Breastfeeding Promotion Among Minority Populations
1.) Identify a need, real or potential, in the community where you live.
Breastfeeding rates among mothers in the United States are lower than the Academy of Pediatrics recommendation (M. Bartick & A. Reinhold, 2010).The American Academy of Pediatrics recommends breastfeeding exclusive breastfeeding for six months, followed by uninterrupted breastfeeding for at least 12 months as complementary foods are introduced(Meek & Yu, 2011). Exclusive breastfeeding has been shown to reduce morbidity from life-threatening illness. Indeed, studies show that exclusive and/or predominant formula feeding is associated with increased risk for negative health outcomes(Bernard et al., 2013; Delgado & Matijasevich, 2013; Keith, Fontaine, Pajewski, Mehta, & Allison, 2011; Moore, Anderson, Bergman, & Dowswell, 2012). Compared to Whites, minorities are significantly less likely to breastfeed, which further increases their risk to adverse health outcomes(Jones, Power, Queenan, & Schulkin, 2015; Sparks, 2011). Minority populations are more likely to experience maternal and child health problems(Zhang et al., 2013), thus, measures need to be taken to remedy such health disparities. Health professionals (HPs), specifically nurses, are in the position to have a crucial role in addressing this public health concern through implementing strategies to promote breastfeeding within the hospital setting(Davis & Sherrod, 2015; Gross et al., 2011) Community-based efforts made by Nursing Education and Social Support services such as WIC have implemented breastfeeding (BF) promotion interventions(Long, Funk-Archuleta, Geiger, Mozar, & Heins, 1995; Yun et al., 2010), and there is supporting evidence of the nurses’ role in the efficacy of the intervention(L. Feldman-Winter, 2013; Humphries, 2011; Paul, Beiler, Schaefer, & et al., 2012).
2.) Explain why it is a real or potential need?
Socioeconomic, Racial, and Ethnic disparities exist specifically about increased risk of infant mortality, low birth weight, total mortality and disease such as cancer, diabetes, and heart disease(Jones et al., 2015; Sparks, 2011) .Research has shown that particular immunities in breastmilk protect the child against certain infections more during the second year of life(Perrin, Fogleman, Newburg, & Allen, 2016). Compared to non-breastfed kids, children who are still breastfeeding over the age of 1 have not only less frequent, but less severe infection as a result of concentrated nutrients during the second year(Perrin, Fogleman, Newburg, & Allen, 2016). This is critical for working, or working-poor mothers who can not afford to lose work or pay for increased medical care. Breastfeeding is associated with lower risk of otitis media, childhood leukemia, obesity, diabetes mellitus, gastroenteritis, and asthma(Bernard et al., 2013; Delgado & Matijasevich, 2013; Eidelman et al., 2012; Sparks, 2011). Exclusive breastfeeding is combined with reduced risk of atopic dermatitis, necrotizing enterocolitis, severe decrease respiratory tract infections, otitis media, gastroenteritis, and instant infant death concurrence (Bartlick et.al, 2010). With the objection of otitis media and childhood leukemia, each of these has evidence of higher ratio observed among black (Bartlick et al., 2010;Sparks, 2011; Jones et al. 2015). The potential consequences of lower breastfeeding among black females are particularly concerning because their health is already much poorer than other populations(Jones et al. 2015). Breastfeeding befits mothers by lowering maternal exposure for ovarian and breasts cancers(Bartlick et al., 2010;Sparks, 2011; Jones et al. 2015)..Currently, there increased the amount of literature examining breastfeeding interventions among minority groups, some of which have been featured in The CDC Guide to Breastfeeding Interventions(Meek & Yu, 2011).
3.) Who is the population that is affected?
Currently, there are racial and ethnic disparities such as increased mortality and morbidity for parent and children among African Americans(Jones et al., 2015; Zhang et al., 2013). Researchers suggest this is related to the fact that African-American women breastfeed at significantly low rates than the U.S. mean (58.9% of Black women initiate breastfeeding, compared with the national average of 76.5%), Hispanic and Native American women also report lower rates of breastfeeding(M. Bartick & A. Reinhold, 2010; CDC, 2013).
The gap between current breastfeeding practices and the Healthy People 2020 breastfeeding goals affect black females the most, as they are more likely to supplement with formal infants during the first days after birth(CDC, 2013; Gross et al., 2011). Black infants have the lowest prevalence of breastfeeding initiation and quantity, highlighting the need for targeted interventions in this population to promote and support breastfeeding. Breastfeeding interventions that increased nursing education and support for breastfeeding highlight the promising notion that health disparities among minorities will be eliminated. Recent efforts to address constant disparities in parental, infant, and child health have been made to influence intention at improving the health of a woman before she becomes breeding through a variety of evidence-supported interventions. Nutrition Program for Women, Infants, and Children (WIC), WIC is invested in serving their community and thus attempts to provide breastfeeding support for minority women have been implemented via peer counseling(Baumgartel & Spatz, 2013; Long et al., 1995; Yun et al., 2010).
