Eliminating Disparities in Breastfeeding and Infant Mortality: Conference 2018

Although breastfeeding rates are increasing in the US, significant disparities in breastfeeding and infant mortality persist.  Cincinnati Children’s Hospital Medical Center and partners were delighted to host the “Third Annual Conference to Eliminate Disparities in Breastfeeding and Infant Mortality:  Taking Action for Equity” as a pre-Conference to the Ohio Infant Mortality Summit at the Duke Energy Convention Center in Cincinnati, Ohio.  Our Keynote speaker was the inspiring Dr. Camara Jones from Morehouse School of Medicine, who helped us critically examine how racism must be acknowledged and addressed to make inroads toward health equity.

Our First Annual Conference with Keynote speaker, Dr. Michal Young, helped us to define the problem of breastfeeding disparities and infant mortality.  The Second Annual Conference featured Keynote speaker, Dr. Kimarie Bugg, who took us deeper by addressing the role of Implicit Bias.  Our participants provided feedback, requesting to leave the next conference with Action Tools to make changes in their own communities to eliminate disparities so this year we are “Taking Action for Equity”.

To that end, our Conference this year began with an inspiring opening from City of Cincinnati Health Commissioner, Melba Moore, who challenged everyone to develop novel ways to improve community health.  From there, the conference highlighted the successful efforts of 42 speakers from around the State of Ohio and beyond, representing these programs:  CenteringPregnancy, the State of Ohio efforts to improve breastfeeding (Ohio First Steps, WIC, Ohio Department of Health), Hospital Quality Improvement, the importance of Fathers, and the amazing work of Doulas.  These programs provided the first set of Key Highlights to nearly 400 health care providers, community members, and parents, who then were able to “go deeper” in workshop formats, along with an option to learn the basics of “Breastfeeding 101.”  After lunch, attendees rejoined for a second set of Key Highlights, with representatives from Home Visitation programs, Mom-to-Mom Support groups (https://www.facebook.com/Avondale-Moms-Empowered-to-Nurse-1257926900973280/), Rural and Appalachian breastfeeding groups and Breastfeeding while Going back to Work.  These presenters also provided a deeper dive with workshop sessions, and the option for a “Breastfeeding 911” course to help front-line providers and support people troubleshoot common problems.  Each workshop provided a take home “toolkit” for attendees.

In addition to many local Cincinnati area efforts to eliminate disparities in breastfeeding, we were delighted to have experts from Cleveland, Columbus and beyond share their expertise with us.  The Doula segment was especially exciting  as co-presenter, Jessica Roach from ROOTT (Restoring Our Own Through Transformation) arrived to the conference JUST as her bio was being read, (coming, of course, from a delivery, directly to the stage!), as well as Christin Farmer, at Birthing Beautiful Communities in Cleveland who brought her “Dude-la”, Neal Hodges!  We learned about ROBE (Reaching Our Brothers Everywhere) from our local Wisdom Council Member, Calvin Williams, and Founder, Wesley Bugg, Esq., the CenteringPregnancy program in Cleveland , and so many more Ohio highlights!

Dr. Lori Winter and Dr. Julia Ware

Commissioner, Melba Moore, Dr. Camille Graham, Dr. Corinn Taylor, Dr. Karen Bankston

Dr. Camara Jones and Jamaica Gilliam

Dr. Camara Jones took us through an intensive discussion of the multiple dimensions through which racism drives health disparities using her powerful 3-dimensional cliff analogy highlighting differences in: the quality of care received within the healthcare system, access to healthcare and preventive services, and life opportunities, exposures, and stresses that result in differences in underlying health conditions.

She defines racism as “a system of structuring opportunity and assigning value based upon the social interpretation of how one looks. Racism is a system that:

1. Unfairly disadvantages some individuals and communities
2. Unfairly advantages other individuals and communities
3. Saps the strength of the whole society through the waste of human resources.

