% to 35% post-cesarean.
  •         In Mississippi CHAMPS-enrolled hospitals, breastfeeding initiation rates rose from 49% to 62%; from 69% to 77% among white individuals, and from 33% to 45% among black individuals.”

Rigorous data collection has allowed institutions to recognize and address racism, although there’s still a lot of progress to be made.

“There’s an awful lot of institutional racism and it needs to be figured out,” says Dr. Merewood.

All this activity has led to tremendous momentum in Mississippi; now 80% of Mississippi’s 43 birthing hospitals are on the Baby-Friendly Hospital Initiative’s 4D pathway to designation.

In December 2015, Mississippi’s first Baby-Friendly Hospital was designated. That same month, Mississippi opened a human milk bank. In February 2016, the first Lactation Counselor Training Course in the state took place. In April 2016, the first Baby Café opened. Since its infancy, CHAMPS has trained over 40 Reaching Our Sisters Everywhere (ROSE) Community Transformers.

CHAMPS also works in Indian Country where hospitals are generally severely under resourced; they lack federal funding, they suffer from remoteness and high staff turnover and they serve high-risk populations. Dr. Merewood served as Baby-Friendly consultant to the Indian Health Service (IHS), and 100% of federally funded IHS birthing hospitals are now Baby-Friendly designated.

IHS accomplishments are “an example for the nation,” Dr. Merewood states in a WKKF article.

Through its American Indian and Alaska Native Communities and Hospitals Advancing Maternity Practices (AI/AN CHAMPS) project, the group has helped four out of five tribally run birthing hospitals become Baby-Friendly designated and is now working with all Alaska Native hospitals to implement the Ten Steps.

“We found a winning solution with CHAMPS and the same with Indian Country,” Dr. Merewood says. “The way to go is regional. Once you get momentum going, everyone gets on board and things move much more quickly.”

A geographic or system-based focus has proven effective along with the formation of partnerships. CHAMPS team members and participants have collaborated with state health departments, WIC, the Mississippi Perinatal Quality Collaborative and Blue Cross & Blue Shield of Mississippi for example.

In fact, Blue Cross Blue Shield’s Quality Model requires all delivering network hospitals across Mississippi to gain Baby-Friendly designation as part of criteria for achieving Blue Distinction for maternity care. [More here:]

With the launch of CHEER, the team is now working on a broad range of projects: drug abuse prevention, Community Health Assessments in tribal communities, enhancement of prenatal care, domestic violence prevention, suicide prevention and technical assistance especially in tribal communities. CHEER partners with the Indian Health Service (Billings area), the Rocky Mountain Tribal Epidemiology Center in Billings, Montana and the Blackfeet, Northern Cheyenne and Chippewa Cree tribes.

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