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ESPHL PROJECT HIGHLIGHTS
WASHINGTON
July 2014
Team Members:
John Wiesman *
Randi Becker
Christopher Blake
Kathleen Buchli
Eileen Cody
Kelly Cooper
Jason McGill
Jennifer McNamara
Janis Snoey
* Team Leader
For additional information, contact:
Jennifer McNamara Deputy Assistant Secretary
Prevention and Health Division Washington State Department of
Health
[email protected]
States policies shape where we live, learn, work, and play, and
impact the publics health. While there is evidence
for what works to improve populations health outcomes, many
states lack robust partnerships capable of
mobilizing stakeholders, re-examining existing legal models, and
innovating through statue and regulation. The
Excellence in State Public Health Law (ESPHL) program sought to
strengthen the relationships among health
policy decision-makers in and among selected states and to
increase the ability of these states to understand how
policy could improve the publics health. States determined their
own priorities, and ESPHL did not pre-
determine states outcomes.
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Breastfeeding is a primary prevention public health strategy,
positively impacting the health of both babies and mothers. In
Washington State, most mothers (about 88%) report breastfeeding
their baby at some point. However, only 20% of mothers report
following the recommendation from the American Academy of
Pediatrics to exclusively breastfeed until their baby is six months
old. Research has shown that mothers are more likely to initiate
and continue breastfeeding when hospital maternity practices and
policies support breastfeeding. The goal established by the
Washington State Excellence in State Public Health Law (ESPHL)*
team was for every birthing hospital in Washington to establish and
implement maternity care practices that reflect the Baby-Friendly
Ten Steps to Successful Breastfeeding, as developed by the World
Health Organization. Key strategies were to implement a voluntary
recognition program for hospitals called Washington Steps Up for
Breastfeeding Success!; increase the visibility of breastfeeding as
an important public health strategy related to other priorities
such as childhood obesity prevention; and explore the possibility
of policies that would further these goals. A baby-friendly or
breastfeeding-friendly hospital sounds like an oxymoron to those
who arent intimately involved with maternity care practices in
birthing hospitals. How could a hospital not be baby or
breastfeeding-friendly? For several on Washingtons ESPHL team, the
problem was a revelation. For all on the team, the solution was
unifying; we could support hospitals to become
breastfeeding-friendly by helping them implement the Ten Steps to
Successful Breastfeeding. Another motivating factor was the link
between breastfeeding and childhood obesity. The Maternity
Practices in Infant Nutrition and Care in Washington Survey (mPINC)
from the Centers for Disease Control and Prevention (CDC) is a
survey of all birthing hospitals in Washington about their
maternity care practices. Questions are grouped into seven sections
by dimensions of care (such as feeding of infants, breastfeeding
assistance, and staff training) and each section is scored based on
the percent of hospitals reporting ideal responses to the
questions. Washingtons score in 2011 was 77 out of 100 (9th best in
the country). By cross-walking the mPINC with the Ten Steps to
Successful Breastfeeding we were able to see which steps hospitals
in
* ESPHL, a program of the Aspen Institute Justice & Society
Program, was made possible by a grant from the Robert Wood Johnson
Foundation.
Ten Steps to Successful
Breastfeeding:
1. Have a written
breastfeeding policy that is
routinely communicated to
all healthcare staff.
2. Train all healthcare staff in
skills necessary to
implement this policy.
3. Inform all pregnant women
about the benefits and
management of
breastfeeding.
4. Help all mothers initiate
breastfeeding within one
hour of birth.
5. Show mothers how to
breastfeed and how to
maintain lactation even if
they should be separated
from their infants.
6. Give newborns no food or
drink other than breast
milk, unless medically
indicated.
7. Practice rooming-in;
allowing mothers and
infants to remain together
24 hours a day.
8. Encourage breastfeeding
on demand.
9. Give no artificial teats or
pacifiers.
10. Foster the establishment of
breastfeeding support
groups and refer mothers
to them upon discharge
from the hospital.
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Washington were having trouble with. We quickly found a strong
partnership with the Washington State Hospital Association (WSHA).
WSHA is a membership organization representing community hospitals
and other health-related organizations. They are a well-respected
organization with a finger on the pulse of their members needs and
interests. We also continued our partnership with WithinReach, a
community-based organization serving families and children in
Washington. Breastfeeding is a priority of WithinReach and they
participate in the Department of Healths Breastfeeding Workgroup.
We used our technical assistance funding from the ESPHL program to
contract with WithinReach to convene staff members from various
hospitals in two community meetings. These meetings helped
determine what would motivate hospitals to participate in
Breastfeeding-Friendly Washington and make decisions about visual
marketing.
Through convening stakeholders and talking with prospective
parents, the ESPHL team identified a three-tier designation system
(bronze, silver, and gold) and designed a visual recognition symbol
for the marketing materials to promote that system. We are working
on creating a presence on the Department of Healths website to
educate parents and providers about breastfeeding, and we are also
setting up an online application system for hospitals to apply for
recognition. We plan to identify ways to share the mPINC data
analysis and continue to mine it for strategies to support
hospitals in becoming breastfeeding friendly. We are also working
on identifying the number of hospitals that would fall into each of
the three recognition tiers so we can identify metrics for the
Breastfeeding-Friendly Washington program. We hope to encourage
hospitals to use it as a leveraging point for achieving the
Baby-Friendly accreditation. What we learn through the hospital
recognition program will help us identify and quantify the need for
additional resources if and when we expand to recognize provider
offices, employers, and day care centers that take steps to support
breastfeeding.
Our ESPHL project has helped elevate the importance of
breastfeeding in Washington State, specifically the need for
breastfeeding-friendly environments. This concept has strong
policymaker support and is now a key component in Governor Jay
Inslees Healthiest Next Generation initiative to support healthy
weight in children.
In our department, we have a
strategy around how we do our
work, which basically says, through
collaborations and partnerships,
we leverage knowledge, resources,
and relationships to create
healthier choices and communities.
Being able to very quickly build
relationships with our state elected
officials and their staffers, around
supporting breastfeeding-friendly
hospitals, was remarkable.
- Dr. John Wiesman,
Secretary of Health,
Washington State
Department of Health
