BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | SB 402|
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UNFINISHED BUSINESS
Bill No: SB 402
Author: De León (D), et al.
Amended: 6/18/13
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
SENATE FLOOR : 38-0, 5/29/13
AYES: Anderson, Beall, Berryhill, Block, Calderon, Cannella,
Corbett, Correa, De León, DeSaulnier, Emmerson, Evans, Fuller,
Gaines, Galgiani, Hancock, Hernandez, Hill, Hueso, Huff,
Jackson, Knight, Lara, Leno, Lieu, Liu, Monning, Nielsen,
Padilla, Pavley, Price, Roth, Steinberg, Torres, Wolk, Wright,
Wyland, Yee
NO VOTE RECORDED: Walters, Vacancy
ASSEMBLY FLOOR : 70-6, 8/26/13 - See last page for vote
SUBJECT : Breastfeeding
SOURCE : California WIC Association
DIGEST : This bill requires all general acute care hospitals
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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 defined.
Assembly Amendments cross reference a definition for the Model
Hospital Policy Recommendations and add a coauthor.
ANALYSIS :
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
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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
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 defined.
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
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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
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
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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.
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
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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.
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 8/28/13)
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 Academy of Preventive Medicine
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
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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 Los Angeles
First 5 Yolo, Children and Families Commission
Fresno County Department of Public Health
Fresno Economic Opportunities Commission
Fresno Economic Opportunities Commission WIC Program
Henry Mayo Newhall Memorial Hospital
Hunger Action Los Angeles
Kaiser Permanente
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
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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
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.
ASSEMBLY FLOOR : 70-6, 8/26/13
AYES: Achadjian, Alejo, Allen, Ammiano, Atkins, Bloom,
Bocanegra, Bonilla, Bonta, Bradford, Brown, Buchanan, Ian
Calderon, Campos, Chau, Chávez, Chesbro, Conway, Cooley,
Dahle, Daly, Dickinson, Eggman, Fong, Fox, Frazier, Beth
Gaines, Garcia, Gatto, Gomez, Gonzalez, Gordon, Gorell, Gray,
Hagman, Hall, Roger Hernández, Holden, Jones-Sawyer, Levine,
Linder, Logue, Lowenthal, Maienschein, Mansoor, Medina,
Mitchell, Morrell, Mullin, Muratsuchi, Nazarian, Nestande,
Pan, Perea, V. Manuel Pérez, Quirk, Quirk-Silva, Rendon,
Salas, Skinner, Stone, Ting, Wagner, Waldron, Weber,
Wieckowski, Wilk, Williams, Yamada, John A. Pérez
NOES: Donnelly, Grove, Jones, Melendez, Olsen, Patterson
NO VOTE RECORDED: Bigelow, Harkey, Vacancy, Vacancy
JL:k 8/28/13 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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