2004 BREASTFEEDING SURVEY FINAL REPORT
Released for World Breastfeeding Week, August 1-7, 2005
By the Healthy Start Coalition of Sarasota County, Inc.
Executive Summary:
Overview. The 2004 Breastfeeding Survey was conducted the week of October 25-29, 2004, in 15 private and public pediatric health care settings in Sarasota County. Although the sample size was small (156 respondents), much of the data follows trends seen in the state of Florida and nationally. Data obtained from this survey can be used for needs assessment and evaluative purposes by the Healthy Start Coalition of Sarasota County, the Sarasota County Health Department, the WIC Program (Women, Infants and Children Nutrition Program), local hospitals, private and public maternal child health care providers, the La Leche League of Sarasota, and others.
Breastfeeding Data Partnership. The Breastfeeding Data Partnership (BDP) is a group of local agencies/organizations and individuals with an interest in or responsibility for breastfeeding promotion, education, and/or support. The BDP was initiated by the Healthy Start Coalition of Sarasota County in 2002 to begin collecting breastfeeding data in Sarasota County. This is the second survey conducted by the BDP in Sarasota County.
The Survey Tool. The survey, in English and Spanish, was designed to be administered to the parent of any child 0-14 months of age visiting a pediatric health care provider during the week of October 25-29, 2004. The original 2002 survey tool was field tested prior to use; the 2004 tool was slightly revised to focus on employment and breastfeeding.
Preparation for the Survey. Prior to the survey, the members of the BDP trained staff in the offices of the participating providers. The training included easy-to-read written instructions and a verbal review of the procedure. Brightly-colored reminder sheets were given to providers to post around the office during the survey week, and phone calls were made to remind office personnel to conduct the survey. The BDP members also provided technical assistance as needed during the week of the survey and collected the surveys at the end.
Results. One hundred-fifty six (156) surveys were completed and returned by fifteen pediatricians and pediatric clinics. ZIP code information shows that 86% of the respondents resided in Sarasota County; 12% in Manatee County; and 2% in Charlotte County. Of those residing in Sarasota County, there was distribution of ZIP codes throughout the county, with the majority occurring south of University Avenue to north of Vamo Road (south Sarasota County). Osprey, Nokomis, Venice, Warm Mineral Springs and North Port were also similarly represented.
Four (4) post-survey evaluation forms returned by pediatricians after the survey unanimously showed that 1) the survey was easy to administer, 2) the overall response of patient to the survey was positive, and 3) no changes or additions to the 2006 survey are necessary.
The Breastfeeding Data Partnership has summarized major findings below. More detailed information can be found in the Data Tables which start on page four.
MAJOR FINDINGS
1. Sarasota County has met the United States Department of Health and Human Services Healthy People 2010 breastfeeding initiation goal: Goal, 75%; Sarasota County, 79%.
2. Few (15%) Sarasota County infants are exclusively breastfed until six month of age[1].
3. African-American mothers in Sarasota County have the lowest breastfeeding rates.
4. The greatest influencers on breastfeeding are the mother herself, family, husband/partner and pediatrician, in that order.
5. Breastfeeding rates decline precipitously after the baby is two weeks old.
6. The mother’s knowledge of health benefits of breastfeeding increases confidence in breastfeeding; unresolved breastfeeding problems decrease confidence in breastfeeding.
7. There continues to be the incorrect perception that it is common for mothers to have insufficient milk supply.
8. Most employers in Sarasota County do not allow breastfeeding or pumping breastmilk at work.
9. The difficulties of breastfeeding or pumping breastmilk at work cause working mothers to supplement their baby’s breastfeeding with infant formula too early.
RECOMMENDATIONS
The Breastfeeding Data Partnership makes the following recommendations to all agencies, organizations, and individuals involved in maternal and child health. We hope that these same agencies, organizations, and individuals will work independently and collectively to implement the recommendations of the Breastfeeding Data Partnership found below.
Goal: To assure that infants, children, mothers, families, employers, and society obtain optimal benefits imparted by breastfeeding, by increasing the “any” breastfeeding rate in Sarasota County at 6 months of age from the present rate of 30% to 50% in 2006 by:
I. Improving availability of and access to breastfeeding support for issues and problems that arise during the baby’s first six months of life, such as:
§ Providing early and immediate post-discharge, face-to-face support for at-risk premature infants and other newborns.
