BILL ANALYSIS Ó
SB 402
Page 1
Date of Hearing: June 25, 2013
ASSEMBLY COMMITTEE ON HEALTH
Richard Pan, Chair
SB 402 (De León) - As Amended: June 18, 2013
SENATE VOTE : 38-0
SUBJECT : Breastfeeding.
SUMMARY : Requires, by January 1, 2025, all general acute care
hospitals and special hospitals that have a perinatal unit to
adopt the "Ten Steps to Successful Breastfeeding," as adopted by
Baby-Friendly USA, or an alternative process adopted by a health
care service plan, or the Model Hospital Policy Recommendations
approved by the Department of Public Health (DPH).
Specifically, this bill :
1)Requires all general acute care hospitals and special
hospitals, that have a perinatal unit to adopt by January 1,
2025, the United Nations Children's Fund (UNICEF) and World
Health Organization's (WHO) "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 currently
approved by DPH.
2)Defines "perinatal unit" to be a maternity or newborn service
of a hospital for the provision of care during pregnancy,
labor, delivery, and postpartum and neonatal periods with
appropriate staff, space, equipment, and supplies.
3)Makes legislative findings and declarations about the
importance of early infant-feeding practices and their effects
on later growth and development, particularly with regard to
obesity.
EXISTING LAW :
1)Establishes DPH, which among other things licenses and
regulates hospitals and promotes child and maternal health.
Requires DPH to include in its public service campaign, the
promotion of mothers breast-feeding their infants.
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2)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.
3)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 and to clearly post the
policy and routinely communicate the policy to perinatal unit
staff.
4)Requires the infant-feeding policy to promote breastfeeding,
utilizing guidance provided by the BFHI or the DPH Model
Hospital Policy Recommendations.
FISCAL EFFECT : The bill, as amended, has not been analyzed by a
fiscal committee.
COMMENTS :
1)PURPOSE OF THIS BILL . According to the author, 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.
The author asserts that 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. This bill will help to achieve health equity
for new mothers and their children by requiring all perinatal
hospitals in California to implement the Ten Steps to
Successful Breastfeeding recommended by the Baby Friendly
Hospital Initiative.
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The United States Surgeon General recommends exclusive
breastfeeding for most babies for the first six months and
continued breastfeeding until one year of age, with the
addition of appropriate foods, unless specifically
contraindicated. The Centers for Disease Control and
Prevention's benchmarks suggest that 10% or fewer of
breastfeeding infants should receive supplemental formula.
However, according to 2009 data presented in a California WIC
Association (CWA) report, "One Hospital at a Time, Overcoming
Barriers to Breastfeeding," January 2011, fewer than 10% of
California hospitals reached this goal.
2)BACKGROUND . The BFHI is a global program to encourage and
recognize hospitals and birthing centers that offer an optimal
level of care for breastfeeding. The core components of the
BFHI are the UNICEF/ WHO Ten Steps to Successful
Breastfeeding, which are designed to facilitate the role of
the hospital and birthing center in providing women the choice
and opportunity to breastfeed, regardless of the method of
birth. More than 170 countries have undertaken implementation
of the Ten Steps to Successful Breastfeeding, resulting in the
designation of more than 20,000 birth facilities throughout
both the developing and industrialized world. The BFHI has
been endorsed by hundreds of organizations worldwide. The
BFHI focuses on the following 10 steps:
a) Have a written breastfeeding policy that is routinely
communicated to all health care staff;
b) Train all health care staff in the skills necessary to
implement BFHI policy;
c) Inform all pregnant women about the benefits and
management of breastfeeding;
d) Help mothers initiate breastfeeding within one hour of
birth;
e) Show mothers how to breastfeed and how to maintain
lactation even if they are separated from their infants;
f) Give infants no food or drink other than breast milk
unless medically indicated;
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g) Practice rooming-in and allow mothers and infants to
remain together 24 hours a day;
h) Encourage breastfeeding on demand;
i) Give no pacifiers or artificial nipples to breastfeeding
infants; and,
j) Foster the establishment of breastfeeding support groups
and refer mothers to them on discharge from the hospital
birth center.
Baby-Friendly USA provides technical assistance to the
facility to create a plan for achieving Baby-Friendly
guidelines. All plans are reviewed and feedback is provided
by Baby-Friendly USA. Baby-Friendly USA offers a sliding fee
schedule to hospitals seeking a Baby-Friendly designation
based on the size of the hospital and the number of births per
year.
According to the CWA, some 58 of the approximately 260
perinatal hospitals in California have implemented
comprehensive policies, and become certified as Baby Friendly,
and approximately 40 hospitals are planning to begin the
certification process, leaving nearly 162 perinatal hospitals
that still must become certified.
