Meeting 5 Notes
April 12, 2007
Welcome to Child Health Advisory Committee Discussion Group!
Members present: Mary Baskett (phone), Dennis Cooley, Karen Cox, Betsy Hineman, Vicki Hoffman, Gerard Lozada, Tom Ostrander, Nick Rogers, Penney Schwab (phone), Mim Wilkey
Staff present: Linda Kenney, Paula Marmet, Ileen Meyer, Howard Rodenberg, Connie Satzler
Guests Present: Brenda Bandy, Aimee Gross, Walaiporn Rojjanasrirat, Karen Wambach
Dr. Rodenberg, legislative update: For first time in a while, school finance is not on the table.
Leg has left a lot undone for the veto session.
Dr. Rodenberg highlighted the following bills/issues:
* Health Care reform. House Substitute for Senate bill 11. Governor had originally proposed $10 million to extend benefits under Healthy Kansas First Five. We aren't yet sure of the impact of this. Interest on the people sponsoring to have some type of evaluation, not just based on dollars saved but on clinical impact.
* Expanded newborn screening, though not exactly as we had expected. Had worked on a cost-sharing agreement. Legislature is going to sponsor the whole thing. $800K this year to set up infrastructure. When go live in ‘08, will be funded $1.2 million per year (anticipated.) House Bill 2224. Going through with the exception that we can change the fee.
* Senate Bill on thimerisol in vaccines. Did get a hearing, but didn't go anywhere. SB01
* Mentioned bill(s) related to pharmacists and vaccinations.
* Senate Bill 211. Specific primary seat belt law for teenagers.
* House Bill 2090. Height and weight from school children to get Body Mass Index. This one died in committee. Reason didn't make it through committee - one quote “we already know kids are fat, why do we need more data?”
* What has gone someplace – House Bill 2423. Obesity task force. Will work within existing structures. This bill did go through.
* House Bill 2227. HPV for 6th graders. Introduced by Representative Garcia. Funding was not an issue. In front of the cameras, seems to be a morality issue. But the hold up (the real issue) if a parent, for whatever reason, wants to opt out, they should be able to (not just for religious or medical reasons), but personal or philosophical reasons. Maybe can use this group as a sounding board, way to respond to this concern, some way to distinguish this vaccine to give personal exemption that wouldn't apply to other vaccines (e.g., measles). Maybe we can discuss in a session this summer. Is a personal exemption something we should even consider? If we do, how should it be structured?
Dr. Cooley: In some ways, successful section. The fact that the primary seatbelt law was passed was a real plus. The newborn screening bill was a real plus. The Obesity Task Force, as well. This year was not bad.
Dr. Rodenberg: I would agree. I would have loved to have seen House Bill 2090 (related to BMI data) pass. Unless we can see exactly where the problems are, will continue to throw money out but will not be able to target interventions as best we could.
Paul Getto: Have you thought about working with the state board on body mass index data?
Dr. Rodenberg: Have not yet. A little limited on what contacts we can make. Appreciate that comment. Need to expand that envelope a little maybe. Perhaps the way to do it is to have this body go to the state Board of Education.
Expert Panel
Brenda Bandy with Kansas La Leche League. International organization. Sole purpose is to provide information and support to mothers who want to breastfeed. We are volunteers.
Brenda's role is area professional liaison. Couple year ago, worked on the breastfeeding law. Did get calls from women who had problems breastfeeding in public. These are not isolated cases. Variety of settings women asked not to breastfeed in public.
Interesting process to get this passed. Took 2 sessions. Concern was, why are you telling businesses what to do?
Talked about how we can't tell babies when and when not to be hungry, to feed, importance of breastfeeding.
Next session, once educated, passed unanimously. Wonder if the next step might be support for workplace legislation.
Overview of other legislation.
If here in Kansas we should decide to tackle, will see that easy to do, doesn't cost, will have an impact.