§ Increasing the number of referrals by health care providers and self-referrals to available resources in the post-partum period when breastfeeding problems arise.
§ Assuring health care professionals, breastfeeding women, and the public understand the supply and demand dynamics of milk production, the rarity of true insufficient milk supply, and methods for increasing a mother’s milk supply.
II. Increasing initiation and duration rates among African-Americans by:
§ Targeting 3 major providers of prenatal care for African-American women in Sarasota County for intensive training on breastfeeding education and support.
§ Forming an African-American Work Group on Breastfeeding.
III. Educating employers about workplace breastfeeding support programs and assuring that resources are available to help them implement such programs.
§ Benefits to the employer: reduced employee absenteeism, increased productivity, increased company loyalty and morale, lower health care costs, improved employee retention
§ Development of a breastfeeding support program: facilities, policy, and education required for adequate, expanded or comprehensive support program components.
IV. Improving public and professional awareness of the 10 Steps to Successful Breastfeeding[2].
DATA TABLES
Table of Contents
|
Breastfeeding Rates for “Any” Breastfeeding……………………………………………… |
5 |
|
Exclusive Breastfeeding Rates in Sarasota County Compared to AAP Recommendations.. |
6 |
|
Race, Ethnicity and Exclusive Breastfeeding in Sarasota County…………………………. |
7 |
|
Race, Ethnicity and Combined Exclusive and Partial Breastfeeding in Sarasota County…. |
8 |
|
Influencers of the Decision to Breastfeed…………………………………………………... |
9 |
|
Sources of Breastfeeding Information……………………………………………………… |
10 |
|
Sarasota County Exclusive Plus Partial Breastfeeding Rate Decline over Baby’s 1st Year... |
11 |
|
Obstacles to Initiation and Continuation of Breastfeeding……………………………….. |
12 |
|
Major Factors that Influenced Maternal Breastfeeding…………………………………….. |
13 |
|
Enrollment of Respondents in WIC and Healthy Start and Breastfeeding Rates for Each Category…………………………………………………………………………………….. |
14 |
|
Breastfeeding Rates for Respondents Who Talked with or Met with a Lactation Consultant or Attended a Breastfeeding Class…………………………………………… |
15 |
|
Top Six Reasons Respondents Chose to Supplement with Infant Formula………………... |
16 |
|
Employment of Respondents………………………………………………………………. |
17 |
|
Breastfeeding Rates According to Category of Employment……………………………… |
18 |
|
Percentage of Employed Respondents Allowed to Breastfeed or Pump during Work….... |
19 |
|
Ten Steps to Becoming Baby-Friendly…………………………………………………..... |
20 |
|
Acknowledgements………………………………………………………………………… |
21 |
BREASTFEEDING RATES FOR “ANY” BREASTFEEDING
|
Healthy People 2010 Objectives[3]
|
2003 National Data[4] |
2003 Florida Data[5] |
2004 Sarasota County Data[6] |
2004 Sarasota County WIC[7] Data |
|
75% of women will initiate breastfeeding |
71% |
69% |
79% |
71% |
|
50% of women will continue breastfeeding for at least 6 months |
36% |
36% |
30% |
Not Measured |
|
25% of women will continue breastfeeding for at least 12 months |
17% |
15% |
12% |
Not Measured |
Comments:
In 2004, 79% of women in Sarasota County initiated breastfeeding, thereby meeting the first breastfeeding objective of 75% outlined by the United States Department of Health and Human Service’s objectives for Healthy People 2010. This rate of “any” or “ever having breastfed” exceeds national and Florida rates.
The data show that Sarasota County falls below the Nation and Florida for any breastfeeding at six months and twelve months post-partum.
