This semester I am enrolled in a class for public health planning. I have to develop my own public health program to address an issue of my choosing. I chose increasing breastfeeding rates among teen mothers, though I quickly found that in California Hispanic teen mothers in particular have some of the lowest rates of breastfeeding, so I decided to focus on that demographic. This has been really exciting so far!!!
Your Best Gift: A Rationale for the development of a program to increase breastfeeding rates among Hispanic teen mothers in California
Teenage mothers have much lower rates of breastfeeding than the national average. Only 50 percent of teen mothers initiate breastfeeding, compared to the national average of 78 percent for mothers over 30. (Johnson, 2010). Hispanic mothers within California have the lowest rates of exclusive breastfeeding initiation at 30.8 percent. US born Hispanic mothers have the lowest breastfeeding rates of any ethnic group in California, with only 40 percent giving their babies any breastmilk by four months. (Breastfeeding Promotion Committee of California, 2007).
Compounding this problem, Hispanic teens account for 74 percent of all teen births within California. The teen birth rate for Hispanic women is extremely high for California at 31.3 teen births per 1000 Hispanic women (California Department of Health, 2015). Hispanic teen mothers and their babies therefore represent a population at significant risk for health problems associated with low breastfeeding rates.
Low breastfeeding rates are a significant public health concern.
Breastfeeding has a number of long-term benefits for both infants and mothers. Breastfeeding provides protection from many common infections, eczema and decreases the risk of Sudden Infant Death Syndrome. Infants who are breastfed are less likely to develop diabetes, obesity, asthma, some allergies, and leukemia. Mothers who breastfeed for several months are at less risk of breast and ovarian cancer, diabetes and osteoporosis (Office on Women’s Health in the Department of Health and Human Services, 2016).
The costs of formula feeding are very high both for families and the community. If no babies in California were breastfed, the cost would amount to approximately $93 million annually- excluding the additional heating and water costs. Breastfeeding lengthens the spacing between children, potentially decreasing teen birth rates. Since teenagers often rely on public assistance for food and medical care for their child, breastfeeding has the potential to greatly reduce these costs to the public (Breastfeeding Promotion Committee of California, 2007). Some of the primary barriers to breastfeeding initiation and continuation for teen mothers are lack of support from staff at the hospital, lack of support for pumping at school, social concerns, and lack of support from family.
The “Your Best Gift” (“El Mejor Regalo Para Tu Bebé”) program will target Hispanic teen mothers between the ages of 15-19 in California, with a special focus on the Kern, Imperial, Madera, King, Del Norte, Fresno, Kings, Monterey, Merced, Lake, Tehama, Colusa, Mendocino, Glenn, Inyo, Stanislaus, Tulare, and San Bernadino counties which have the highest rates of teenage births (California Department of Health, 2015). These counties also have some of the lowest rates of breastfeeding in all of California (Breastfeeding Promotion Committee of California, 2007). Though mothers under the age of 15 make up a smaller proportion of teen births, they should be included in outreach and in the services this program will offer.
To address the issue of lack of breastfeeding support from hospital staff at birth, this program will provide information and guidelines to hospital staff on how to sensitively work with teen mothers. Johnson (2009) points out that maternal self-confidence is an important indicator of breastfeeding success and one that can be highly influenced by sensitive nursing staff. Teenage mothers often require more attention and encouragement with breastfeeding, and nursing staff are present at a crucial point in the process. The support and positive influence of the hospital staff can help create a positive start for breastfeeding. Hospital staff should follow guidelines to support and encourage all mothers in exclusive breastfeeding, regardless of age.
Staff can also be trained in the “Golden Hour” protocols, where a healthy newborn and parents are given privacy in the first one to two hours after the baby’s birth and all non-essential medical procedures are postponed so that the infant and mother can begin breastfeeding uninterrupted. Making immediate skin-to-skin contact a standard practice for healthy mothers and infants (including cesarean deliveries) will also help with breastfeeding (Phillips, 2013). The practice of rooming-in (where mothers and babies share the same room in a hospital) should be encouraged when the condition of the infant and mother permits. Mothers should be reassured that under most circumstances there is no need for an hours old infant to be fed formula.
