Breastfeeding plays an important role in the maintenance of both maternal and infant health. Breast milk is known to contain all the nutrients that are able to provide a complete nutrition to the infants. It provides benefits with respect to growth, health, development and immunity. Breast fed infants are less likely to develop medical conditions like respiratory illnesses, obesity, among others (Victora et al., 2016). Moreover, breastfeeding also impacts the relationship between the mother and child as it increases the bonding between the mother and her child. It reduces the risk of the mothers in developing breast cancer as well as ovarian cancer. Moreover, breastfeeding is also economically more advantageous than the feeding of formula milk (Dieterich et al., 2013). However, breastfeeding rates have been on a continuous decline.
In the United States, there is an alarming decrease in the number of mothers to initiate and continue breastfeeding. It has been found that 79% of US mothers never initiate breastfeeding. Moreover, it was found that only 49% continue breastfeeding for 6 months, while only 27% continue breastfeeding for 12 months (Fear, 2016). In Kansas City, the breastfeeding rates were low and were found to be below the national averages (High5kansas.org, 2018).
Figure 1: Statistics showing the breastfeeding rates in Kansas city
(Source: High5kansas.org, 2018)
The objective of the Healthy people 2020 initiative is to increase the number of infants who are breast fed to 81.9%. The initiative also aims to increase the number of infants who are breast fed till 6 months to 25.5% and those who are fed till 1 year to 34.1% (Cdc.gov, 2018). This health promotion proposal also aims to compliment the approaches of Healthy people 2020 initiative and will further contribute by identifying the barriers that prevent the mothers to initiate or continue breastfeeding and provide necessary interventions to overcome this issue. The rate of breastfeeding is very low among the young mothers in the United States as compared to the older mothers and very little intervention or programs are available that target this population, however, this program proposal will aim to increase the rate of breastfeeding among the young mothers.
This program proposal is aimed to promote breastfeeding among young mothers in Kansas City. The target audiences for this program proposal will be the healthcare sectors, policy makers, low income groups and underserved mothers and infants. Healthcare sectors like hospitals and nursing homes as well as policy makers can play a very important role in the promoting successful breastfeeding among young mothers (Pérez-Escamilla et al., 2012). According to the baby friendly hospital initiative, breastfeeding policies can be communicated to healthcare workers. Moreover, healthcare workers can get training in implementing these policies. The initiative also indicates the role of the healthcare sector in educating women about the benefits of breastfeeding, methods of lactation, encouraging breastfeeding, establishment of breastfeeding support groups, among others that world enable the promotion of breastfeeding among women (Who.int, 2018). Moreover, in some low-income communities, issues associated with latching, workplace pressure, social as well as peer pressure promote the use of bottle feeding over that of breastfeeding. Additionally this program is also going to target the new mothers. According to some first time mothers, breastfeeding is painful, inconvenient and brings about drastic changes in their lifestyles. As a result they avoid breastfeeding and carry out bottle feeding or formula feeding. Moreover, the lack of education and knowledge also deter women in carrying out breastfeeding. Employers in the workplace can also function as target audiences as they can support the breastfeeding mothers by allowing them time to pump their breast milk and also by providing private areas, which are clean where the mothers can express their milk (Ncbi.nlm.nih.gov, 2018). Adolescent mothers cite barriers such as they have to return to their schools and colleges and as a result they cannot carry out breastfeeding (Sipsma, Jones & Cole-Lewis, 2015).
The project will be carried out in different settings like schools, colleges, workplaces, hospitals, community centers, among others. Young mothers who go to schools and colleges conceive breastfeeding as a burden and prefer bottle or formula feeding. This is because they are eager to return to their schools and colleges and complete their education. Moreover, they also cite problems with time as to finding the right time during their school or college hours to carry out breastfeeding (Smith et al., 2012). Apart from these workplaces also play a very important role as they can also promote and support young mothers by providing them the necessary break, where they can either carry out breastfeeding or pump their breast milk (Desmond & Meaney, 2016). Hospitals and community centers also play an important role by providing education about the health benefits associated with breastfeeding. They can also generate policies that would ensure enhanced breastfeeding rates among new and young mothers. Some of the list of healthcare organizations include the St. Luke’s hospital, North Kansas City, Liberty and University of Kansas Hospital, among others. The program will be carried out in the 5 counties of Kansas city, Missouri. These are Jackson, Platte, Wyandotte, Clay and Cass.