EXCLUSIVE[8] BREASTFEEDING RATES COMPARED TO
THE AMERICAN ACADEMY OF PEDIATRICS RECOMMENDATIONS[9]
|
The American Academy of Pediatrics recommends human milk for all infants in whom breastfeeding is not specifically, medically, contraindicated; with no supplements given unless ordered by a physician when a medical indication exists. Exclusive breastfeeding should continue for the first 6 months of life.
|
||
|
Nationally, only 14% of babies are exclusively breastfed until at least six months of age.
|
In Florida, only 14% of babies are exclusively breastfed until at least six months of age.
|
In Sarasota County, only 15% of babies are exclusively breastfed until at least six months of age. |
Comments: The American Academy of Pediatrics first released its breastfeeding recommendations in 1997, and issued a second position statement February, 2005. The entire nation, including Florida and Sarasota County, fail to meet the recommendation that all babies, with few medically necessary exceptions, be exclusively breastfed until at least six months of age.
RACE, ETHNICITY, AND EXCLUSIVE8 BREASTFEEDING
IN SARASOTA COUNTY
|
Exclusive Breastfeeding
|
White
|
Hispanic |
African-American |
Other[10] |
||
|
White |
Non-white |
White + Non-white |
||||
|
At birth |
70% 67/96[11] |
71% 12/17 |
82% 9/11 |
75% 21/28 |
29% 4/14 |
89% 8/9 |
|
At 3 months |
36% 22/61 |
31% 4/13 |
50% 3/6 |
37% 7/19 |
8% 1/13 |
80% 4/5 |
|
At 6 months |
20% 10/51 |
18% 2/11 |
0% 0/4 |
13% 2/15 |
0% 0/12 |
0% 0/3 |
|
At 12 months |
10% 4/41 |
12% 1/8 |
0% 0/4 |
8% 1/12 |
0% 0/12 |
0% 0/1 |
Comments:
Breastfeeding rates for all racial/ethnic groups except African-American are at or above a 70% initiation rate at birth. For all groups, there is sharp decline overall in duration rate beginning at or before 3 months of age. The breastfeeding rates at birth and 3 months of non-white Hispanics far exceed rates for other non-whites, i.e. African-Americans. Non-white Hispanics residing in Florida are generally from the Caribbean Islands.
African-American respondents have very low initiation and duration rates. The African-American Breastfeeding Alliance, Inc.,[12] attributes low breastfeeding rates among this group to:
§ Breastfeeding is not seen as “normal” in this community.
§ Breastfeeding is thought to be painful.
§ There is lack of support from relatives and partners.
§ There is reduced access to helpful breastfeeding information.
§ New mothers are overloaded with coupons, samples and literature from formula companies.
§ There is lack of culturally sensitive images in brochures, posters, and other breastfeeding literature.
RACE, ETHNICITY AND COMBINED EXCLUSIVE8 AND PARTIAL[13] BREASTFEEDING IN SARASOTA COUNTY
|
Combined Exclusive and Partial Breastfeeding
|
White
|
Hispanic |
African-American |
Other10 |
|||
|
White |
Non-white |
White + Non-white |
|||||
|
At birth |
81% 78/96 |
88% 15/17 |
91% 10/11 |
89% 25/28 |
43% 6/14 |
67% 2/3 |
|
|
At 3 months |
46% 28/61 |
46% 6/13 |
67% 4/6 |
53% 10/19 |
15% 2/13 |
67% 2/3 |
|
|
At 6 months |
29% 15/51 |
36% 4/11 |
25% 1/4 |
33% 5/15 |
0% 0/12 |
33% 1/3 |
|
|
At 12 months |
12% 5/41 |
25% 2/8 |
0% 0/4 |
17% 2/12 |
0% 0/12 |
0% 0/1 |
|
Comments:
When exclusive and partial breastfeeding are combined, breastfeeding rates are high at birth for all racial/ethnic groups except African-Americans in Sarasota County. As in exclusive breastfeeding, there is also a sharp decline of the combined exclusive and partial breastfeeding rates at 3 months. Partial breastfeeding continues beyond 3 months more than does exclusive breastfeeding.
INFLUENCERS OF THE DECISION TO BREASTFEED
FOR SARASOTA COUNTY RESPONDENTS (N=144)
Comments: The chart above shows that most women feel that they alone make the decision to breastfeed, though we know cultural and other factors throughout the lifetime of a female subtly influence her thoughts about breastfeeding. Sarasota County respondents felt the next three important groups of influencers are pediatricians, other family members and the husband/partner. Of groups responsible for some aspect of maternal-child health care, the pediatrician and/or the pediatric nurse has the greatest influence on the woman’s decision to breastfeed.