Staff should help grandparents and the partner/father to understand the importance of breastfeeding. Educational materials in English and Spanish should be readily available at hospitals for the teenage mother and other family members. Information on pumping for work or school should be easily available to teenage mothers and their families who may be feeding expressed milk to the baby.
While laws protect a working mother’s right to express breastmilk for her infant, frequently there are no such mandates for mothers in school. High schools can be very inflexible about students taking time to express milk or nurse their infants. Many teenage mothers do not finish school, drastically increasing their chances of living in poverty. Engaging secondary schools to allow teenage mothers the space and time to express milk will be a crucial component of this program.
The teenage mother faces a very different experience socially than her peers. Connecting with other teenage mothers and local breastfeeding support groups can provide a network to help her grow into her new role, make new friends and have a support system for dealing with problems that may arise during the breastfeeding process. A support group for fathers and partners (either separate or as a couple) should also be a consideration. The support of the infant’s father (if possible) can be another element to help the mother with breastfeeding. In areas where the California Home Visiting Program is in place, visiting nurses can refer mothers to breastfeeding support services.
Data collection will utilize single-step surveys to gather self-reported data from Hispanic teen mothers on breastfeeding initiation and duration, maternal health and infant health. Data should also be collected on mothers’ experiences at the hospital, including their feelings about the support they received, whether breastfeeding friendly policies were practiced and if the mothers experienced any violations of the World Health Organization’s guidelines for the marketing of artificial infant milks.
Despite the limitations of self-reporting, single-step and cross-sectional surveys remain the method of choice for collecting data about breastfeeding practices and perceptions about breastfeeding (Centers for Disease Control, 2015). Single-step surveys from the target population will give the most accurate data since the mothers will have an intimate knowledge of their breastfeeding experience and the health of their child.
This program is also uniquely poised to address the needs of the teenage mother with regards to breastfeeding. The strategies employed in this program such as Golden Hour and skin-to-skin contact after birth have been well-established in helping mothers from all backgrounds to initiate and continue breastfeeding (Phillips, 2013). The benefits will apply to teenage mothers as well.
After birth new challenges arise for the breastfeeding teenage mother and “Your Best Gift” addresses each of these. Smith, Hall, Habbock, et. al. (2012) reported that lack of knowledge about pumping and lack of support from schools were among the most commonly cited reasons for not breastfeeding. Getting schools to address the needs of teenage mothers will greatly reduce the barriers to breastfeeding continuation among this demographic.
Teenage mothers also frequently rely on the help of other family members in caring for their infants, so recruiting grandparents and (when possible) fathers will also help to create an environment where the mother has fewer barriers to breastfeeding. Addressing these issues by creating a support system for teenage mothers will help them achieve the goals of greater initiation and longer breastfeeding duration.
Breastfeeding Promotion Committee of California (2007). Breastfeeding: Investing in California’s future. Retrieved from https://www.cdph.ca.gov/programs/breastfeeding/Documents/MO-BreastfeedingFullDocument.pdf
California Department of Public Health (2015). Adolescent births in California. Retrieved from 2000-2014. https://www.cdph.ca.gov/data/statistics/Documents/2014ABRFinalPressReleaseSlides.pdf
Centers for Disease Control (2015). Breastfeeding data and statistics. Retrieved from https://www.cdc.gov/breastfeeding/data/
Johnson, Susanne (2010). Breastfeeding initiation among teenage mothers. Journal of student nursing research, 3(2). Retrieved from http://repository.upenn.edu/cgi/viewcontent.cgi?article=1036&context=josnr
Office on Women’s Health in the Department of Health and Human Services (2016). Why breastfeeding is important. Retrieved from https://www.womenshealth.gov/breastfeeding/breastfeeding-benefits.html
Phillips, Raylene. The Sacred Hour: Uninterrupted Skin-to-Skin Contact Immediately After Birth.” Newborn and Infant Nursing Reviews, Vol. 32 No. 2, 2013, p. 67-72.
Smith, Paige Hall, Coley, Sheryl L, Habbock, Miriam H, Cupito, Susan and Nwokah, Eva (2012). Early breastfeeding experiences of adolescent mothers: a qualitative prospective study. International Breastfeeding Journal, 7(13). doi: 10.1186/1746-4358-7-13