Abstract
Objective While the Affordable Care Act improves access to lactation services for many women across the US, low-income mothers in states without Medicaid expansion lack coverage for lactation support. As these states consider individual Medicaid reimbursement policies, the availability, effectiveness, and cost-benefit of lactation services must be evaluated. We conducted such an analysis for low-income mothers in North Carolina (NC), providing a model for other states. Methods First, we analyzed the distribution of NC International Board Certified Lactation Consultants (IBCLCs) and county-level breastfeeding rates among low-income infants. Logistic regression was used to examine the association between IBCLC density and 6-week breastfeeding duration. Finally, state advocates collaborated on a cost-benefit analysis of Medicaid coverage of IBCLCs. Results Maps of the NC breastfeeding support landscape indicate that IBCLCs are available to provide services to low-income women across the state. Compared to counties with no IBCLCs, those with high IBCLC density were found to have a 6-week breastfeeding prevalence ratio of 1.20 (95 % CI 1.12, 1.28). Medicaid reimbursement of IBCLCs showed an estimated annual cost savings of $2.33 million. Conclusions for Practice In one state without Medicaid expansion, we found that breastfeeding support resources are available across the state, high density IBCLC support is associated with increased breastfeeding by low-income mothers, and services are cost-effective. Our model for Medicaid reimbursement in NC provides a framework for states to improve equity in access to optimal lactation support.
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References
American Academy of Family Physicians. (2014). Breastfeeding, family physicians supporting (position paper)—AAFP policies. Retrieved January 30, 2016, from http://www.aafp.org/about/policies/all/breastfeeding-support.html.
American Academy of Pediatrics Section on Breastfeeding. (2012). Breastfeeding and the use of human milk. Pediatrics, 129(3), e827–e841.
Bartick, M. C. (2011). Breastfeeding and the US Economy. Breastfeeding Medicine, 6(5), 313–318. doi:10.1089/bfm.2011.0057.
Bartick, M. C., & Reinhold, A. (2010). The burden of suboptimal breastfeeding in the United States: A pediatric cost analysis. Pediatrics, 125(5), e1048–e1056. doi:10.1542/peds.2009-1616.
Bonuck, K. A., Stuebe, A., Barnett, J., Labbok, M. H., Fletcher, J., & Bernstein, P. S. (2014). Effect of primary care intervention on breastfeeding duration and intensity. American Journal of Public Health, 104(S1), S119–S127. doi:10.2105/AJPH.2013.301360.
Britton, C., McCormick, F. M., Renfrew, M. J., Wade, A., & King, S. E. (2007). Support for breastfeeding mothers. Cochrane Database of Systemic Reviews, 1, Cd001141. doi:10.1002/14651858.CD001141.pub3.
CDC. (2009). Maternity practices in infant nutrition and care in North Carolina, 2009 mPINC Survey. Retrieved from http://www.cdc.gov/breastfeeding/data/mpinc/state_reports.html#states2011.
CDC. (2012). Breastfeeding among US children born 2002–2012, CDC National Immunization Surveys. Retrieved January 28, 2016, from http://www.cdc.gov/breastfeeding/data/nis_data/index.htm.
CDC. (2013). Breastfeeding report card. Retrieved from http://www.cdc.gov/breastfeeding/data/reportcard.htm.
Chantry, C. J. (2011). Supporting the 75 %: Overcoming barriers after breastfeeding initiation. Breastfeeding Medicine, 6(5), 337–339. doi:10.1089/bfm.2011.0089.
Chatterji, P., & Brooks-Gunn, J. (2004). WIC participation, breastfeeding practices, and well-child care among unmarried, low-income mothers. American Journal of Public Health, 94(8), 1324–1327. doi:10.2105/AJPH.94.8.1324.
Chowdhury, R., Sinha, B., Sankar, M. J., Taneja, S., Bhandari, N., Rollins, N., … Martines, J. (2015). Breastfeeding and maternal health outcomes: A systematic review and meta-analysis. Acta Paediatrica, 104, 96–113. doi:10.1111/apa.13102.
Colaizy, T. T., Bartick, M. C., Jegier, B. J., Green, B. D., Reinhold, A. G., Schaefer, A. J., … Stuebe, A. M. (2016). Impact of optimized breastfeeding on the costs of necrotizing enterocolitis in extremely low birthweight infants. The Journal of Pediatrics. doi:10.1016/j.jpeds.2016.03.040.
