A statewide approach to motivate hospitals to develop breastfeeding policies in California

Background: Breastfeeding is an early intervention that reduces the risks of acute diseases, such as infections; or chronic diseases, such as obesity and Type 2 diabetes. Hospital initiation of breastfeeding fosters long term success. Methods: The Maternal, Child and Adolescent Health (MCAH) Division of the California Department of Public Health offers a cooperative approach to hospitals to promote breastfeeding policies. MCAH provides web-based resources and technical assistance for hospitals implementing breastfeeding policies. These resources include hospital training curriculums, evaluation tools to initiate and manage breastfeeding quality improvement teams and Regional Networks. Model hospital policies and a related “Toolkit” are also available. An annual California Hospital Breastfeeding Summit is convened to provide resources to motivate and assist hospital staff to collaborate and adopt these policies. In 2011, the state of California added Health and Safety Code 123366, requiring hospitals which have perinatal units to have an infant feeding policy that promotes breastfeeding in place by January 1, 2014. In addition, state nurse evaluators will be trained by MCAH to evaluate that hospitals have infant feeding policies as mandated. Utilizing the Maternity Practices in Infant Nutrition and Care (mPINC) Survey results, the Centers for Disease Control and Prevention report the percent of hospitals implementing evidence-based maternity care policies that lead to improved breastfeeding rates. These data will be used to provide trends and technical assistance. Results: In 2009, mPINC data showed 22% of California hospitals have policies that include all 10 recommended elements for infant nutrition. In 2009, less than 60% of surveyed hospitals had policies requiring staff education and assessment, prenatal patient classes or limiting pacifier use. Improvement was seen in 9 out of 10 recommended elements from 2007 to 2009. Conclusions: MPINC is a valuable resource to track progress and motivate hospitals to improve the quality of breastfeeding support services.