BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                SB 402
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        SENATE THIRD READING
        SB 402 (De León)
        As Amended June 18, 2013
        Majority vote

         SENATE VOTE  :38-0  
         
         HEALTH              19-0        APPROPRIATIONS      15-2        
         
         ----------------------------------------------------------------- 
        |Ayes:|Pan, Logue, Ammiano,      |Ayes:|Gatto, Harkey, Bocanegra, |
        |     |Atkins, Bonilla, Bonta,   |     |Bradford, Ian Calderon,   |
        |     |Chesbro, Gomez, Roger     |     |Campos, Eggman, Gomez,    |
        |     |Hernández, Gonzalez,      |     |Hall, Holden, Linder,     |
        |     |Maienschein, Mansoor,     |     |Pan, Quirk, Wagner, Weber |
        |     |Mitchell, Nazarian,       |     |                          |
        |     |Nestande,                 |     |                          |
        |     |V. Manuel Pérez, Wagner,  |     |                          |
        |     |Wieckowski, Wilk          |     |                          |
        |-----+--------------------------+-----+--------------------------|
        |     |                          |Nays:|Bigelow, Donnelly         |
        |     |                          |     |                          |
         ----------------------------------------------------------------- 
         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 and World Health Organization's "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  








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          staff, space, equipment, and supplies.

         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  
          breastfeeding their infants.

        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  :  According to the Assembly Appropriations Committee,  
        negligible state costs.
         
         COMMENTS  :  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  








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        staff with education for breastfeeding support; and, avoid  
        unnecessary formula supplementation.

        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 California WIC Association (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.

        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  
        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.


         Analysis Prepared by  :    Lara Flynn / HEALTH / (916) 319-2097


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