Flower, K. B., Willoughby, M., Cadigan, R. J., Perrin, E. M., Randolph, G., & The Family Life Project Investigative Team. (2008). Understanding breastfeeding initiation and continuation in rural communities: A combined qualitative/quantitative approach. Maternal & Child Health Journal, 12(3), 402–414. doi:10.1007/s10995-007-0248-6.
Gutowski, J. L., Walker, M., & Chetwynd, E. (2014). Containing health care costs: Help in plain sight. International Board Certified Lactation Consultants: Allied Health Care Providers Contribute to the Solution (3rd Ed.). Washington, DC. Retrieved from http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0CB8QFjAA&url=http://uslca.org/wp-content/uploads/2013/02/Containing-Health-Care-Costs-3rd-edition-7-2014.pdf&ei=tWehVYJayrP5Abinp_AN&usg=AFQjCNGMUFsEG9r7ZkXl6MCMNrH8WpT7rQ&.
Health Resources and Services Administration. (2012). Women’s preventive services: Required health plan coverage guidelines. Retrieved January 16, 2016, from http://www.hrsa.gov/womensguidelines/.
Henry J. Kaiser Family Foundation. (2016). State health facts: Status of state action on the medicaid expansion decision. Retrieved January 30, 2016, from http://kff.org/health-reform/state-indicator/state-activity-around-expanding-medicaid-under-the-affordable-care-act/.
Herold, R. A., & Bonuck, K. A. (2015). Medicaid IBCLC Service Coverage following the Affordable Care Act and the Center for Medicare and Medicaid Services Update. Journal of Human Lactation. doi:10.1177/0890334415599164.
Horta, B. L., de Mola, C. L., & Victora, C. G. (2015). Long-term consequences of breastfeeding on cholesterol, obesity, systolic blood pressure, and type-2 diabetes: Systematic review and meta-analysis. Acta Paediatrica, 104, 30–37. doi:10.1111/apa.13133.
Hurley, K. M., Black, M. M., Papas, M. A., & Quigg, A. M. (2008). Variation in breastfeeding behaviours, perceptions, and experiences by race/ethnicity among a low-income statewide sample of Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participants in the United States. Maternal & Child Nutrition, 4, 95–105.
Ip, S., Chung, M., Raman, G., Trikalinos, T. A., & Lau, J. (2009). A summary of the Agency for Healthcare Research and Quality’s evidence report on breastfeeding in developed countries. Breastfeeding Medicine: The Official Journal of the Academy of Breastfeeding Medicine, 4(Suppl 1), S17–S30. doi:10.1089/bfm.2009.0050.
Jacknowitz, A., Novillo, D., & Tiehen, L. (2007). Special supplemental nutrition program for women, infants, and children and infant feeding practices. Pediatrics, 119(2), 281–289. doi:10.1542/peds.2006-1486.
Kranz, A. M., Lee, J., Divaris, K., Baker, A. D., & Vann, W. (2014). North Carolina physician-based preventive oral health services improve access and use among young medicaid enrollees. Health Affairs, 33(12), 2144–2152. doi:10.1377/hlthaff.2014.0927.
Li, R., & Grummer-Strawn, L. (2002). Racial and ethnic disparities in breastfeeding among United States infants: Third National Health and Nutrition Examination Survey, 1988–1994. Birth: Issues in Perinatal Care, 29(4), 251–257. Retrieved from http://www.nclive.org/cgi-bin/nclsm?url=“http://search.ebscohost.com/login.aspx?direct=true&AuthType=cookie,ip,cpid&custid=s5823000&db=c8h&AN=2003022908&site=ehost-live”.
Lynch, S., Bethel, J., Chowdhury, N., & Moore, J. B. (2011). Rural and urban breastfeeding initiation trends in low-income women in North Carolina from 2003 to 2007. Journal of Human Lactation, 28(2), 226–232. doi:10.1177/0890334411430086.
Ma, P., Brewer-Asling, M., & Magnus, J. H. (2013). A case study on the economic impact of optimal breastfeeding. Maternal and Child Health Journal, 17(1), 9–13. doi:10.1007/s10995-011-0942-2.