Please note that not all women who participated in this survey are exposed to all of the choices offered in this question, such as WIC or Healthy Start.
SOURCES OF BREASTFEEDING INFORMATION
FOR RESPONDENTS (N=144)
Comments: The staff at Sarasota Memorial Hospital and “books” are the two major sources of breastfeeding information for mothers in our county. This question did not require specification as to which staff at Sarasota Memorial Hospital were sources of information, but during a woman’s pregnancy, delivery, and post-partum period, she may meet with staff who teach the breastfeeding or childbirth education classes or work in Labor & Delivery, the Mother-Baby Unit, the Nursery, the Neonatal Intensive Care Unit, or the Lactation Shoppe.
The survey did not attempt to evaluate whether sources of breastfeeding information were those which uphold the World Health Organization’s (WHO) Code for Marketing Breastmilk Substitutes or follow the 10 Steps to Successful Breastfeeding.[14]
Please note that not all women who participated in this survey are exposed to all of the choices offered in this question, such as WIC or Healthy Start.
SARASOTA COUNTY COMBINED EXCLUSIVE AND PARTIAL BREASTFEEDING RATE DECLINE OVER 12 MONTHS
Comments:
This chart demonstrates that the breastfeeding rate decline in Sarasota County is precipitous and steady. The greatest reduction occurs between 6 weeks and 6 months.
The benefits of breastfeeding decrease then disappear as breastfeeding rates decline prematurely. The benefits of breastfeeding for at least six months include, but are not limited to9:
§ Protection of the premature infant against necrotizing enterocolitis and late-onset sepsis, both of which can be fatal.
§ Decrease in the incidence or severity of numerous infectious diseases in infancy and childhood, such as bacterial meningitis, bacteremia, diarrhea, respiratory tract infection, otitis media, and urinary tract infection.
§ Reduction of SIDS.
§ Reduction in Type 1 and Type 2 diabetes mellitus, lymphoma, leukemia, and Hodgkin Disease.
§ Decreased incidence of overweight and obesity, asthma, and hypercholesterolemia in older children and adults who were breastfed.
§ Improved performance on cognitive testing.
§ Decreased annual health care costs of at least $3.6 billion in the U.S. annually, paid to treat diseases and conditions preventable by breastfeeding.
OBSTACLES TO INITIATION AND CONTINUATION OF BREASTFEEDING (AMERICAN ACADEMY OF PEDIATRICS9)
|
§ Insufficient prenatal education about breastfeeding
|
§ Disruptive hospital policies and practices
|
|
§ Inappropriate interruption[15] of breastfeeding
|
§ Early hospital discharge in some populations
|
|
§ Lack of timely routine follow-up care and postpartum home health visits
|
§ Maternal employment (especially in the absence of workplace facilities and support for breastfeeding)
|
|
§ Lack of family and broad societal support
|
§ Media portrayal of bottle feeding as normative
|
|
§ Commercial promotion of infant formula through distribution of hospital discharge packs, coupons for free or discounted formula, and some television and general magazine advertising
|
§ Misinformation
|
|
§ Lack of guidance and encouragement from health care professionals
|
|
MAJOR FACTORS THAT INCREASED AND DECREASED CONFIDENCE IN BREASTFEEDING AMONG RESPONDENTS
|
INCREASED CONFIDENCE IN BREASTFEEDING |
DECREASED CONFIDENCE IN BREASTFEEDING |
||
|
Event: |
Number of Responses |
Event: |
Number of Responses |
|
Knowing it improves baby’s health |
20 |
Baby wouldn’t take breast |
9 |
|
Positive experience with breastfeeding in the past |
6 |
“Not enough milk” |
6 |
|
Bonding |
4 |
Pain |
6 |
|
Support from husband, mother or breastfeeding friends |
2 |
Not having enough time to breastfeed / inconvenience |
5 |
|
Cognitive development |
2 |
Engorgement |
3 |
|
Staff at Sarasota County Health Department |
1 |
Bleeding nipples |
3 |
|
Staff in Labor and Delivery |
1 |
Baby biting nipple |
2 |
|
Doctor’s encouragement |
1 |
Hospital staff |
2 |
|
The fact that it’s natural |
1 |
Pumping problems |
2 |
|
Finally “getting” it after 8 wks |
1 |
Baby lost weight |
2 |
|
Decreased cancer risk |
1 |
No past experience |
1 |
|
|
|
Infection |
1 |
|
|
|
Baby sick in NICU |
1 |
|
|
|
Having to breastfeed in public |
1 |
Comments: The benefits of breastfeeding are widely understood. Problems requiring post-partum breastfeeding support are prevalent and in most instances can be readily solved with proper assistance and support. It is not known if these mothers with decreased confidence had that support.
