Reducing Obesity in Alabama by Increase Breastfeeding ...€¦ · Childhood obesity rates are...
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Reducing Obesity in Alabama by Increase Breastfeeding Initiation Morgan Haygood, Elizabeth Murray, Suzanna Niehoff, Erin Marie Patenaude The University of Alabama
Transcript of Reducing Obesity in Alabama by Increase Breastfeeding ...€¦ · Childhood obesity rates are...
Reducing Obesity in Alabama by Increase Breastfeeding Initiation
Morgan Haygood, Elizabeth Murray, Suzanna Niehoff, Erin Marie Patenaude
The University of Alabama
Purpose
To characterize obesity and breastfeeding rates in Alabama.
Alabama has a higher prevalence of obesity as well as lower breastfeeding rates in comparison with national data.
Cycle of ObesityObesity in women of childbearing age may decrease breastfeeding rates which in turn may increase childhood obesity rates leading to more obese adults.
Obesity in Adults &
Women of Child-bearing
Age
Decreased Breastfeeding
Rates
Overweight Children
Chart 2: Obesity in Third Graders, Alabama, 2006-2007
24.6% 25.3%24.0%
22.5%
27.5%
33.5%
12.7%
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15.0%
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25.0%
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Total Male Female White Black Hispanic Other
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Alabama Department of Public Health Oral Health Branch (Dental) 2006 – 2007
Presenter
Presentation Notes
Childhood obesity rates are higher among minorities, BF rates among minorities are typically lower with the exception of the hispanic population.
Chart 3: Obesity Rates among High School Students in Alabama, 2001-2011
Youth Risk Behavior Surveillance System (YRBSS), Center for Disease Control and Prevention, 2011
2001 2003 2005 2007 2009 2011
Male 16.8% 15.6% 16.4% 16.9% 19.7%
Female 7.6% 11.0% 12.8% 9.6% 14.3%
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15.0%
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in %
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Presentation Notes
Students 9-12 grade. Upward trend in obesity among High School students since 2001, males higher than females. Females increasing rates from 7% in 2001 to 14% in 2011. Data missing for 2007.
Chart 4: Adult Obesity Rates, Alabama vs. The United States, 2001-2011
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Alabama 24.5% 25.7% 28.4% 28.8% 28.9% 30.5% 30.9% 32.2% 31.6% 33.0% 32.0%
U.S. 20.9% 21.9% 22.9% 23.2% 24.4% 25.1% 26.3% 26.7% 26.9% 27.5% 27.8%
0.0%
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2001-2011Behavioral Risk Factor Surveillance System (BRFSS), 2011
Presenter
Presentation Notes
Alabama remaining higher than the nation. Increase in prevalence up to 2008, remaining constant at 32% since.
Chart 5: Obesity Rates Among Women ages 19-44 in Alabama vs. The United States, 2001-2011
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Alabama 23.5% 25.2% 30.7% 28.3% 29.3% 27.8% 30.4% 32.2% 29.6% 32.4% 30.3%
U.S. 17.6% 17.8% 19.2% 20.2% 21.4% 21.7% 23.6% 23.7% 24.4% 25.1% 24.9%
0.0%
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35.0%
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Behavioral Risk Factor Surveillance System, Centers for Disease Control and Prevention, 2011
Presenter
Presentation Notes
Correlates closely with the trendline seen previously for adult obesity. Again, al higher than the nation. 2011, 30% of women of childbearing age are obese. Importance of this population group, obesity impact on breastfeeding.
Chart 7: Breastfeeding rates in the United States and Alabama in 2009, CDC Provisional Data
Initiation at 6 months at 12 months
Alabama 57.2% 29.7% 14.4%
U.S. 76.9% 47.2% 25.5%
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70.0%
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CDC Breastfeeding Report Card, 2012
Presenter
Presentation Notes
The percentage of mothers who breastfeed in Alabama is substantially lower than that of the United States as a whole. Initiation rates and continuance at both six and twelve months is at least 10% below the national average.17 Healthy People 2020 initiatives state a national goal for breastfeeding initiation of 81.9% with goals for at 6 months and 12 months at 60.6% and 34.1% respectively.