3)MODEL HOSPITAL POLICY RECOMMENDATIONS . The model hospital
policy recommendations were developed by the Inland Empire
Breastfeeding Coalition and are approved by DPH. They are
intended for use as a framework that should be molded to fit
each particular setting. The policies and recommendations are
similar to the BFHI and provide hospitals with another option
that does not involve certification or a fee. The
recommendations for successful development and implementation
of hospital policies on breastfeeding state that hospitals
should:
a) Create an interdisciplinary team to review and
strengthen breastfeeding policies. The team should include
members who:
i) Support breastfeeding;
ii) Understand the breastfeeding process; and
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iii) Represent the cultures of the community they serve.
b) Revise hospital breastfeeding policies as they come up
for review;
c) Review the literature prior to making recommendations to
the hospital policy committee;
d) Recognize that these policy recommendations are intended
as a guide and should be adapted to fit the hospital's
needs; and,
e) Implementation of new or revised policies should be
accompanied by staff education, patient education
materials, and ongoing support, and reinforcement of the
new policies.
4)OTHER EVIDENCE BASED POLICY . This bill allows hospitals to
use, "an alternate process adopted by a health care service
plan that includes evidenced-based policies and practices?"
One such example would be the Kaiser Toolkit, which was based
on the Institute for Healthcare Improvement (IHI)
Collaborative model, forming a working group of several local
teams, each made up of accountable representatives from
medical centers. The collaborative was led by a core faculty
team of subject matter experts in breastfeeding and
performance improvement.
5)SUPPORT . The CWA is the sponsor of this bill and writes that
the Ten Steps will increase exclusive breastfeeding rates in
California, improve health outcomes for moms and kids, and
ultimately save millions in unnecessary health care costs.
The California Hospital Association also supports this bill,
stating, this bill further promotes the breast feeding support
provided to new mothers in our hospitals and allows each
hospital to select from an array of options to provide that
support. Hospitals throughout the state have demonstrated
this commitment by leading the nation with over 60 hospitals
voluntarily achieving the prestigious "Ten Steps to Successful
Breastfeeding" Baby-Friendly Hospital designation status.
The American Academy of Pediatrics writes in support that the
importance of addressing the issue of the impact of hospital
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practices and policies on breastfeeding outcomes is
highlighted by the decision of The Joint Commission to adopt
the rate of exclusive breast milk feeding as a Perinatal Care
Core Measure. As such, the rate of exclusive breastfeeding
during the hospital stay has been confirmed as a critical
variable when measuring the quality of care provided.
6)RELATED LEGISLATION . SB 464 (Jackson) 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.
7)PREVIOUS LEGISLATION . SB 502 (Pavley and De León), Chapter
511, Statutes of 2011, implements 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,
requires hospitals to clearly post the policy and routinely
communicate the policy to perinatal unit staff.
REGISTERED SUPPORT / OPPOSITION :
Support
California WIC Association (sponsor)
Alameda County Board of Supervisors
Alameda County Breastfeeding Coalition
Alta Bates Summit Medical Center
American Academy of Pediatrics
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 San Joaquin County
Breastfeeding Coalition of Solano County
Breastfeed LA
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
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California Conference of Local Health Department Nutritionists
California Food Policy Advocates
California Health Collaborative
California Hospital Association
California Medical Association
California Nurses Association
California Pan-Ethnic Health Network
Clinica Sierra Vista
Community Resource Project, Inc.
Confident Childbirth - Lamaze
County Health Executives Association of California
Delta Health Care
E Center
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 WIC Program
Health Officers Association of California
Henry Mayo Newhall Memorial Hospital
Hunger Action Los Angeles
Junior Leagues of California
Kern County Breastfeeding Coalition
Labor Project for Working Families
Los Angeles County Board of Supervisors
Maternal and Child Health Access
Maternal, Child and Adolescent Health Directors
MCAH Action
MomsRising
Mono County WIC Program
Monterey County Board of Supervisors
Monterey County WIC Program
Native Breastfeeding Council
Prevention Institute
Riverside- San Bernardino County Indian Health
San Diego County Breastfeeding Coalition
San Francisco Food Security Task Force
San Luis Obispo County WIC Program
San Mateo Breastfeeding Advisory Committee
Santa Cruz County Breastfeeding Coalition
Solano County Public Health WIC Program
Sonoma County Department of Health Services
Strategic Alliance for Healthy Food and Activity Environments
Tulare County Breastfeeding Coalition
Tulare Regional Medical Center
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Tuolumne County Breastfeeding Coalition
Ventura County Public Health
Numerous individuals
Opposition
None on file.
Analysis Prepared by : Lara Flynn / HEALTH / (916) 319-2097