Racism has created inequities in our country. Dr. Jones helped us to see that the barriers to health equity include the narrow focus on the individual (“I am not racist, so these facts don’t apply to me or how I treat my patients!”); the fact that we are an “A-historical” culture that is disconnected from and fails to acknowledge our recent past (“Slavery ended more than a hundred and fifty years ago – why can’t you get over it?”; we don’t recognize the underlying structural system of inequity and privilege that is at the foundation of health disparities (“Why is it that a mom’s zip code is more likely to predict birth outcomes, infant survival, and breastfeeding success than her access to health care?”); and that we are instead overly focused on the myth of meritocracy – an example – two babies – equal opportunity or equal potential? (“They just aren’t trying hard enough – they could breast feed if they really wanted to!”)

Some key takeaways from Dr. Jones:

1. When you feel uncomfortable, “LEAN IN”
2. To achieve health equity we need to:
   1. Value all individuals and population equally
   2. Recognize and rectify historical injustices
   3. Provide resources according to need
3. You can learn more about Dr. Jones’ Cliff Analogy in this 5 minute video by the Urban Institute.

An added treat to the Conference was an optional learning lunch with new AAP Section on Breastfeeding Chair, Dr. Lori Feldman-Winter, who was giving a talk on Safe Sleep and Breastfeeding at a Safe Sleep Summit occurring simultaneously to our Conference!  Over 130 of our participants were able to join this event, and enjoyed the review of the evidence and guidelines for safe sleep and breastfeeding from the AAP lens.

One of the most exciting aspects of the Conference is still to come.  We will harness the energy generated from the diverse Conference presenters and attendees to continue improving breastfeeding rates in marginalized populations. It is clear that we have a wealth of talent and will need to use many different strategies to achieve this goal. Our participants are filling out a “Call to Action” survey as part of their Conference evaluation, so that we can continue to connect and collaborate in areas of interest to eliminate disparities through learning communities across the state. Stay tuned for More to Come!

Pre- and post-conference video clips:

http://www.fox19.com/video/2018/12/14/breastfeeding-disparities-challenges/

http://www.fox19.com/video/2018/12/14/breaking-down-barriers-breastfeeding/

Shared Safe Sleep and Breastfeeding Posters (unbranded) from Ohio First Steps:

www.ohiohospitals.org/OHA/media/Images/Patient%20Safety%20and%20Quality/Documents/Breastfeeding/First-Steps-2017-Feeding-Safe-Sleep-flierUNBR.pdf

www.ohiohospitals.org/OHA/media/Images/Patient%20Safety%20and%20Quality/Documents/Breastfeeding/First-Steps-2017-Spanish-Feeding-Safe-Sleep-flier.pdf

Cincinnati Children’s Conference Co-Chairs:

Julie Ware, MD, MPH, FABM and ABM Board Member

Laura Ward, MD, ABM Member

Camille Graham, MD, Executive Community Leader

 

For more information, please contact Dr. Julie Ware, julie.ware@cchmc.org

Blog posts reflect the opinions of individual authors, not ABM as a whole.

ABM Member Profile: Featuring Caroline Chantry, MD, FABM

ABM: Why did you become a member of ABM?

Chantry: To attain more knowledge, skill and inspiration; to promote, protect and support breastfeeding, because surely it is an important cause.

ABM: What is ABM‘s greatest strength?

Chantry: Its membership which possesses vast expertise, experience and enthusiasm, and spans the globe.

ABM: What inspires you to promote, protect and support breastfeeding?

Chantry:  Breastfeeding has the potential, by far, to make the most impact on maternal and child health of any preventive intervention.  ABM helps me in many ways, e.g. with information and tools, but also by reinforcing the importance of what I do.  Sometimes at work I feel like an army of one, and ABM is full of reinforcements at the ready – I can call on them by phone, email or read the journal!

ABM: What advice can you offer to physicians who are interested in learning more about breastfeeding?

Chantry: ABM  conferences help, starting with “What Every Physician Needs To Know About Breastfeeding”; there are several online courses also.  You also need hands-on experience.  Find an expert to shadow and also just starting helps mothers and babies to get your own experience of what works. Every dyad is unique.

ABM: What accomplishment are you most proud of in your career?

Chantry: I am proud to have had the opportunity to serve ABM previously as President and for many years on the protocol committee. I am also proud of some of my research that ultimately I hope will help breastfeeding dyads.

ABM: What is a current challenge for you in your work?