North Carolina Child Fatality Task Force. (2014). Perinatal health committee meeting minutes. Retrieved from http://www.ncleg.net/gascripts/DocumentSites/browseDocSite.asp?nID=116&sFolderName=\Perinatal%20Health\2014-2015
Odom, E. C., Li, R., Scanlon, K. S., Perrine, C. G., & Grummer-Strawn, L. (2013). Reasons for earlier than desired cessation of breastfeeding. Pediatrics, 131(3), e726–e732. doi:10.1542/peds.2012-1295.
Rollins, N. C., Bhandari, N., Hajeebhoy, N., Horton, S., Lutter, C. K., Martines, J. C., … Victora, C. G. (2016). Why invest, and what it will take to improve breastfeeding practices? Lancet, 387(10017), 491–504. doi:10.1016/S0140-6736(15)01044-2.
Sparks, P. J. (2010). Rural–urban differences in breastfeeding initiation in the United States. Journal of Human Lactation, 26(2), 118–129. doi:10.1177/0890334409352854.
State Center for Health Statistics Center. (2011). Risk factors and characteristics for 2010 North Carolina resident live births: Medicaid mothers. Retrieved January 16, 2016, from http://www.schs.state.nc.us/schs/births/matched/2010/medicaid.html.
State Center for Health Statistics Center. (2013). Percent of births to medicaid and WIC mothers (2008–2012). Retrieved January 16, 2016, from http://www.schs.state.nc.us/data/databook/CD7DMedicaidandWICbirths.html.
Stopka, T. J., Krawczyk, C., Gradziel, P., & Geraghty, E. M. (2014). Use of spatial epidemiology and hot spot analysis to target women eligible for prenatal women, infants, and children services. American Journal of Public Health, 104(S1), S183–S189. doi:10.2105/AJPH.2013.301769.
Stuebe, A. M., & Bonuck, K. (2011). What predicts intent to breastfeed exclusively? Breastfeeding knowledge, attitudes, and beliefs in a diverse urban population. Breastfeeding Medicine, 6(6), 413–420. doi:10.1089/bfm.2010.0088.
Su, L. L., Chong, Y. S., Chan, Y. H., Chan, Y. S., Fok, D., Tun, K. T., … Rauff, M. (2007). Antenatal education and postnatal support strategies for improving rates of exclusive breast feeding: Randomised controlled trial. BMJ, 335(7620), 596. doi:10.1136/bmj.39279.656343.55.
The American College of Obstetricians and Gynecologists. (2016). Committee opinion no. 658: Optimizing support for breastfeeding as part of obstetric practice.
US Census Bureau. (2010). 2010 census urban and rural classification and urban area criteria. Retrieved January 30, 2016, from https://www.census.gov/geo/reference/ua/urban-rural-2010.html.
US Department of Health and Human Services. (2011). The surgeon general’s call to action to support breastfeeding.
US Department of Health and Human Services. (2012). Healthy people 2020: Summary of objectives: maternal, infant, and child health, 2010 (pp. 1–19).
USPSTF. (2008). Primary care interventions to promote breastfeeding: US preventive services task force recommendation statement. Annals of Internal Medicine, 149(8), 560–564.
WIC. (2010a). 2010 directory of NC public health nutritionists. Retrieved from http://nutritionnc.com/wic/wicLAR.htm.
WIC. (2010b). Percent of infants participating in WIC who are breastfeeding at 6 months of age. Retrieved from http://nutritionnc.com/wic/wicLAR.htm.
Witt, A. M., Smith, S., Mason, M. J., & Flocke, S. A. (2012). Integrating routine lactation consultant support into a pediatric practice. Breastfeeding Medicine, 7(1), 38–42. doi:10.1089/bfm.2011.0003.
Acknowledgments
This research is supported in part by a predoctoral training grant from the National Institute of Child Health and Human Development (5T32HD052468-08). The authors would like to acknowledge Philip McDaniel at the Odum Institute for his GIS support and Najmul Chowdhury at the Nutrition Services Branch of the North Carolina Division of Public Health for his assistance with the PedNSS data.
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Wouk, K., Chetwynd, E., Vitaglione, T. et al. Improving Access to Medical Lactation Support and Counseling: Building the Case for Medicaid Reimbursement. Matern Child Health J 21, 836–844 (2017). https://doi.org/10.1007/s10995-016-2175-x
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DOI: https://doi.org/10.1007/s10995-016-2175-x