Moms that choose to start breastfeeding in hospitals in Kansas are pretty good. Most people understand that breastfeeding is best for babies.
What happens is that moms face every day obstacles, being able to breastfeed, pump - workplace, day care providers, restaurants, etc.
Drops off to 12% exclusive breastfeeding at 6 months.
AAP has identified 10 barriers to breastfeeding, including public breastfeeding, workplace accommodations
Yes, they now it is the right thing, but how to make it work in reality.
We need to help women continue, but one of important pieces is workplace support. A lot written about it.
Research has shown that workplace support does increase duration rates. Refer to CDC book on breastfeeding interventions.
Workplace support - also legislative piece. 14 states have something on the books that have something to encourage breastfeeding moms.
Two states - Virginia and Wyoming have simple resolutions.
6 states - what they would like to see employers do.
6 states mandate that employers accommodate moms in workplace.
1 state - California - makes civil penalty ($100 fine) for workplaces that do not accommodate breastfeeding moms.
2 states address discrimination issues related to breastfeeding. Courts are not defending moms’ rights to breastfeed in the workplace. California and Hawaii have prohibited workplaces from discriminating against moms who need to breastfeed, pump in the workplace.
Texas has come up with designation - mother-friendly businesses; have a breast-feeding accessible business.
Jury is still out on how effective this will be.
4 states have met goal of 6-month duration of 25%. All 4 of those states have mandates. We think this is most effective.
What are the components of a good bill?
1. Break time. Mom is entitled to express breast milk during normal break times. (California has said can have longer or more extended, but unpaid.) Women who are having problems are those who work at grocery stores, manufacturing, restaurants, etc. Women who most need our community's protection and support are the ones that are not getting it.
2. Location. What are we going to do to accommodate location? Something “other than a toilet stall.” Others add to this - access to a sink, access to refrigeration unit. At the minimum, clean, safe place to wash.
3. Exception. Can be excepted if it presents undue hardship or undue disruption. BETTER wording is employer is to be held harmless if reasonable effort is made to accommodate with workplace accommodation law.
That is what is left to decide - exactly how to write the workplace law here. Lots of examples there.
Linda Kenney: Think some of these provisions would be almost impossible to get through the legislature given the resistance when public breastfeeding was first introduced.
Brenda Bandy: The way women breastfeed now is different than 20 years ago. Women are in the workplace more, they eat out more.
Brenda Bandy: Mentioned Colorado law. Did not get through this year. Is a benefit to employers. Women are sick less, out less with baby, recruitment tool.
Linda Kenney: Perinatal Council - hospitals explained they are doing their part; women are breastfeeding when they leave the hospital, but they drop off later.
Tom Ostrander: How do we address businesses? May not be employers, but may be clientele. How do we address that?
Brenda Bandy: Think it's education. Not sure customers are going to know that's taking place. Don't think the public would know if they are smoking or breastfeeding on their break.
Tom Ostrander: If accommodations are made...
Brenda Bandy: Can get very creative on making accommodations for women. U.S. breastfeeding committee has great workplace accommodations checklist. Tools out there already to help employers get on board, but piece of legislation goes a long way.
Letting employers know how often, how long is needed to pump - educating employers.
Betsy Hineman: what states have mandated?
Brenda Bandy: Mandate states are California, Connecticut, New Mexico, Illinois, Minnesota, Rhode Island, Tennessee [not sure I have the list correct]
What about mandated law - any documented evidence besides those 4 states that have met the goal?
Brenda Bandy: Evidence is not yet in. Leg works together with education, support of employers and mothers, not a stand alone fix it all. Works together.
Oldest is 1994 (New York)
Three in last two years.
Kansas is one of only 13 states with jury exclusion.
Aimee Gross - next presenter
Nurse Practitioner, Certified Lactation Consultant, have worked to have enough space and enough pumps.
Creating mother-friendly workplaces.