Chart 8: Percent of Mothers Who Initiated Breastfeeding in Alabama 2001 to 2010
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Alabama 54.2% 57.5% 57.9% 60.0% 57.7% 64.7% 63.7% 63.0% 64.8% 70.6%
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PRAMS Surveillance Report Alabama, 2010
Presenter
Presentation Notes
From 2001 to 2010, the percentage of mothers in Alabama who initiated breastfeeding increased thirteen out of sixteen years. In 2010, Alabama reached its highest percent of initiation at 70.6% rising 5.8% from the previous year. Comparing 2010 to 2001, there has been a total increase in mothers who initiate breastfeeding of 30.2%.19 Though Alabama has shown a positive progression in the rates of mothers who breastfeeding, the overall rate in Alabama is still well below the national average.
Chart 9: Percent of Mothers Who Initiated Breastfeeding by Mother's Race in
Alabama 2001 to 2010
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
White 62.9% 67.7% 65.9% 68.9% 65.6% 73.2% 69.0% 70.7% 71.3% 77.5%
Black and Other 33.9% 37.1% 40.2% 40.6% 37.0% 44.4% 52.5% 46.6% 52.7% 55.1%
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PRAMS Surveillance Report Alabama, 2010
Presenter
Presentation Notes
From 2001 to 2010, there was a substantial increase in the percent of mothers who initiated breastfeeding in both racial groups. The prevalence of breastfeeding initiation is higher among white women than black and other races in Alabama. In 2010, initiation rates were the highest in both groups and had increased 8.3% for white and 4.5% for black and other races from the previous year.
Chart 11: Percent of Mothers Who Initiated Breastfeeding by Mother's Education in Alabama 2001 to 2010
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
0 to 11 years 35.4% 40.9% 41.7% 37.2% 38.4% 48.6% 48.2% 47.1% 44.9% 59.2%
12 years 45.8% 46.4% 49.4% 49.6% 44.5% 50.6% 55.0% 57.8% 55.6% 60.0%
13+ years 71.6% 73.6% 69.4% 76.4% 74.4% 79.9% 75.8% 73.5% 78.4% 82.5%
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PRAMS Surveillance Report Alabama, 2010
Presenter
Presentation Notes
PRAMS broke down breastfeeding rates by multiple demographics including age, education and marital status. Here you can see the prevalence of breastfeeding initiation is the highest in mothers with 13 plus years of education and lowest amongst mothers with 11 years or less of education. From 2001 to 2010, there has been a substantial increase in initiation rates in all three age groups. All three groups have seen an increase in initiation rates on average of 5.2 to 32.3% from 2009. The 0 to 11 and 12 year groups were almost at equal percentages in 2010 showing the large increase among the 0 to 11 year group and small increase for the 12 year group. In 2010, women 10 to 34 years of age had the highest initiation rates to date in their perspective groups. Women in the 35 plus age group had a decline in initiation of 10.1% since 2008. The percentage of teenage mothers who initiate breastfeeding has been the lowest of all groups over time while the 35 plus group is still trending with the highest percentage of initiation. Among married and unmarried women, there has been a substantial increase in the initiation rate of breastfeeding from 2001 to 2010. In 2010, both groups experienced their highest rates of initiation to date. Over time it can be seen that married women have a higher rate of initiation than unmarried women. This may be contributed to married women being older in age or having a higher level of education than the unmarried women.
Chart 13: Percent of Mothers who Initiated Breastfeeding by Method of Payment for Delivery and Participation in WIC in Alabama, 2010.
70.6%
62.6%
79.4%
33.4%
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Alabama Medicaid Non-Medicaid WIC
PRAMS Surveillance Report Alabama and USDA Food & Nutrition Service, 2010
Presenter
Presentation Notes
In 2010, mothers who were on Medicaid for the birth of their child were substantially less likely to initiate breastfeeding than mothers who paid for the delivery by another method. The percentage of mothers who initiated breastfeeding who were enrolled in WIC in Alabama was pointedly less than the state prevalence percentage.19,20 WIC in Alabama is an area where mothers should be encouraged the most since breastfeeding can reduce the cost of feeding the child for the first year. The percent of breastfeeding mothers on WIC in Alabama is substantially less than the national average of WIC mothers who initiated breastfeeding, which was 63.2%.18 Mothers on Medicaid should also be more encouraged to breastfeed to reduce cost of care. There is an opportunity to learn what information the mothers who are not on Medicaid are receiving which encourages them to breastfeed more than the state average.