Not breastfeeding is associated with several health risks not only for the infant as well as for the mother. According to statistical data, women who do not breast feed their infants are at a higher risk of developing breast cancer and ovarian cancer apart from obesity, metabolic syndromes like type 2 diabetes, cardiovascular disorders, among others (Nodo, 2014). Moreover, compared to breast-fed infants, formula fed infants are at a higher risk of infectious morbidity. The risk of developing otitis media is doubled in the case of infants who are fed formula milk as compared to breast fed infants. Moreover, formula fed infants are at a higher risk of developing lower respiratory tract infections, necrotizing enterocolitis, obesity, cognitive impairment, among others. Moreover, formula feeding as compared to breastfeeding also increases the risk of infant mortality. Additionally breastfeeding also prevents the development of asthma, atopic dermatitis, type 1 diabetes, childhood cancer, among others (Colchero et al., 2015). According to reports, only 28.1% of the children in Kansas city were breast fed for the first six months after their birth. Moreover, 39.3% of children who were less than one month old were fed other foods apart from breast milk. Only 33.2% of children were subjected to breastfeeding for 1-5 months and only 22.1% were breast fed for 6-12 months. Infants in mid sizes counties of Kansas were found to die before their first birthdays when compared with other counties. About 7.8 babies died for each 1000 births in the rural areas of Kansas city. Moreover, in Kansas city the number of breastfeeding mothers was found to be only 16.3% (Kansashealthmatters.org, 2018). The infant mortality rate among the black population of the Kansas City is double than those observed in the white population. Uneducated women, teenage or young mothers and black women did not engage themselves in breastfeeding (Fontana, 2018). African American women of Kansas city was found to have the lowest breastfeeding rates. This in turn puts the mothers and their infants at risk of development of various postnatal outcomes. The African American teenage mothers suffer from perinatal problems like depression, chronic illnesses, post traumatic stress disorder, among others when compared with the white population. These are associated with poor breastfeeding rates among this community. These in turn are associated with poor income, systemic discrimination, racial disempowerment, among others. The workplace is also unsupportive to black mothers. Other predictors of low breastfeeding rates include lack of personal support, inadequate and inaccessible breastfeeding resources, low efficacy in breastfeeding and racial biasedness in healthcare systems contributes to the low breastfeeding rates. According to a recent research family support and breastfeeding support and resources enabled the African American teenage mothers of Kansas city to carry out successful breastfeeding (Johnson et al. 2015). Due to the decrease in breastfeeding rates in Kansas city the program is designed to address this highly significant issue that has gripped the population of Kansas city.
The socio-ecological factors that contributed to decrease in the rates of breastfeeding mothers are intentions and practices, behavioral beliefs, control beliefs, normative beliefs, family structure, father and healthcare provider influence. Moreover, poverty also plays an important role. According to breastfeeding intentions, most mothers believe that breastfeeding should be carried out for 6 months. Moreover, they also give formula milk to infants if they cannot produce enough milk. Moreover, as they had to return to their workplace or schools or colleges, they used formula milk as compared to breastfeeding. According to behavioral beliefs, the women believe that breast milk is insufficient for the infants and they need additional supplementations. Another common belief is that breast milk is not nutritious after 6 months and that continued breastfeeding would result in the inability of the child to eat other foods thereby resulting in losing weight. According to the breastfeeding control beliefs, is the perceived notion of insufficient production of breast milk. The perceived notion of the inability to produce sufficient breast milk results in the mothers feeding their children with infant formula milk. Moreover, another belief is that breastfeeding is painful and as a result contributes to reduction in breastfeeding rates among mothers (Muchacha, M., & Mtetwa, 2015; Desai et al., 2014). Another barrier is work and school or college education that forces the mothers to engage in formula milk feeding. Moreover, the normative beliefs associated with breastfeeding is that the women feel embarrassed or being judged if they engaged in breastfeeding in public places. Moreover, breastfeeding of older children who are more than 1 year of age are generally less accepted or not accepted at all. Additionally, family structure also plays an important role in the decreased rates of breastfeeding infants. According to some family structure, breastfeeding is acceptable for the first six months. Minimal participation of the fathers in post-natal care also plays an important contributing factor. Influence of healthcare providers also plays an important role. Some healthcare workers recommend breastfeeding for the initial months after which according to them the breast milk loses its nutritional properties (Swigart et al., 2017).
