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Implementing Legislation to Improve Hospital Support of Breastfeeding, New York State, 2009–2013

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Implementing Legislation to Improve Hospital Support of Breastfeeding, New York State, 2009–2013



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Implementing Legislation to Improve Hospital Support of Breastfeeding, New York State, 2009–2013

CME — Volume 12 — July 30, 2015

Barbara A. Dennison, MD; Bethany A. Hawke, MPH; Rachael A. Ruberto, MPH; Deborah J. Gregg, MPH

Suggested citation for this article: Dennison BA, Hawke BA, Ruberto RA, Gregg DJ. Implementing Legislation to Improve Hospital Support of Breastfeeding, New York State, 2009–2013. Prev Chronic Dis 2015;12:150121. DOI: http://dx.doi.org/10.5888/pcd12.150121.

MEDSCAPE CME

Medscape, LLC is pleased to provide online continuing medical education (CME) for this journal article, allowing clinicians the opportunity to earn CME credit.
This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education through the joint providership of Medscape, LLC andPreventing Chronic Disease. Medscape, LLC is accredited by the ACCME to provide continuing medical education for physicians.
Medscape, LLC designates this Journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
All other clinicians completing this activity will be issued a certificate of participation. To participate in this journal CME activity: (1) review the learning objectives and author disclosures; (2) study the education content; (3) take the post-test with a 75% minimum passing score and complete the evaluation at www.medscape.org/journal/pcd; (4) view/print certificate.
Release date: July 30, 2015; Expiration date: July 30, 2016

Learning Objectives

Upon completion of this activity, participants will be able to:
  1. Discuss the regulation of hospitals in New York regarding breastfeeding protocols
  2. Assess adherence to breastfeeding protocols in New York before the introduction of regulatory changes
  3. Evaluate the effects of legislation and regulatory oversight on breastfeeding promotion in New York
  4. Distinguish particularly effective public tools that improved breastfeeding promotion in hospitals in New York
EDITORSRosemarie Perrin
Editor, Preventing Chronic Disease
Disclosure: Rosemarie Perrin has disclosed no relevant financial relationships.

CME AUTHOR
Charles P. Vega, MD,
Clinical Professor of Family Medicine, University of California, Irvine
Disclosure: Charles P. Vega, MD, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: Lundbeck, Inc.; McNeil Pharmaceuticals; Takeda Pharmaceuticals North America, Inc.

AUTHORS AND CREDENTIALS
Barbara A. Dennison, MD, New York State Department of Health, Albany, New York; School of Public Health, University at Albany — State University of New York, Rensselaer, New York
Disclosure: Barbara A. Dennison, MD, has disclosed no relevant financial relationships.

Bethany Hawke, MPH, Formerly at the New York State Department of Health; currently a medical student at Albany Medical School, Albany, New York
Disclosure: Bethany Hawke, MPH, has disclosed no relevant financial relationships.

Rachael A. Ruberto, MPH, CPH, New York State Department of Health, Albany, New York
Disclosure: Rachael A. Ruberto, MPH, CPH, has disclosed no relevant financial relationships.

Deborah J. Gregg, MPH, RDN, CDN, CLC, New York State Department of Health, Albany, New York
Disclosure: Deborah J. Gregg, MPH, RDN, CDN, CLC, has disclosed no relevant financial relationships.

PEER REVIEWED

Abstract

Introduction
Increasing breastfeeding is a public health priority supported by strong evidence. In 2009, New York passed Public Health Law § 2505–a, requiring that hospitals support the World Health Organization’s (WHO’s) recommended “Ten Steps for Successful Breastfeeding” (Ten Steps). This legislation strengthened and codified existing New York State’s hospital perinatal regulations. The purpose of this study was to assess hospital policy compliance with New York laws and regulations related to breastfeeding.
Methods
In 2009, 2011, and 2013, we collected written breastfeeding policies from 129 New York hospitals that provided maternity services. A policy review tool was developed to quantify compliance with the 28 components of breastfeeding support specified in New York Codes, Rules, and Regulations and the new legislation. In 2010 and 2012, hospitals received individual feedback from the New York State Department of Health, which informed hospitals in 2012 that formal regulatory enforcement, including potential fines, would be implemented for noncompliance.
Results
The number of components included in hospital policies increased from a mean of 10.4 in 2009, to 16.8 in 2011, and to 27.1 in 2013) (P < .001); a greater increase occurred from 2011 through 2013 than from 2009 through 2011 (P < .001). The percentage of hospitals with fully compliant policies increased from 0% in 2009, to 5% in 2011, and to 75% in 2013 (P < .001), and the percentage that included all WHO’s 10 steps increased from 0% to 9% to 87%, respectively (P < .001).
Conclusion
Although legislation or regulations requiring certain practices are important, monitoring with enforcement accelerates, and may be necessary for, full implementation. Future research is needed to evaluate the impact of improved hospital breastfeeding policies on breastfeeding outcomes in New York.

Acknowledgments

This work was supported in part by the US Department of Health and Human Services, Centers for Disease Control and Prevention (no. DP09-901/3U58DP001963-01S2), the Robert Wood Johnson Foundation, Public Health Law Research Program (no. 70514), the Maternal Child Health Block Grant (no. B04MC11183) for funded internship, and the New York State Department of Health. The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of the funders.
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Author Information

Corresponding Author: Barbara A. Dennison, MD, New York State Department of Health, Division of Chronic Disease Prevention, Empire State Plaza, Corning Tower, Rm 1042, Albany, NY 12237. Telephone: 518-474-0512. Email: barbara.dennison@health.ny.gov.
Author Affiliations: Bethany A. Hawke, medical student, Albany Medical School, Albany, New York. Rachael A. Ruberto, Deborah J. Gregg, New York State Department of Health, Albany, New York. Dr. Dennison is also affiliated with the School of Public Health, University at Albany–State University of New York, Rensselaer, New York.
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