Chart 14: Percent of Mothers who Initiated Breastfeeding in Alabama vs. Oregon, Mississippi in
2009
Alabama Oregon Mississippi
Mothers who Initiated Breastfeeding 57.2% 88.9% 47.2%
0.0%
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CDC Breastfeeding Report, 2012
Baby-Friendly Hospital Initiative
“to encourage and recognize hospitals and birthing centers that offer an optimal level
of care for infant feeding”
Alabama Oregon Mississippi
1 5 0
*143 in the nation as of 5/12
The 10 Steps
o Have a written breastfeeding policy that is routinely communicated to all health care staff.
o Help mothers initiate breastfeeding within one hour of birth.
o Give newborn infants no food or drink other than breastmilk, unless medically indicated.
o Practice “rooming in”-- allow mothers and infants to remain together 24 hours a day.
o Encourage breastfeeding on demand.o Give no pacifiers or artificial nipples to breastfeeding
infants.
Presenter
Presentation Notes
1 - Have a written breastfeeding policy that is routinely communicated to all health care staff. 2 - Train all health care staff in skills necessary to implement this policy. 3 - Inform all pregnant women about the benefits and management of breastfeeding. 4 - Help mothers initiate breastfeeding within one hour of birth. 5 - Show mothers how to breastfeed and how to maintain lactation, even if they are separated from their infants. 6 - Give newborn infants no food or drink other than breastmilk, unless medically indicated. 7 - Practice “rooming in”-- allow mothers and infants to remain together 24 hours a day. 8 - Encourage breastfeeding on demand. 9 - Give no pacifiers or artificial nipples to breastfeeding infants. 10 - Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic
International Board Certified Lactation Consultants
Alabama Oregon Mississippi
Total (as 4/2012)
127 303 67
Per 1,000 live births
2.03 6.4 1.6
Table 3: Breastfeeding laws addressing a mother’s right
Alabama Oregon Mississippi
Ala. Code § 21-1-13 allows a mother to breastfeed her child in any public or private place.
Or. Rev. Stat. § 109.001 (1999) allows a woman to breastfeed in a public place. (SB 744)
Miss. Code Ann. § 17-25-7/9 (2006): a mother may breastfeed her child in any location she is otherwise authorized to be.
Miss. Code Ann. § 97-29-31 and §97-35-7et seq. (2006) specifies that a woman breastfeeding may not be considered an act of indecent exposure, disorderly conduct, or disturbance of the public space.
Laws addressing Jury Duty
Alabama Oregon Mississippi
Or. Rev. Stat. § 10.050 excuses a woman from acting as a juror if the woman is breastfeeding a child.
Miss. Code Ann. § 13-5-23 (2006) provides that breastfeeding mothers may be excused from serving as jurors.
Breastfeeding Laws, cont.
Additional laws address:– BF in the workplace {Miss. Code Ann. Ch. 1 § 71-1-
55} {Or. Rev. Stat. § 653.075, § 653.077 and §653.256}
– BF at daycares {Miss. Code Ann. § 43-20-31}
Other Initiatives
Alabama
o La Leche League (w/ Miss. & Louisiana)
o Alabama Breastfeeding Coalition
o WIC
Oregon
o La Leche League
o Breastfeeding Coalition of Oregon
o Nutrition & Health
o Obesity Prevention/ Weight Loss
o WIC
o Nursing Mother’s Counsel
Obesity Recommendations
Data Needs:
• Recent data on childhood obesity
• Pre-pregnancy weights and gestational weight gain of mothers
• Obesity rates among women who chose to breastfeed and those who did not
• Accurate ethnicity reporting
Breastfeeding Recommendations
• Trend data on mothers who initiated breastfeeding and were enrolled in WIC in Alabama
• A more active Alabama Breastfeeding Coalition or a partnership between the ABC and the OTF
• Advocates for more breastfeeding laws and promote positive and supportive language in new legislation
• Information on how to achieve the credential of Certified Lactation Consultant
• An increase in the availability of breastfeeding support groups for mothers and families
Conclusion• The prevalence of obesity among children and
females of childbearing has been increasing, but remains stable since 2007.
• Alabama is well below the national average for breastfeeding and maintains a higher obesity prevalence in the nation.
• Breastfeeding is one of the many important dietary and lifestyle behaviors that play a vital role in obesity prevention.
THANK YOU.
QUESTIONS?
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