African American women face many barriers and compared to white women suffer from perinatal health consequences. They suffer from chronic illnesses, depression, stress and post traumatic stress disorder that affects their ability to breast feed. These are some of the risks associated with poor breastfeeding rates among the African American population. Moreover, the presence of racial disparities contributed by low income rates, systematic discrimination, racial disempowerment and living in racially isolated communities are associated with adverse health related outcomes among the black population. Women of high socio-economic status have been found to be associated with increased rates of breastfeeding, while low socio-economic status and racial discrimination enhances the vulnerability of the African American woman to adverse health outcomes. Moreover, these are also associated with low rates of breastfeeding. Moreover, low income as well as lack of personal or social support from family as well as lack of flexibility in the workplace is also associated with poor rates of breastfeeding. Additionally, lack of resources or models as well as social or environmental stress associated with low income also contributes to the poor breastfeeding rates among the African American population. Racial biasedness in the healthcare sectors as well as poor education also contributes to the low breastfeeding rates (Johnson et al., 2015; Furman, Banks & North, 2013).
In order to address the problem of decreased rates of breastfeeding in Kansas city it is necessary to engage key stakeholders and utilize various resources in order to ensure that the breastfeeding rates steadily increase, particularly among the young mothers who are engaged in schools, colleges or workplaces. Stakeholders and partners who should be involved in the proposed program are the elected officials of the local regions and state, mayor and the staff of local municipalities, healthcare sectors, professors and teachers from schools and colleges, organizations engaged in social support as well as the experienced mothers and other citizens. Some of the key stakeholders could be the staffs from the Clay County Public Health Center staff, representatives of the Kansas Department of Health and Environment, State of Kansas-woman infant and child (WIC) nutrition and breastfeeding coordination (Clayhealth.com, 2018). Apart from these, counselors and mangers from WIC offices in various healthcare centers in Kansas city can also participate. These include the Crescent health center, Saint Luke’s hospital, Johnson county health department, Truman medical center, Wyandotte county health department, Samuel U. Rodgers health center, University of Kansas hospital, North Kansas city hospital, Children’s mercy hospital, Providence medical center, among others. The role of the lactation consultants and counselors would be to provide insights to young mothers about the misconceptions associated with breastfeeding like insufficiency of milk production, problems with latching and that breastfeeding is painful. Moreover, the role of the stakeholders like healthcare officials and representatives from healthcare centers would be to educate the mothers about the importance and health benefits of lactation (Harris et al., 2015). Moreover, educational advisors from schools, colleges and universities can help to educate the target audiences like workplace employers. Young mothers always face the problem of returning to their workplaces and this prevents them to carry out breastfeeding of their infants in the offices due to lack of specific rooms for to carry out lactation or the lack of time as well. The employers will be advised by the stakeholders to implement lactation policies and programs in the workplace. Staffs from healthcare sectors like doctors, lactation specialists, pediatricians, nurses can advice the breastfeeding mothers as well as pregnant women on the use of resources like breast pumps, educational materials, hospital websites, where they can get information about the advantages of breastfeeding, techniques of breastfeeding, use of breast pumps and how to provide optimal nutrition to the infant and meet their breastfeeding goals (Haroon et al., 2013). Additionally, experienced mothers or mothers who had a bad experience with respect to breastfeeding their infants can also participate in educating or sharing their experiences that can encourage the new mothers and pregnant women to indulge in breastfeeding their infants keeping in mind the health benefits of breast milk and the necessary positive outcomes on both the infant as well as the mother. Civic leaders can also act as stakeholders by providing education and promoting the importance of breastfeeding among the community members. Businessmen, government agencies and healthcare organizations can act as funders. State legislators, political leaders and others can participate in policy making that would help to increase the rate of breastfeeding in the area. The resources that can be provided will be educational resources like breastfeeding posters and brochures, breastfeeding audio visuals, breastfeeding teaching aids, breastfeeding books, websites, teen resources and curriculums, breastfeeding guide for physicians, breastfeeding programs, training courses for hospital staff as well as for pregnant women and new mothers, family support and workplace support for breastfeeding mothers, breast pumps, among others (Dshs.texas.gov, 2018).
