BILL ANALYSIS �
SB 502
Page 1
Date of Hearing: June 21, 2011
ASSEMBLY COMMITTEE ON HEALTH
William W. Monning, Chair
SB 502 (Pavley and De Le�n) - As Amended: June 15, 2011
SENATE VOTE : 30-6
SUBJECT : Hospital Infant Feeding Act.
SUMMARY : Effective January 1, 2014, establishes the Hospital
Infant Feeding Act which will require 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.
Specifically, this bill :
1)Defines perinatal unit as a maternity and 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.
2)Requires the infant-feeding policy to promote breastfeeding
using guidance provided by the Baby-Friendly Hospital
Initiative (BFHI) or the Department of Public Health (DPH)
Model Hospital Policy Recommendations.
3)Permits the infant-feeding policy to include guidance on
formula supplementation or bottle-feeding if preferred by the
mother or when exclusive breastfeeding is contraindicated.
4)Requires the infant-feeding policy to be routinely
communicated to perinatal unit staff and to apply to all
infants in a perinatal unit.
5)Makes legislative findings and declarations regarding
recommendations for breastfeeding by the United States Surgeon
General and other major health organizations, such as the
American Academy of Pediatrics (AAP) and specifies 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 and that 34 hospitals
in California have received Baby Friendly USA accreditation.
SB 502
Page 2
EXISTING LAW :
1)Establishes the Maternal Child and Adolescent Health (MCAH)
program, administered by DPH, which monitors and reports
infant-feeding data.
2)Requires DPH to recommend training for general acute care
hospitals and special hospitals that is intended to improve
breast feeding rates among mothers and infants.
3)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.
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.
5)Establishes the "Breastfeeding Peer Counseling Program" at
local agency WIC sites to increase the rate of breastfeeding
for WIC participants.
6)Covers, as part of the Medi-Cal program, durable medical
equipment, including the rental or purchase of breast pumps
for pregnant and postpartum women, subject to medical
necessity.
7)Defines a general acute care hospital as a health facility
having a duly constituted governing body with overall
administrative and professional responsibility and an
organized medical staff that provides 24-hour inpatient care,
including the following basic services: medical; nursing;
surgical; anesthesia; laboratory; radiology; pharmacy; and,
dietary services
8)Defines special hospitals as a health facility having a duly
constituted governing body with overall administrative and
professional responsibility and an organized medical or dental
staff that provides inpatient or outpatient care in dentistry
or maternity.
FISCAL EFFECT : According to the Senate Appropriations
SB 502
Page 3
Committee, pursuant to Senate Rule 28.8, negligible state costs.
COMMENTS :
1)PURPOSE OF THIS BILL . According to the author, the intent of
this bill is to establish infant-feeding programs in all
California hospitals that provide maternity and delivery
services. The author states that a growing body of evidence
indicates that early infant-feeding practices can affect later
growth and development in children, while significantly
reducing their risk for infections and chronic disease such as
diabetes, asthma, and obesity. The author argues that even
though regulations require general acute care hospitals to
have a written breastfeeding policy many do not have
infant-feeding policies in place. For example, according to
information gathered by California WIC Association (CWA), 14
out of the 22 lowest performing hospitals, those with the
highest formula supplementation rates, do not have a
breastfeeding policy. The author further states that the goal
of this bill is to provide hospitals with guidance on
infant-feeding policies that address both breastfeeding and
proper bottle feeding. The author contends that this bill is
a modest approach that will help increase the exclusive
breastfeeding rates in California hospitals and update current
regulations while giving the hospitals a reasonable amount of
time to develop their infant-feeding policies and to educate
their perinatal unit staff.
2)BACKGROUND . According to a report, "One Hospital at a Time",
produced by CWA and the University of California Davis Human
Lactation Center, nearly 90% of California mothers enter the
hospital intending to breastfeed and that hospital policies
can play a pivotal role in whether they are successful. The
report states that hospital practices can discourage or
prevent mothers from carrying out that decision by failing to
provide skilled support, separating mothers from their babies,
delaying the first feeding, or routinely providing formula
supplementation even for infants whose mothers intend to
breastfeed exclusively. The United States Surgeon General and
major health organizations, such as the AAP, recommend
exclusive breastfeeding for most babies for the first six
months of life. A 2010 Harvard study found that the United
States would save $13 billion per year if 90% of infants were
breastfed exclusively for six months.
