142nd APHA Annual Meeting and Exposition

Annual Meeting Recordings are now available for purchase

Bringing Baby-Friendly to the Indian Health Service: A Systemwide Approach to Implementation

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Monday, November 17, 2014 : 12:48 PM - 1:06 PM

Susan Karol, MD , Indian Health Service, Rockville, MD
Tina Tah, RN, BSN, MBA , Indian Health Service, Rockville, MD
Anne Merewood, PhD, MPH, IBCLC , Division of General Pediatrics, Boston Medical Center, Boston, MA
Background: Breastfeeding protects against obesity and diabetes, conditions to which Native Americans are particularly prone. The Baby-Friendly Hospital Initiative (BFHI) increases exclusive breastfeeding . As part of the First Lady’s Let’s Move Indian CountryInitiative, the Indian Health Service (IHS) began implementing  the BFHI in 2011. The IHS administers 13 US birthing hospitals, many in remote locations and all serving a high risk population.

Methods:  At the system level, in all 13 hospitals, IHS implemented a Baby-Friendly infant feeding policy, extensive clinician training, Baby-Friendly compatible medical record templates, and an online data collection system. All 13 hospitals entered Baby-Friendly USA’s Baby-Friendly pathway. Public health nurses supported transitions of care into the community by providing breastfeeding support and partnering with the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). 

Results:By January 2014, 7/13 (54%) of IHS hospitals had gained Baby-Friendly designation. The first Baby-Friendly hospitals in New Mexico, North Dakota, Oklahoma, and South Dakota were all IHS sites. All 13 hospitals adopted Baby-Friendly policies, created a prenatal curriculum, removed pacifiers for healthy newborns, began paying for infant formula, mastered Step 10 (outreach) and became compliant with the WHO’s International Code of Marketing of Breast Milk Substitutes. We anticipate that more sites will be designated before the end of 2014.

Conclusion: Systemwide implementation of the BFHI is possible in a US government-run system serving a high-risk population. Other systems looking to implement the BFHI can learn from the IHS model.

Learning Areas:

Diversity and culture
Public health or related organizational policy, standards, or other guidelines
Public health or related public policy

Learning Objectives:
Describe at least 2 components of a systemwide approach to implementation of the Baby-Friendly Hospital Initiative (BFHI).

Keyword(s): Breastfeeding, Native Americans

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: As the Chief Medical Officer of the Indian Health Service, I directly oversee and work with our 13 Baby-Friendly Hospital sites for initiative preparation and achievement of the designations along with development of our sustainability model. As a past Director of the Hunt Breast Health Center in Danvers, Massachusetts, I appreciate the importance of breastfeeding for diabetes and obesity prevention in our American Indian and Alaska Native populations.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.