BILL ANALYSIS Ó ----------------------------------------------------------------- |SENATE RULES COMMITTEE | SB 402| |Office of Senate Floor Analyses | | |1020 N Street, Suite 524 | | |(916) 651-1520 Fax: (916) | | |327-4478 | | ----------------------------------------------------------------- THIRD READING Bill No: SB 402 Author: De León (D), et al. Amended: 5/28/13 Vote: 21 SENATE HEALTH COMMITTEE : 7-2, 4/3/13 AYES: Hernandez, Beall, De León, DeSaulnier, Monning, Pavley, Wolk NOES: Anderson, Nielsen SENATE APPROPRIATIONS COMMITTEE : 5-2, 5/23/13 AYES: De León, Hill, Lara, Padilla, Steinberg NOES: Walters, Gaines SUBJECT : Breastfeeding SOURCE : California WIC Association DIGEST : This bill requires all general acute care hospitals and special hospitals, that have a perinatal unit by January 1, 2025, to adopt the Ten Steps to Successful Breastfeeding, as adopted by Baby-Friendly USA, per the Baby-Friendly Hospital Initiative (BFHI), or an alternate process adopted by a health care service plan that includes evidenced-based policies and practices and targeted outcomes, or the Model Hospital Policy Recommendations as revised by the Department of Public Health (DPH) in 2012. ANALYSIS : CONTINUED SB 402 Page 2 Existing law: 1. Establishes the Hospital Infant Feeding Act which requires all general acute care and special hospitals that have a perinatal unit to have an infant-feeding policy, as specified, to clearly post the policy and routinely communicate the policy to perinatal unit staff. 2. Establishes the Maternal Child and Adolescent Health (MCAH) program, administered by DPH, which monitors and reports infant feeding data. Under MCAH, establishes the program "Birth and Beyond California" which utilizes quality improvement methods and training to implement evidence-based policies and practices that support breastfeeding within the maternity care setting. 3. Requires DPH to recommend training for general acute care hospitals and special hospitals that is intended to improve breastfeeding rates among mothers and infants. 4. Establishes the Women, Infants and Children program (WIC), administered by DPH to provide nutritional food supplements to low-income pregnant women, low-income postpartum and lactating women, and low-income infants and children under five years of age, who have been determined to be at nutritional risk. Establishes the "Breastfeeding Peer Counseling Program" at local agency WIC sites to increase the rate of breastfeeding for WIC participants. 5. Establishes the Medi-Cal program, administered by the Department of Health Care Services, which provides comprehensive health benefits to low-income children, their parents or caretaker relatives, pregnant women, elderly, blind or disabled persons, and nursing home residents who meet specified eligibility criteria. Covers, as part of the Medi-Cal durable medical equipment benefit, the rental or purchase of breast pumps for pregnant and postpartum women, subject to medical necessity. This bill: 1. Makes several legislative declarations, including a declaration that the BFHI is a global program sponsored by the World Health Organization (WHO) and the United Nations CONTINUED SB 402 Page 3 Children's Fund (UNICEF) to encourage and recognize hospitals that offer an optimal level of care for infant feeding. 2. Requires all general acute care hospitals and special hospitals, that have a perinatal unit by January 1, 2025, to adopt the "Ten Steps to Successful Breastfeeding," as adopted by Baby-Friendly USA, per the BFHI, or an alternate process adopted by a health care service plan that includes evidenced-based policies and practices and targeted outcomes, or the Model Hospital Policy Recommendations as revised by the DPH in 2012. 3. Defines "perinatal unit" to be a maternity or newborn service of the hospital for the provision of care during pregnancy, labor, delivery, and postpartum and neonatal periods with appropriate staff, space, equipment, and supplies. Background BFHI . Launched in 1991, the BFHI is a global program sponsored by the WHO and UNICEF to encourage and recognize hospitals and birthing centers that offer an optimal level of care for infant-feeding. According to the BFHI guidelines, Baby-Friendly USA is the national body that provides accreditation for BFHI in the United States. Currently, hospitals voluntarily adopt a set of breastfeeding policies and pay a fee to become certified as a Baby-Friendly Hospital. Baby-Friendly USA sends their staff out to the hospitals to provide technical assistance, to certify the facilities, and to provide ongoing monitoring to maintain hospital certification. According to the California WIC Association, of the 260 California hospitals with perinatal units, approximately 22% have voluntarily become certified by the BFHI. The number of hospitals in California participating in the BFHI has increased from only 12 in 2006 to 58 to-date and 40 more hospitals are currently in the process of becoming certified as a Baby Friendly Hospital. The BFHI focuses on the following 10 policies designed to reduce barriers to breastfeeding. These "Ten Steps to Successful Breastfeeding" include extensive additional instructions, narrative, references and guidelines to assist hospitals and staff in interpreting and applying these guidelines: 1. Have a written breastfeeding policy that is routinely CONTINUED SB 402 Page 4 communicated to all health care staff. 2. Train all health care staff in the skills necessary to implement BFHI policy. 3. Inform all pregnant women about the benefits and management of breastfeeding. 4. Help mothers initiate breastfeeding within one hour of birth. 5. Show mothers how to breastfeed and how to maintain lactation even if they are separated from their infants. 6. Give infants no food or drink other than breast milk unless medically indicated. 7. Practice rooming-in and allow mothers and infants to remain together 24 hours a day. 8. Encourage breastfeeding on demand. 9. Give no pacifiers or artificial nipples to breastfeeding infants. 10.Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital birth center. WIC . WIC is a federally-funded health and nutrition program for women, infants, and children. Participants must meet income guidelines and be pregnant women, new mothers, infants or children under age five. In California, 82 WIC agencies provide services locally to over 1.4 million women, infants and children each month at over 600 sites throughout the state. The California WIC program recently adopted rules to support exclusive breastfeeding. These rules offer an incentive by increasing the value of the WIC food package for mothers who fully breastfeed; reduce the amount of formula available for mothers who partially breastfeed; calibrate formula amounts for infants by age; and, postpone the addition of complementary foods for infants. Additionally, in order to firmly establish exclusive breastfeeding, breastfeeding mothers are not routinely given formula in the first month postpartum. CONTINUED SB 402 Page 5 Comments According to the author's office, evidence indicates that early infant feeding practices can affect later growth and development in children, while significantly reducing their risk for infections and chronic diseases such as diabetes, asthma and obesity. Although nearly 90% of California mothers enter the hospital intending to breastfeed, only about 50% leave the hospital breastfeeding exclusively. This disparity is a health equity issue since many of the hospitals that have low or very low exclusive breastfeeding rates are in areas that serve low-income women. Exclusive breastfeeding rates increase when hospitals keep mothers and babies together; encourage feeding shortly after birth; provide staff with education for breastfeeding support; and avoid unnecessary formula supplementation. Requiring all perinatal hospitals to become BFHI certified can better ensure that regardless of what hospital in California a baby is born, the mother and baby will be provided quality care that supports breastfeeding and the mother's infant feeding decision. This type of maternity care, requiring a set of policies and practices that are evidenced based, has been shown to reduce health disparities and improve breastfeeding across all sociodemographic groups, not only in the hospital, but in the days and weeks after hospital discharge. Prior/Related Legislation SB 464 (Jackson, 2013) enacts the Healthy Eating and Physical Activity Act which, among other things, requires adults who work in infant care programs with infants and their families to promote and support exclusive breastfeeding for six months and continuation of breastfeeding in conjunction with complementary foods for one year or more. SB 502 (Pavley and De León, Chapter 511, Statutes of 2011) implemented the first step of the BFHI by requiring that all hospitals with perinatal units in California have a breastfeeding policy in place by January 1, 2014. In addition to having the breastfeeding policy, hospitals are required to clearly post the policy and routinely communicate the policy to perinatal unit staff. CONTINUED SB 402 Page 6 FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes Local: No According to the Senate Appropriations Committee, there will be potential one-time costs to the DPH to adopt regulations, if DPH recognizes an alternative process to the "Ten Steps to Successful Breastfeeding." The costs to adopt a regulation are likely to be between $100,000 and $200,000 (General Fund). SUPPORT : (Verified 5/29/13) California WIC Association (source) Alameda County Breastfeeding Coalition American Cancer Society Cancer Action Network American Congress of Obstetricians and Gynecologists American Red Cross WIC Program Antelope Valley Hospital WIC Program Breastfeeding Coalition of Nevada County Breastfeeding Coalition of San Joaquin County Breastfeeding Coalition of Solano County BreastfeedLA California Association of Food Banks California Association of Women's Health, Obstetric and Neonatal Nurses California Black Health Network California Breastfeeding Coalition California Center for Public Health Advocacy California Conference of Local Health Department Nutritionists California Health Collaborative California Nurses Association California Pan-Ethnic Health Network Clinica de Salud del Valle de Salinas Clinica Sierra Vista Community Resource Project, Inc. Confident Childbirth - Lamaze Delta Health Care E Center Family HealthCare Network First 5 Association of California First 5 Fresno County First 5 Yolo, Children and Families Commission Fresno County Department of Public Health Fresno Economic Opportunities Commission Fresno Economic Opportunities Commission WIC Program CONTINUED SB 402 Page 7 Henry Mayo Newhall Memorial Hospital Hunger Action Los Angeles Kern County Breastfeeding Coalition Kern County Call to Action Healthcare Working Group La Clinica de La Raza WIC Program Labor Projects for the Working Families Maternal Child and Adolescent Health Access MCAH Action MomsRising Mono County WIC Program Monterey County Board of Supervisors Monterey County WIC Program Mothers' Milk Bank Native Breastfeeding Council Planned Parenthood WIC Prevention Institute Public Health Foundation Enterprises WIC Program Public Health Institute San Bernardino County Department of Public Health WIC Program San Diego County Breastfeeding Coalition San Luis Obispo County WIC Program San Mateo Breastfeeding Advisory Committee Santa Cruz County Breastfeeding Coalition Solano County Public Health WIC Program Southern California Consortium of WIC Program Directors Strategic Alliance for Healthy Food and Activity Environments Tulare County Breastfeeding Coalition Tulare Regional Medical Center Tuolumne County Breastfeeding Coalition Watts Healthcare Corporation Women, Infants and Children Nutrition Program ARGUMENTS IN SUPPORT : The sponsor of this bill, the California WIC Association (CWA), CWA member organizations, and health advocates write that breastfeeding success is critical during the first 24 to 72 hours of a baby's life and support from hospital staff, standards of care, and hospital policies play important roles in determining if a mother will continue to exclusively breastfeed her baby when the family goes home. Supporters maintain that a growing body of evidence indicates that early feeding practices can affect a child's long-term growth and development. Supporters argue that studies have shown that hospital practices can have a dramatic impact on breastfeeding rates. Exclusive breastfeeding rates increase CONTINUED SB 402 Page 8 when hospitals keep mothers and babies together; promote skin to skin contact; encourage feeding shortly after birth; provide staff with education for breastfeeding support; and avoid unnecessary formula supplementation. According to supporters, this bill will help increase breastfeeding rates, while giving maternity hospitals a reasonable amount of time to become certified as Baby-Friendly Hospitals or adopt an equivalent process recognized by DPH. MW/AL:k 5/29/13 Senate Floor Analyses SUPPORT/OPPOSITION: SEE ABOVE **** END **** CONTINUED