New Mexico - with recent legislation, at the forefront with breastfeeding promotion.
We have 14 area coalitions, but New Mexico has cohesive statewide coalition. Looking to solidify things throughout Kansas.
3 basic requirements for mother-friendly workplace.
1. Rime to pump or breastfeed baby
2. Space to pump or location to bf (not a restroom)
3. Support
First two were addressed very well with previous presenter.
Women make feeding choices often before they conceive. It's not that they don't understand that it's best for the baby, it's that they don't see how they will continue to make it work.
We need to help mothers when talking with them about their feeding choice, how to build a support network, strategic plan for how this will work. Also need to build support with employers.
Employers who had previous experience with breastfeeding employees were supportive - saw how it worked.
Workers that have flow in their work that provide challenges (farmworker, restaurant) - many employers are willing to work on it, but don't know what to do
Baby Friendly Hospital Initiative. Designation that can be achieved internationally. Requires hospital to implement 10 steps. Majority relate to keep moms and babies together, not to give breastfeeding infants any other fluid or formula unless medically indicated. No artificial pacifiers, etc.
18,000 hospitals worldwide, only 55 in the U.S.!
Main reason - issue with formula.
Hospital to achieve baby-friendly hospital, must purchase formula, cannot accept free formula, distribute formula bags.
Have been successful (at our hospital) in eliminating free bags, but they then go to physician's offices, midwives, gets mailed to them with sample of infant formula, sample mailed to them at the time the baby's appetite increases. (All based on marketing research by the formula companies.)
Some hospitals, once achieving the designation, have lost it, because administration wants to start getting free formula again.
Mothers who feel supported in feeding choice at place of delivery go on to develop support network. Have a unique situation in Topeka - a lot of free support women can access.
How many breastfeeding-friendly hospitals in Kansas?
None. St. Francis is only one with intent.
Dr. Cooley: Funding issues for hospitals. Especially true of Level II or III ICU with special formulas needed.
68 hospitals nationwide have certificate of intent now.
Karen Cox: Do you think impact of moms with Medicaid who aren't able to get pumps? Is equipment an issue?
Aimee Gross: Think it can be. Peer counselors - effective way of increasing breastfeeding duration. Pumps - don't know if we have good data on the effect one way or the other.
Dr. Cooley: When I have young moms on Medicaid come in, hardly ever nursing. Socioeconomic factors - have seen in practice - as big factor.
Karen Cox: In encouraging our employees - even when encourage - it is still easier for professional staff versus non-professional staff because their lives are different.
Linda Kenney: Have you heard of any program to support employers?
Aimee Gross: Not really, but have seen data about employers wanting to learn more about how they can be accommodating.
Dr. Cooley: Yes, if had something about what employers could do, educational issue with employer - need education on benefits and need to know exactly what to do.
Ross Labs had website about what employers could do for pumping, but would not recommend! They made it sound very difficult!!
***10 minute break***
Please refer to presentation (currently being shown here)
Karen Wambach and Walaiporn Rojjanasrirat
We are certified lactation consultants, but do not currently practice. We are researchers.
Karen Wambach focuses on early postpartum, special population groups, factors that promote/inhibit breastfeeding, currently working on NIH project related to breastfeeding and teenage moms. Making the decision and keeping them going.
Walaiporn's research has been more connected to promoting breastfeeding among working women.
We have worked together for a while. She is project director for NIH project clinical trial.
Talking about significance of breastfeeding, how to support in working mothers. Will talk about breastfeeding support in workplace with federal examples, Kansas examples, very briefly about current breastfeeding legislation, then recommendations for KS.
**See presentation**
Reviewed Benefits slide - for baby
Benefits for mom
Benefits to society & private sector
Employment-related benefits
Data slides to document where BF has come last 20-30 years. We're getting there!
Kansas is paralleling U.S. rates.