SB 502
Page 4
3)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. Since 2004, the California WIC Program has implemented
a Breastfeeding Peer Counseling (BPC) Program to enhance WIC's
breastfeeding management and counseling efforts. In 2004, the
United States Department of Agriculture (USDA) allocated $2.15
million to California for BPC programs. Eight local WIC
agencies were authorized for implementation in October 2004.
Seven additional agencies received planning grants in February
2005. In April 2005, the California WIC Program received an
additional $2.12 million from USDA and 15 local agencies
received $1.3 million for BPC programs. The remaining funds
were spent on breastfeeding training and materials for
agencies statewide. In 2009, WIC received $12.5 million from
the USDA to further expand the BPC Program.
4)INFANT-FEEDING POLICY . This bill requires the hospital
infant-feeding policy to utilize either the BFHI or the DPH
Model Hospital Policy Recommendations. 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 sponsors, Baby-Friendly USA is the national body which
provides accreditation for BFHI in the United States.
Hospitals 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, as
well as to provide ongoing monitoring to maintain hospital
certification.
According to the "One Hospital at a Time" report, since the
implementation of BFHI, California has seen a rise in the
number of baby-friendly hospitals, growing from 12 in 2006 to
34 in 2010. Hospitals that have instituted Baby-Friendly USA
practices have the highest rates of breastfeeding. In April
2010, the Joint Commission, the accreditation organization for
hospitals, began including exclusive breastfeeding rates as
part of its Perinatal Care core evaluation indicators for
maternity hospitals.
SB 502
Page 5
"Model Hospital Policy Recommendations" are the guidelines
developed by the Inland Empire Breastfeeding Coalition and
approved and provided to hospitals as another resource to
improve breastfeeding policies by the DPH. The official
guidelines, which are approved and published by DPH, are
entitled, "Providing Breastfeeding Support: Model Hospital
Policy Recommendations." These policies do not include a
certification process, fee or oversight.
Both policies include extensive additional instructions,
narrative, references and guidelines to assist hospitals and
staff in interpreting and applying these guidelines.
a) BFHI. The BFHI focuses on specific policies designed to
reduce barriers to breastfeeding. The 10 steps are as
follows:
i) Have a written breastfeeding policy that is
routinely communicated to all health care staff.
ii) Train all health care staff in skills necessary to
implement this policy.
iii) Inform all pregnant women about the benefits and
management of breastfeeding.
iv) Help mothers initiate breastfeeding within one
hour of birth.
v) Show mothers how to breastfeed and how to maintain
lactation, even if they are separated from their
infants.
vi) Give newborn infants no food or drink other than
breast milk, unless medically indicated.
vii) Practice "rooming in"-- allow mothers and infants
to remain together 24 hours a day. Encourage
breastfeeding on demand.
viii) Give no pacifiers or artificial nipples to
breastfeeding infants.
ix) Foster the establishment of breastfeeding support
groups and refer mothers to them on discharge from the
SB 502
Page 6
hospital or clinic.
b) The DPH policies are intended to be used as a framework
and are to be molded to fit each particular setting. The
10 policies are as follows:
i) Hospitals should promote and support
breastfeeding.
ii) Nurses, certified nurse midwives, physicians, and
other health professionals with expertise regarding the
benefits and management of breastfeeding should educate
pregnant and postpartum women when the opportunity for
education exists, for example, during prenatal classes,
in clinical settings, and at discharge teaching.
iii) The hospital will encourage medical staff to
perform a breast exam on all pregnant women and provide
anticipatory guidance for conditions that could affect
breastfeeding. Breastfeeding mothers will have an
assessment of the breast prior to discharge and will
receive anticipatory guidance regarding conditions that
might affect breastfeeding.
iv) Hospital perinatal staff should support the
mother's choice to breastfeed and encourage exclusive
breastfeeding for the first six months.
v) Nurses, certified nurse midwives, and physicians
should encourage new mothers to hold their newborns skin
to skin during the first two hours following birth and
as much as possible thereafter, unless contraindicated.
vi) Mothers and infants should be assessed for
effective breastfeeding. Mothers should be offered
instruction in breastfeeding as indicated.
vii) Artificial nipples and pacifiers should be
discouraged for healthy, breastfeeding infants.
viii) Sterile water, glucose water, and artificial milk
should not be given to a breastfeeding infant without
the mother's informed consent and/or physician's
specific order.
ix) Mothers and infants should be encouraged to remain
SB 502
Page 7
together during the hospital stay.
x) At discharge, mothers should be given information
regarding community resources for breastfeeding support.