4.) How would meet this need benefit the community? S
Increasing breastfeeding helps in preventable infant deaths among minorities, and suboptimal maternal and child health(Bartick and Reinhold, 2010; Humphries, 2011).Breastfeeding outcomes impact infant physiology and maternal neurobehavioral(Melissa Bartick & Arnold Reinhold, 2010; Baumgartel & Spatz, 2013). All of which has shown to be significantly and positively effected by the support of nurses to assist with skin to skin and breastfeeding intentions during <90min after birth(Davis & Sherrod, 2015). Racial and ethnic disparities in breastfeeding are responsible for furthering disparities in maternal and child health outcomes that currently exists. African-American children have the highest rates of obesity, SIDS and other diseases associated with the lack of breastmilk(Zhang et al., 2013). For example, minorities account for 55% of the premature and low birth weight deaths and 49% of the respiratory illness deaths(CDC, 2013; Zhang et al, 2013). Given the minimal evidence bf in this community, this suggest that BF is a significant contribution to the unnecessary increased rates morbidity and mortality among minorities.Studies have concluded that lack of breastfeeding support is the most important factor in why there are disparities of bf rates among racial and ethnic groups(Zhang et al., 2013). WIC's program have helped, for example, a study in North Carolina confirmed WIC enrollees have a higher take of breastfeeding than general population(Long et al., 1995). Nurses who are lactation consultants are also seen as reliable and efficient means of increases bf among minority women(da Graça, Figueiredo, & Conceição, 2011; L. Feldman-Winter, 2013; Paul et al., 2012).
5.) Identify at least one intervention that could improve this problem or meet the need.
Considering that biological issues are not the main reason women do not breastfeed attitudes and experiences to decide to formula feed needs to be better understood(Lori Feldman-Winter, 2013). This parallel shed light on inconsistencies in perceptions between perceived barriers of staff versus mothers. Mothers are not knowledgeable in breastfeeding technique and have minimal knowledge of benefits, which further supports why they decide to formula feed(Baumgartel & Spatz, 2013; Brown, Raynor, & Lee, 2011; Gross et al., 2011). Perhaps if they were informed of the benefits and felt there would postpartum support for breastfeeding their feeding choice would be different.Nurses and mothers should be encouraged to attend local breastfeeding lectures given by experts from American Academy of Pediatrics and Center for Disease Control which I hope could be achieve through contacting larger advocacy agencies. The lecture included on the importance of the nurse's role in breastfeeding, health benefits for the infant and mother, nutritional, and emotional bonding components of breastfeeding, anatomy, and physiology, positioning techniques, identifying barriers to breastfeeding and way to be instrumental in overcoming them to avoid formula feeding and supplementation. Thus, interventions in increasing knowledge and practice among nurses would be one way of addressing this issues. Also, the rise in awareness about the Peer Counseling program which provided training to WIC staff in BF, sponsoring lactation counselors, media campaigns for BF, and education resources to encourage breastfeeding. Over 149 million dollars of national funds went to this initiative coming to an average of 159 dollars per pregnant WIC participant(Baumgartel & Spatz, 2013). Again, to address racial/ethnic disparities in breastfeeding rates, could be addressed by increasing availability of breastfeeding support services at WIC sites as they serve many minority low-income women. The peer counseling program helps support nursing staff (Baumgartel & Spatz, 2013; Davis & Sherrod, 2015; Paul et al., 2012)by taking some of the maternal and child health responsibilities, which enhances their ability to meet other needs of mother and child(Adamo, Rutherford, & Goldfield, 2010; Yun et al., 2010).
6,)Who is the target population for the intervention?
African American and multiethnic mothers are more likely to face barriers to breastfeeding, Given the high number of African American women served by WIC programs, WIC peer counselor lactation support service program coupled with increased nursing education could assist in healthy remedy disparities among minority women and children(Jones et al., 2015; Sparks, 2011). WIC peer counseling programs are similar to lactation consultants; studies reveal they have been effective in increasing breastfeeding rates of WIC clients that include women from several different racial and ethnic backgrounds(da Graça et al., 2011; L. Feldman-Winter, 2013; Paul et al., 2012).
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7.) What steps might you take to implement your idea?
I would first contact Nursing Education administrators and Lactation Consultant and Breastfeeding advocacy groups to assist in developing a plan to remedy health disparities on a local level through breastfeeding promotion. I may also hold focus groups at local health care clinics that serve minority low-income populations to assess the barriers to breastfeeding. Exploring the efficacy of lactation support and nursing education further would be helpful in developing community-based initiative to increase breastfeeding rates and decrease negative health among minority women and children.
8.) Who would you involve in your community to help with this project?
There has been an evidence-based educational intervention for breastfeeding promotion among nursing students. One study found nurses scored significantly higher on Breastfeeding Knowledge and Attitude Questionnaire post evidence-based educational seminar, pre-intervention scores averaged to 3.33 and increased to 4.13 post intervention(Davis & Sherrod, 2015).I would contact the local nursing school to outline the benefits of breastfeeding and their need for addressing health disparities. Breastfeeding education has been noted as a significant barrier to providing breastfeeding support. The inclusion of breastfeeding educational interventions for nurses during training can be very helpful. Nurses are in a special a position to provide critical knowledge and guidance to initiate and sustain breastfeeding because patients view nursing staff as the primary source of BF support(Baumgartel & Spatz, 2013; da Graça et al., 2011; Davis & Sherrod, 2015; L. Feldman-Winter, 2013). Evidence that providing BF education to nurses has shown to improve breastfeeding outcomes. Considering the benefits of breastfeeding for the mother and infant implementing this intervention into practice could improve maternal and child health.
Unfortunately, professionals raised the concern of lack of time and resources, therefore reframing the issue of breastfeeding barriers from focusing on increasing knowledge in training to the systemic clinical setting and the limitations that pose for staff to successful help mothers who want to breastfeed(L. Feldman-Winter, 2013; Humphries, 2011; Paul et al., 2012).
. Staff expressed willingness and desire to help mothers, but due to limited resources, their time is too limited to provide this form of care to mothers(L. Feldman-Winter, 2013; Humphries, 2011; Paul et al., 2012).. Again, this supports my belief that nurses are an in the needed position to help breastfeeding outcomes improve, and focus on remedying the structural barriers need to be addressed in order to improve BF rates and the benefits associated with such outcomes. Thus, addressing health disaprites that current exist among low income, multinthinc populations.
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