Yes, have 70% women initiating breastfeeding, but at 6 months, down to 30%. The longer women breastfeed, the more health benefits there are.
Women & Employment slide
Overview of impact of employment on breastfeeding
Working women & breastfeeding impact - points from literature
Breastfeeding Incidence by Employment status
Down to about 20% in Fulltime mother
Barriers to breastfeeding in the Workplace
Female Physicians & Employment
Support for breastfeeding in the workplace
Workplace Lactation Program
Effects of On-site lactation program (research results)
Breastfeeding Policy (research results, examples of policy)
Federal Employee Lactation Support Programs
Texas Mother-Friendly Work Site Program
National Healthy Mothers, Healthy Babies Coalition
Oregon Employer Recognition Program
Kansas Examples
Don't have any data on Kansas. Presenters did informal survey in Kansas City and Topeka.
Hospitals
- KU Med Center
- Overland Park Regional Medical Center
- Shawnee Mission Medical Center
- St. Luke's South
- Providence
- Stormont Vail
- St. Francis
Kansas City Businesses
Kansas City Schools
Legislative support
Breastfeeding Awareness Campaign
Strategies for Resolving Problem & Recommendations
Have to do more to get 6-month rate up.
Must focus on employers, workplace
Questions?
Tom Ostrander: Are there plans or strategies in place to inform employers?
Karen Wambach: There are guidelines out there. HHS blueprint for action. Other published guidelines that very clearly layout what you need for space, flexibility. Even some that give you inexpensive, moderate, more expensive.
Some places where have statewide coalition, they reach out to employers and they do the certificates, give employers signs, etc. Coalitions usually made up of La Leche League leaders, lactation consultants, etc. in own community providing support to small businesses - businesses of all sizes.
Linda Kenney: I was surprised at hospitals.
Karen Wambach: We expected we would see better things, too, but this was an informal survey. I was mainly talking to LC. They all wanted more than they have. Such a process to get it done.
At KU, 6500 employees. Proportion of women at childbearing age has to be fairly high. Have 8 lactation rooms. Don't know how much they get used.
Linda Kenney: WIC program has had some bad press for low income women, promoting formula, we have in past several years launched breastfeeding promotion, billboards on highways, portion goes to purchasing breast pumps for women, hiring culturally competent peer counselors. Think this is the hardest group.
We were mainly talking with large corporations. One of Walai's interest is looking at low income women, supporting them.
Schools?
Vicki Hoffman: Main place for schools - those that have child development centers. In terms of general staff, don't hear any discussion of it. When think of own food production center, where do we find the space?
Dr. Cooley: Have a small room were staff can go and take a break wherever they want
Tom Ostrander: Most schools - have nurses offices, etc. Education business has a lot of young mothers. I'm amazed it hasn't come up.
Nick Rogers: Has it not come up because they don't breastfeeding, or they don't have support or don't place/time to breastfeed?
Vicki Hoffman: One example - teacher pumped in custodial closet.
Tom Ostrander: Don't even know if we encourage it in our health curriculum.
Ileen Meyer: Not in the current text books.
Dr. Cooley: Saw about legislative issues, need to discuss some of those. Legislature not only issue, what else needs to be done?
So much seems like an education issue?
How does employer even know about it?
What do we need to recommend that can be done?
Nick Rogers: Some type of awareness. Until it come up in this meeting, I never realized it was an issue.
Mim Wilkey: Awareness of what? We are struggling to get just a health component in the workplace that supports both sexes. Breastfeeding reflects just one. Where are benefits for workplace if they provide? Not much data. When it comes to workplaces, need to say how it benefits them.
Dr. Cooley: There is data, don't know how much. Less illness, absenteeism. Some evidence about increased productivity, loyalty, things like that. It is important we look at this data.
No data that shows conclusively that leg changes will make a difference.
Have to sell to the employer that it will make an impact.