ENROLLMENT OF RESPONDENTS IN WIC & HEALTHY START
AND BREASTFEEDING RATES[16] FOR EACH CATEGORY
|
Participation of Respondents in Program |
Breastfeeding Rate at Birth |
Breastfeeding Rate at 6 Months |
Breastfeeding Rate at 12 Months |
|
WIC During Pregnancy 44% (67/154) |
65% |
15% |
3% |
|
Healthy Start During Pregnancy 26% (40/154) |
71% |
4% |
0% |
|
WIC Post-Partum 31% (47/154) |
73% |
17% |
8% |
|
Healthy Start Post-Partum 8% (15/154) |
87% |
9% |
0% |
Comments:
More women participate in either WIC or Healthy Start during pregnancy than post-partum, though post-partum support seems to more positively influence initiation and continuance of breastfeeding. Breastfeeding rates at 6 months are only slighter higher if the mother is participating in the program.
Please note that participation in either of the programs indicates either financial need or high risk circumstances, both of which can decrease the likelihood of breastfeeding.
BREASTFEEDING RATES16 FOR RESPONDENTS WHO TALKED WITH OR MET WITH A LACTATION CONSULTANT OR ATTENDED A BREASTFEEDING CLASS
|
Participation of Respondents |
Breastfeeding Rate at Birth |
Breastfeeding Rate at 6 Months |
Breastfeeding Rate at 12 Months |
|
Attended a Breastfeeding Class 18% (28/154) |
100% |
43% |
0% |
|
Talked with a Lactation Consultant Post-Partum 20% (31/154) |
71% |
4% |
0% |
|
Met with a Lactation Consultant Post-Partum 9% (14/154) |
93% |
0% |
0% |
Comments:
Within these three groups, women who attended a breastfeeding class demonstrated the highest breastfeeding rates at birth and six months. Though no correlation can be proven, it may be because those who participate in classes have 1) prior intent to breastfeed and 2) receive information and skills which lead to successful breastfeeding.
Those who talked to or actually met with a Lactation Consultant demonstrate lower rates, and it is noted that breastfeeding problems probably led to those consultations. It is not known if these same women received follow-up or further support for breastfeeding after the initial post-partum period.
The number for responses for these categories is low.
TOP SIX REASONS SARASOTA COUNTY RESPONDENTS
CHOOSE TO SUPPLEMENT WITH INFANT FORMULA (N=97)
Comments: The greatest reason women stop breastfeeding in Sarasota County is the perception of insufficient milk supply or that the baby is “hungry.” Despite the fact that rarely does a woman not have enough milk to feed her baby, this reasoning persists.
The second greatest reason women stop breastfeeding is the need to return to work. This is well-reflected in the precipitous decline of breastfeeding rates which starts when the baby is about six weeks old, although stay-at-home mothers demonstrate a drop of 52 percentage points from birth to six months, as shown on page 18 in the Data Tables.
EMPLOYMENT OF SARASOTA COUNTY
BREASTFEEDING RESPONDENTS (N=144)
Comments: Most participants in this survey are stay-at-home moms or selected “other professional” instead of options listed.
BREASTFEEDING RATES
ACCORDING TO CATEGORY OF EMPLOYMENT
|
Employment Category |
Exclusive and Partial Breast-feeding Combined Rate at Birth |
Exclusive and Partial Breast-feeding Combined Rate at 6 mos. |
Exclusive and Partial Breast-feeding Combined Rate at 12 mos. |
|
Stay-at-Home Mom (N=78) |
79% 60/76[17] |
27% 11/41 |
9% 3/35 |
|
Clerical (N=11) |
73% 8/11 |
0% 0/6 |
0% 0/4 |
|
Food Industry |