The objective of this program proposal is to identify the needs of the target audience, which are the young mothers, who are working mothers or attend schools or colleges. The rate of breastfeeding is lower in the case of such individuals, particularly among the African American population of Kansas city. The goal of the program is to reduce the infant mortality rate in Kansas city, Missouri. The objectives of the program would be to increase the rates of breastfeeding among the young working mothers and to create provisions in the workplace or in the educational institutions to support the young mothers carry out breastfeeding of their infants.
The social ecological health behavior model is based on the interplay of individual, interpersonal, organizational, community and societal factors. The individual factors include the age, income, education, attitudes, beliefs, previous experiences, among others. The interpersonal factors include the support systems like family members, friends, and office colleagues. The organizational factors involve the educational institutes and the healthcare organizations like hospitals. The community factors include the schools, workplaces, among others. The societal factors include cultural or social norms. Other societal factors include the social and economic disparities that help to create inequalities between communities. This model can be applied in the development of interventions required for preventing the high infant mortality rates in Kansas City, Missouri. Young mother are generally engaged in various workplaces and as a result cannot get the necessary time and provisions to continue breastfeeding their young. Moreover, this problem is particularly faced by the African American mothers due to social and economic discrimination (Cdc.gov, 2018).
Keeping in mind the socio-ecological perspectives, the interventions will be directed to carrying out local implementations at the local or institutional level. The interventions will involve healthcare professionals like pediatricians, doctors, nurses, lactation consultants, among others. They will provide breastfeeding education to the young mothers, particularly the African American mothers. Healthcare providers can work as groups to provide institutional breastfeeding interventions that help to improve the breastfeeding behavior and also helps to encourage the inclusion of breastfeeding within the social norms of the community. This will be possible in the form of education, training of the young mothers as well as enhancing the skills of the healthcare workers in providing technical support to the lactating mothers, increasing access to breast pumps and nursing bras. Workplace interventions may include employer based programs that support breastfeeding in the workplace. This can include the presence of private lactation rooms and allotted times to women employees for breastfeeding (Johnson et al., 2015
Conclusion
This report is a program proposal that aims to increase the social support to young lactating mothers who are unable to carry out breastfeeding of their infants due to lack of social support as well as workplace pressure that prevents them to continue their breastfeeding practices. The goal of the program is to reduce the infant mortality rates in Kansas City, Missouri. The objectives were to increase the rates of breastfeeding among young mothers and to increase the support provided to such mothers at both the healthcare sectors as well as in the workplaces. African American mothers in Kansas city suffer hugely due to discriminations in the workplace and the healthcare organizations. The intervention strategies aims to address the socio-ecological barriers by providing education, increasing skills by providing training to healthcare workers as well as the lactating mothers. Moreover, the program also aims to increase the support to the young mothers in the workplace by providing employer education programs. Thus, this program will help to reduce the number of infant mortality rates in Kansas City, Missouri.
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