Researchers with the Center for Eliminating Health Disparities Among Latinos are recommending improvements in breastfeeding monitoring and surveillance at the national and state levels, based on a series of recent publications.
The researchers reached their conclusion after analyzing breastfeeding data collection methods in 11 federally-funded national surveys.
Their study, “U.S. National Breastfeeding Monitoring and Surveillance: Current Status and Recommendations,” was published in the May 2009 issue of the Journal of Human Lactation, the official journal of the International Lactation Consultant Association.
It determined that while breastfeeding data are being collected, these surveys are not optimal for monitoring breastfeeding practices from a health disparities perspective.
Currently, 11 federal surveys or datasets collect information on breastfeeding practices in the United States. However, these surveys are not well integrated to form a comprehensive monitoring system.
“Careful surveillance and monitoring of breastfeeding practices in the U.S. is important, because breastfeeding is associated with decreased rates of several health conditions, including diabetes, obesity, chronic inflammation of the inner ear, and premenopausal breast cancer,” says the study’s lead author Donna Chapman, assistant director of the Center for Eliminating Health Disparities Among Latinos and assistant professor-in-residence in the Department of Nutritional Sciences.
“Conversely, populations that are least likely to breastfeed bear an unusually high level of incidence for these conditions.”
Chapman and her UConn colleague Rafael Pérez-Escamilla, a professor of nutritional sciences and director of the Center for Eliminating Health Disparities Among Latinos, found that the breastfeeding questions used in these federally funded surveys are not standardized.
Many of the surveys also lacked questions regarding relevant variables – such as racial or ethnic subgroup, maternal height and pregnancy weight, delivery mode (cesarean delivery vs. vaginal delivery), and duration of breastfeeding practices – which may be useful in studying the breastfeeding outcomes.
“This type of work is important, because we need to make breastfeeding the norm in the U.S.,” says Chapman.
“If researchers, hospital administrators, and public health officials can’t access useful data on breastfeeding practices in the U.S., they are limited in their ability to develop effective, culturally-sensitive interventions to minimize the barriers to breastfeeding.”
In a related research paper, Chapman, Pérez-Escamilla, and researchers at the Boston Medical Center recommended the adoption of a standardized breastfeeding question on birth certificates as a way to improve breastfeeding surveillance in the U.S.
| Donna Chapman, assistant professor in residence of nutritional sciences, outside of the Roy E. Jones Building. Photo by Frank Dahlmeyer
They reached this conclusion after analyzing breastfeeding data collection methods in each of the 50 states plus New York City, Washington, D.C., and the four U.S. Territories.
Their study, “Breastfeeding Status on U.S. Birth Certificates: Where Do We Go from Here?” was published in Pediatrics in December 2008.
The U.S. Standard Certificate of Live Birth was revised in 2003 to include a question on breastfeeding. States are not required to use this federal birth certificate template, however, or to adopt the exact wording of the question on their birth certificate.
As a result, there are 11 different variations in the wording of the birth certificate breastfeeding question and the number and types of responses available to respondents.
Out of 53 responding U.S. states and territories, 30 were collecting data on breastfeeding on their birth certificates as of May 2008.
By 2010, nearly 80 percent of U.S. states are expected to be collecting breastfeeding data on their birth certificate, according to the study.
This increase in breastfeeding data collection represents a “significant contribution to our national breastfeeding surveillance efforts,” says Chapman, “because in each participating state, data are collected on every newborn to document breastfeeding status during the first days of life. This eliminates any potential errors due to sampling bias.”
Chapman and her colleagues recommend that the wording and administration of a national breastfeeding question on birth certificates be standardized, so that the collected data can be compared across states.
“The development of a carefully constructed breastfeeding question for use on state birth certificates is essential,” she says.
“This question should document, not only if the infant received breast milk, but also if the infant was exclusively breastfed – received only breast milk – during the hospital stay. This will make a valuable contribution to our knowledge on early breastfeeding practices.”
The research study was supported by funding from the National Institutes of Health.