Chantry: Still, in 2012, my hospital is resisting BFHI because they want the free formula!  Ethical blinders!

ABM: What can ABM offer physicians worldwide?

Chantry: The protocols are available for all physicians.  ABM‘s real treasure is the community of experts and advocates that are its membership.  It is small enough that you can actually get to know many of the members and access their expertise and share yours.

Thank you, Dr. Chantry.  We look forward to featuring additional Lifetime and Gold Members on the ABM Blog each month.

Join us at the 17th Annual International Meeting to be held October 11-14, 2012 in Chicago.

ABM Member Profile: Featuring Rima L. Strassman, MD, FABM

ABM: What is ABM‘s greatest strength? 

Strassman: ABM‘s strength is its network of support and knowledge in the area of breastfeeding medicine.

ABM: What inspires you to promote, protect, and support breastfeeding?

Strassman: The satisfaction I get from helping mothers accomplish their goals in parenting their infants and making breastfeeding a part of that. ABM helps me do this by sharing knowledge and offering support from peers doing the same thing.

ABM: What advice can you offer to physicians who are interested in learning more about breastfeeding?

Strassman: Attend ABM meetings including the WEPNTK pre-conference course, look for other lactation/breastfeeding conferences, and read the ABM listserv.

ABM: What accomplishment are you most proud of in your career?

Strassman: This is a tough question to answer, but I suppose becoming a Fellow of ABM and being acknowledged by people I admire within the organization as someone who deserved that honor.

ABM: What is a current challenge for you in your work?

Strassman: Finding time to do as much as I would like to assist nursing mom and baby dyads while still attending to the practice of general pediatrics and meeting the needs of these patients as well as those with nursing issues and questions.

ABM: What can ABM offer physicians worldwide?

Strassman: ABM can offer physicians the knowledge needed to support breastfeeding as well as support and networking for those who already have the knowledge.

Thank you, Dr. Strassman. We look forward to featuring additional Lifetime and Gold Members on the ABM Blog each month.

Don’t forget to register for the 17th Annual International Meeting to be held October 11-14, 2012 in Chicago. Early-bird rates end August 15.

ABM Member Profile: Featuring Felicity Savage, MD, FABM

ABM: Why did you become a member of ABM?

Savage: Because I am so supportive of its aims and enjoy the support of other physicians interested in breastfeeding.

ABM: What is ABM‘s greatest strength?

Savage: Bringing physicians who care and are knowledgeable about breastfeeding together, and setting a high technical evidence-based standard.

ABM: What inspires you to promote, protect and support breastfeeding?

Savage: I developed a passionate interest in the subject when having my own babies, and seeing the harm done to babies who bottle feed, especially when I worked in Africa and Indonesia. I was working for breastfeeding and the BFHI long before ABM existed, but now ABM helps by providing supportive colleagues, and normalizing breastfeeding as part of the physicians’ role.

ABM: What advice can you offer to physicians who are interested in learning more about breastfeeding?

Savage: Take a breastfeeding-related course, and join all the breastfeeding organizations you can, especially ABM.

ABM: What accomplishment are you most proud of in your career?

Savage: Developing breastfeeding training courses – one Masters level 3-4 week course at the Institute of Child Health in London (now transferred to Brighton University), conducting 2 week outreach versions of the course in 7 other countries, and developing the 40-hour in-service “book-led” course “Breastfeeding Counselling” for WHO which has been used and adapted and translated all over the world; writing 2 books “Breastfeeding in practice” (with Elisabeth Helsing) and “Helping Mothers to Breastfeed” which were translated into over 20 languages. These activities have contributed significantly to improved knowledge for doctors and other senior health workers in many countries.

ABM: What is a current challenge for you in your work?

Savage: Trying to ensure that there are future generations of senior health workers with sufficient authority to continue establishing breastfeeding as a mainstream public health subject, for evidence-based teaching and implementation

ABM: What can ABM offer physicians worldwide?

Savage: Ensure that all medical students learn about breastfeeding and feel responsible for promoting it throughout medical services, whether or not they specialize in the subject themselves.

Thank you, Dr. Savage.  We look forward to featuring additional Lifetime and Gold Members on the ABM Blog each week.