Nick Rogers: Awareness to mothers - don't recall hearing that message in our neck of the woods. We probably have higher proportion of lower SES mothers in our area. Education employers, but mothers, too.
Dr. Cooley: KHF TV spots - if they did some on breastfeeding, it might have more of an impact than what they are doing now.
Providers aren't always encouraging it either. Newer providers are more - more material on it now. Also - is a tendency - limited amount of time to spend on BF during appointments. Need to increase awareness to providers, too.
Lack of time for providers is an issue.
Numbers for Topeka are pretty good because hospitals in Topeka do a lot of work.
If could expand the number of hospitals with lactation consultant to support, would be good.
Parents as Teachers - has some information.
Tom Ostrander: One aspect from business standpoint, release of employer liability might help (e.g., not liable for problems in storage, OT payment during break, etc.)
Laws are new, might not have a lot of data yet.
Present in positive way - benefit, way to cater to younger potential employees; benefit rather than punitive.
Increase awareness, give employer some type of support.
Vicki Hoffman: Talked about fragmented coalition in Kansas. What would be process of making statewide coalition?
Several groups supporting process, but no formal statewide alliance.
Not a governmental alliance.
Linda Kenney: Kind of like SAFE Kids, operates in tandem with state injury prevention program, but SAFE Kids is independent.
Dr. Cooley: Perinatal Council, could they take ownership of this?
It is on their strategic plan, some of the strategies you have brought up could be addressed with them. Umbrella organization is Perinatal Association of Kansas. Not as organized and structured as AAP so advocacy is rather fragmented as well.
4 things on page 12 recommended in CDC guidelines - evidence-based.
Initiation is good.
Think we are do-able to hit 2010 goals.
Our data for Kansas show women initiate just as good (or better) as women in any other state, but then we have a cross-over effect on the graph, where KS drops off.
Dr. Cooley: There are a lot of groups, like teenagers, where we need to work better.
Betsy Hineman: Educating employers is important. (on the list.)
Most bill take 2-3 years to get through.
Worksite recognition program. Our department recently launched one related to 'Healthy Restaurants'. Maybe something like that.
Mim Wilkey: Wichita has a positive plate award. Good recognition. But, you have to go out and talk to workplaces. It takes a different type of presentation than this.
Betsy Hineman: Playgroup in Dighton. Asked parents about this. Had one mother say she went to Target and had to sit on the floor in the bathroom to breastfeed.
Linda Kenney: How would Department of Commerce approach employers on this? Not familiar with successful approach. Or Chamber of Commerce.
Mim Wilkey: For those businesses that have healthy workplace initiative, this would just be a tag-on for them, because it would be a healthier mother. If they don't have one of those, have to go back to - what's in it for them?
Tom Ostrander: Also likelihood of woman coming back to work sooner.
Dr. Cooley: Topeka business has gotten national recognition for breastfeeding-friendly policies.
Have to frame for businesses.
Burlington Northern - was surprised.
What is likelihood of model lactation program with state employees.
Linda Kenney: The way I understand it is that every department does it differently. No consistency. Have one room in this facility. Told that it's booked solid. Scheduling for lactation program is run out of WIC program.
If we can't get the state to have a reasonably good model - or the hospitals - how can we expect employers...?
Maybe someone from central HR department.
Vicki Hoffman: I think we need to focus on pilots to gather data. Don't think we are near to the point of putting together legislation to propose UNLESS you are putting it out there as part of the educational process.
(But might turn people off.)
KHF funding?
Can promote private foundations to promote media campaigns.
Betsy Hineman: And their (KHF) focus now is birth to 5
Any campaign to give positive light to BF.
What is consensus - need more information?
Look at action steps? Mull over.
Dr. Lozada: I think Linda's ideas of getting employer representatives, Chamber of Commerce, State HR.
This is supposed to be about encouraging in the workplace, but we haven't heard from the workplace yet.
* Recommendation at this point is to gather more data. *
Next Meeting: July 12
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