Field Placement: Los Angeles County Department of Health Services - Maternal, Child, and Adolescent Health Programs
Location: Los Angeles, CA
Preceptor: Kathye-Petters Armitage, MPH
Student Name: Andrea Hoberman
Year: 2004

The Baby-Friendly Hospital Initiative: Improving Breastfeeding Support in Los Angeles County

The Los Angeles County Department of Health Services (LADHS) Maternal, Child, and Adolescent Health (MCAH) Program is responsible for planning, implementing, and evaluating public health services that address the needs of pregnant and parenting women, children, and families in LA County. As a participant in the LADHS Summer Administrative Internship Program, I focused my field study on improving breastfeeding support and promotion within the LA County public birthing hospitals through the Baby-Friendly Hospital Initiative (BFHI). The BFHI is a global program sponsored by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) to recognize hospitals and birthing centers that maintain an outstanding level of care for lactation. Facilities designated as “Baby-Friendly” follow the WHO/UNICEF “Ten Steps to Successful Breastfeeding” to facilitate better breastfeeding initiation, duration, and exclusivity.

Breastfeeding is the ideal method of infant feeding because it confers numerous benefits to both infant and mother. Research shows that breast milk contains crucial immune factors that decrease an infant’s risk for many childhood illnesses including otitis media, diarrhea, and respiratory infections. Breastfeeding also promotes mother-infant bonding and decreases a woman’s risk of breast and ovarian cancers. For these reasons, the American Academy of Pediatrics (AAP) and WHO recommend that infants be exclusively breastfed for the first six months of life. Locally, only 27% of women in LA County follow this recommendation by breastfeeding exclusively, compared to 42% statewide. Because breastfeeding has the potential to be a cost effective method of improving infant health, I worked with the MCAH unit conducting formative research in order to achieve Baby-Friendly certification at the four County birthing hospitals (Harbor/UCLA, Olive View, LAC+USC, King/Drew).

Informational interviews with lactation consultants, nurse managers, and hospital administrators illustrated the current level of breastfeeding support available to women who deliver at the County medical centers. During these visits I identified champions and internal resources within each hospital to assist in the process of becoming Baby-Friendly. Although each hospital has unique strengths in maternal and child health care, it is clear that many challenges lie ahead before new policies and practices can be adopted. Contacting other hospitals that are currently Baby-Friendly has been a valuable method to identify the common barriers in implementing the BFHI and to obtain suggestions about how to overcome them. With continued support from LADHS administration it is planned for the hospitals to file Certificate of Intents with Baby-Friendly USA in January 2005. Although this project is long-term, the initial gains made during my field study will serve as a strong foundation upon which to move toward achieving Baby-Friendly status in LA County.

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