Quality Improvement Initiative Increases Breastfeeding Rates in Mississippi

Boston – CHAMPS (Communities and Hospitals Advancing Maternity Practices), a multi-year quality improvement (QI) initiative in the state of Mississippi led by Boston Medical Center (BMC) researchers, has increased breastfeeding rates and reduced racial inequities in breastfeeding. These results, published in Pediatrics, demonstrate that the successful implementation of Baby-Friendly Hospital Initiative guidance can lead to increased rates of breastfeeding, skin-to-skin contact for mother and baby immediately after birth, and rooming-in practices (keeping mother and baby together in the same hospital room) while also reducing racial inequities.

In 1991, the World Health Organization and United Nations Children’s Fund launched the Baby-Friendly Hospital Initiative with the goal of improving breastfeeding rates globally. This initiative helps hospitals support new mothers to successfully initiate and continue breastfeeding their babies. Hospitals that achieve certain goals, including successfully implementing the Ten Steps to Successful Breastfeeding as well as not marketing baby formula in the hospital, are designated Baby Friendly.

There is a wealth of data that demonstrates the benefits of breastfeeding for both mother and child. Breastfed children perform better on intelligence tests and are less likely to be overweight, obese or develop diabetes later in life. For women who breastfeed, there is a reduced risk of breast and ovarian cancers.

However, breastfeeding rates remain low in certain geographic areas and among specific populations in the US. Historically, in Mississippi, along with many other southern states, there are low breastfeeding rates and higher rates of infant mortality and morbidity. Data from 2014, prior to the start of CHAMPS, showed that Mississippi had the lowest breastfeeding rates in the US – the initiation rate was 57.5 percent, which was nearly 10 points less than any other state. During that same time, African American breastfeeding rates were the lowest in the country due to several barriers including institutional racism, poverty and traumatic experiences.  In addition, rates of heart disease, obesity and diabetes in Mississippi are at some of the highest levels seen nationally.

“Two of the biggest factors that play into breastfeeding outcomes are race or racism and where you live, which the CHAMPS program addresses at the hospital level, providing the information and support necessary to help all new mothers be successful with breastfeeding,” said Laura Burnham, MPH, associate director of the Center for Health Equity, Education, & Research at BMC and the study’s first author.

The Mississippi CHAMPS program enrolled 39 of the 43 birthing hospitals in the state in the QI initiative, which took place between January 2015 and December 2019. Hospitals received coaching and technical assistance to help them implement the Baby-Friendly Hospital Initiative. Key stakeholders, including local breastfeeding experts and lactation consultants, as well as local and statewide organizations, also provided support during the initiative. Hospitals submitted monthly data on breastfeeding (initiation and exclusivity), skin-to-skin care, and rooming-in practices to the CHAMPS team. These data were reported back to the hospitals and analyzed to track statistically significant changes over time.

During the course of the study, rates for breastfeeding initiation rose overall by 10 percentage points. For Black mother-baby dyads, rates increased by 21 points; for White mother-baby dyads, rates increased by four percent. Exclusive breastfeeding rates increased by 11 percent, with higher monthly increases among Black mother-baby dyads. Skin-to-skin rates for both vaginal and cesarean births increased as well, from 31 to 91 percent and 20 to 86 percent, respectively, in both Black and White mother-baby dyads. In addition, rooming-in rates among Black and White mother-baby dyads increased from 19 to 86 percent. In addition, when CHAMPS launched in Mississippi in 2014, there were zero Baby-Friendly Hospitals in the state; there are currently 22.

Other notable findings include a significant decrease – from 79 to 11 percent – in the number of hospitals distributing free formula sample packs to patients, and there was a significant reduction in the hospitals that accepted free formula from manufacturers. This demonstrates the hospitals’ commitment to achieving and retaining the Baby-Friendly designation.

Over the course of the initiative, CHAMPS conducted 100 training sessions throughout Mississippi, training 1,837 hospital staff. In addition, CHAMPS helped launch the first Baby Café in Mississippi; there are now 15 across the state.

“Expanding access to breastfeeding support in Mississippi is a critical component of addressing health equity for families both in the short and long term,” said Anne Merewood, PhD, MPH, the study’s corresponding author and director of the Center for Health Equity, Education, & Research at BMC.  “We know that there are tremendous health benefits related to breastfeeding for both mother and child, and we need to identify sustainable solutions to maintain these efforts in the future.”

This project was supported through grants from the W.K. Kellogg Foundation (Grant Reference No. P3036679) and the Bower Foundation (Grant Reference Number 2017-186).