5)SUPPORT . The American Congress of Obstetricians and
Gynecologists (ACOG), District IX (California), writes in
support that this bill is one more tool in support of mothers
who plan to breastfeed. According to ACOG, exclusive
breastfeeding has shown to be highly beneficial to mother and
infant for fostering a bond as well as providing many health
advantages, particularly in the first six months of life. As
examples, ACOG states that breastfeeding lowers an infant's
risk of colic, feeding problems, and Sudden Infant Death
Syndrome. In addition, breastfeeding within the first four
months decreases the infant's risk of developing Type I and
Type II diabetes. In support of this bill, ACOG also cites
multiple benefits to the mother such as increased release of
the hormone oxytocin and prolactin leading to decreased
maternal blood loss and increased feelings of relaxation and
attachment to the baby. According to ACOG, breastfeeding has
also been associated with a decreased risk of developing
ovarian and breast cancers.
The American Cancer Society, also in support, states that
breastfeeding has a relationship to cancer because it is
associated with a reduced risk of breast and ovarian cancer
for the mother and childhood leukemia for the child. The
American Cancer Society further states that one way to support
a woman's commitment to breastfeeding is supporting that
decision in the critical hours at the hospital after a baby's
birth.
6)PRIOR LEGISLATION.
a) SB 22 (Migden), Chapter 460, Statutes of 2007, requires
DPH to recommend training for general acute care hospitals
and special hospitals to improve breast-feeding rates among
mothers and infants. Also requires the Department of
Health Care Services to streamline and simplify existing
Medi-Cal Program procedures to improve access to lactation
support and breast pumps among Medi-Cal recipients.
b) SB 1275 (Ortiz), of 2004 would have required
manufacturers of infant formula that distribute free
SB 502
Page 8
formula samples in the maternity unit, nursery, or any
other location in a hospital, to include a single, readable
disclaimer notice stating, "The distribution of the formula
or the marketing materials in a hospital setting does not
necessarily mean that the hospital or its health care
providers endorse the company or the product that is being
distributed." SB 1275 failed passage in the Assembly
Health Committee.
7)Author's Amendment. The author will be offering an amendment
to delete the definition in Section 123366 (2) and substitute
it with Section (e) from the intent section in order to
clarify the definitions in this bill.
REGISTERED SUPPORT / OPPOSITION :
Support
California WIC Association (sponsor)
American Cancer Society
American Congress of Obstetricians & Gynecologists, District IX
(California)
American Red Cross, San Diego/Imperial Counties Chapter
American Red Cross WIC Program
Antelope Valley Hospital WIC Program
Babies First Breastfeeding Task Force of Fresno County
Butte County WIC
California Breastfeeding Coalition
California Center for Rural Policy
California Food Policy Advocates
Clinicas de Salud del Pueblo, Inc. WIC Program
Conscious Surrender Birthing Doula Services
County of Napa WIC Program
E Center WIC
First 5 Fresno County
First 5 LA
Junior Leagues of California State Public Affairs Committee
Kern County Breastfeeding Coalition
Los Angeles County Board of Supervisors
Maternal, Child and Adolescent Health Action Directors
Mothers' Milk Bank of San Jose
Native American Heath Center WIC Program
Orange County Breastfeeding Coalition
Planned Parenthood WIC
SB 502
Page 9
Public Health Foundation Enterprises, Inc. WIC Program
Sacred Birth Services
San Diego County Breastfeeding Coalition
San Diego State University Research Foundation WIC Program
Solano County Health and Social Services WIC Program
Tulare County Breastfeeding Coalition
Numerous individuals
Opposition
None on file.
Analysis Prepared by : Tanya Robinson-Taylor and Marjorie
Swartz/ HEALTH / (916) 319-2097