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Children's Health

N. C. Makes Gains in Breastfeeding, But Disparities Persist

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Since the 1990s, North Carolina has adopted a number of practices and laws to promote breastfeeding. As a result, the state has almost caught up to the national average, but some demographic groups lag behind.

By Hyun Namkoong

Chanee Lynch is the mother of a 9-month-old girl and a first-year student in the UNC Gillings School of Public Health. Lynch uses the designated Mothers’ Room in the School of Public Health daily to pump breast milk. She punches in a code to enter the room, barely big enough for two chairs and a sink, but privacy and cleanliness are what matter most to Lynch.

“My boss was supportive of me breastfeeding, but there wasn’t a Mothers’ Room where I worked,” Lynch said, “so I had to put up curtains around my desk.

Chanee Lynch shows off the pump she uses for pumping breast milk.

Chanee Lynch shows off the pump she uses for pumping breast milk in the “Mothers Room” at the Gillings School of Global Public Health at UNC-Chapel Hill. Photo credit: Hyun Namkoong

“There are women who have told me they had to pump in the bathroom, but that’s like eating food that was prepared in the bathroom. Who wants to do that?”

NC initiatives

North Carolina has two awards that recognize hospitals that promote and support breastfeeding.

The Golden Bow Award, given by the North Carolina Breastfeeding Coalition, recognizes hospitals for “banning the bag,” an effort to stop the distribution of commercial formula samples and coupons. Formula companies give hospitals “bags” of formula samples and coupons to attract mothers to formula.

Several studies have shown that formula advertising discourages women from breastfeeding and multiple countries have banned formula advertising all together. Some countries have even taken measures to require a prescription for formula.

In the 1970’s, the World Health Organization and UNICEF created an International Code of Marketing of Breastmilk Substitutes to recommend the prohibition of unethical marketing of formula, including the advertisement of formula as superior to breast milk. The United States was the only member state to vote against the code in the World Health Assembly in 1981 and finally endorsed it in 1994.

“I can say breastfeeding saves lives. However, if I were to say the corollary, formula use kills babies, people would be up in arms,” said Miriam Labbok, director of Carolina Global Breastfeeding Institute (CGBI) and professor in the maternal and child health department at the Gillings School of Public Health. “We are not ready to hear this because we still have a societal formula norm.”

Chanee Lynch has a bottle per breast as she pumps for her baby.

Chanee Lynch has a bottle per breast as she pumps for her baby. Photo credit: Hyun Namkoong

In 2012, more than 20 hospitals in North Carolina received a Golden Bow.

The N.C. Maternity Center Breastfeeding-Friendly Designation is a five-star system that encourages maternity centers to complete the Ten Steps to Successful Breastfeeding, modeled on the World Health Organization’s guidelines for promoting and supporting breastfeeding.

This initiative, which is endorsed by the N.C. Hospital Association and the N.C. Child Fatality Task Force, was launched in 2010. Some 30 hospitals have been awarded the designation.

Disparities persist

Despite the progress made in the state, black mothers, WIC clients and adolescent mothers continue to lag behind white and Hispanic mothers in initiating breastfeeding. (WIC is the Special Supplemental Nutrition Program for Women, Infants, and Children that provide nutrition education and health care referrals to low-income women and at-risk infant and children under age five). Only 53.7 percent of black mothers in North Carolina breastfed in 2011, compared to 63.3 percent of white mothers and 77.2% of Hispanic mothers.

The consequences of low breastfeeding-initiation rates in black mothers are reflected in the high infant-mortality rate in black babies, Labbok said.
The infant mortality rate in black babies is 2.5 times higher than in white babies and the mortality rate actually increased from 2011 to 2012 in black babies in the state.

Chanee Lynch was able to pump about 150 ml (5.5 oz) during her pumping session. She'll refrigerate it to feed to her baby later at home.

Chanee Lynch was able to pump about 150 ml (5.5 oz) during her pumping session. She’ll refrigerate it to feed to her baby later at home. Photo credit: Hyun Namkoong

Women need a supportive environment to initiate and continue breastfeeding, and women in vulnerable populations, such as WIC clients, have less access to lactation consultants or other women who can teach them how to breastfeed, said Catherine Sullivan, CGBI’s director of Training.

Research has shown that black and low-income mothers need more support and education on the health benefits of breastfeeding.

“A lot of my close friends and family aren’t comfortable with breastfeeding, Lynch said, “but I met other African-American moms who exclusively breastfeed, and I was encouraged by that.”

Lactation consultant course

The Mary Rose Tully Training Initiative, developed by CGBI and supported by UNC Women’s and Children’s Hospital staff, is a clinical training program in breastfeeding and lactation. The program requires students to complete 300 hours of clinical lactation experience under the supervision of an international board certified lactation consultant. This experience allows students to support and teach families the benefits of breastfeeding.

Zakiyah Williams, a student in the course, said she enjoys working one on one with families, especially those that need help with latching – helping babies effectively get milk from a mother’s breast.

The "Mothers' Room" is small, with just two chairs and a sink (right), but is cleaner than a bathroom and equipped with materials to clean bottles and mother.

The “Mothers’ Room” is small, with just two chairs and a sink (right), but is cleaner than a bathroom and equipped with produts to clean bottles and mother. Photo credit: Hyun Namkoong

Every Friday afternoon, students meet in the Health Sciences Library at UNC and present unusual case studies from their clinical experience. They discuss, for example, strategies for encouraging breastfeeding among mothers with gestational diabetes.

Although there are more than 500 lactation consultants in North Carolina, diversity and reimbursement for lactation consultants remain a challenge. A lot of insurers opt out of providing lactation services, and Sullivan said there are pockets in the state where no services are available.

“The lactation consultant helped me understand why Leah was still so hungry after the first 24 hours of breastfeeding,” Lynch said.

“Getting our bodies in sync, I highly recommend breastfeeding for other moms,” she said. “It has really strengthened our bond.”

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