1. Valuing diversity Identifying and addressing barriers to healthcare and their connection to breastfeeding through culturally sensitive practices

2. Purpose This tutorial is designed to Identify the barriers minorities in Louisiana, Mississippi and Arkansas face when accessing healthcare services Identify avenues for public health agencies to promote breastfeeding with minorities while keeping in mind the barriers they face while accessing healthcare These ideas are presented to spark the thought processes. Theories, practices and ideas can be adapted to fit many different situations

3. Outline Disparities in Healthcare Access for minorities Addressing the Gap Breastfeeding Among Minorities Barriers Trends Practices that work WIC 3

4. Disparities in the Target Area In Louisiana, Mississippi, and Arkansas: poor quality of healthcare High minority population Rate of low birth weight high among minorities The following slides show some of the disparities in the target region. These challenges are specifically relevant for Maternal and Child Public Health workers

5. 5 States with the largest percentage of white residentshave the highest Medicare quality rankings. Percentage of population that is non-Hispanic white according to2000 census by Medicare Quality Ranking for 2000–2001 The target area has the lowest quality ranking and lower percentage of white residents Note: Medicare rankings are shown for the top 12 and the bottom 12 states only. Sources: S. F. Jencks et al., “Change in the Quality of Care Delivered to Medicare Beneficiaries,1998–1999 to 2000–2001,” Journal of the American Medical Association, Jan. 15, 2003 289(3):305–12; United States Census Bureau, Census 2000. Chart 6-3

6. Low birth weight percentage in the target area for minority populations March of Dimes Peristats

7. Transportation Childcare Language Cultural Barriers Financial barriers Lack of social supports Lack of Insurance These factors limit minority populations from accessing care. Evidence shows that these factors cause some Hispanic populations to not even seek care. Disparities in US Healthcare The Commonwealth Fund Chartbook March 2008

8. Addressing the Gap Insurance coverage for vulnerable minority populations Interpreter services for those with English as a second language Providing more permanent solutions to racial and ethnic disparities is key The Commonwealth Fund Chartbook March 2008

9. Addressing the Gap Providing a Medical Home Culturally Competent Training Developing a relationship with a primary care provider is associated with better overall healthcare Regular source of care gives the patient access to more services and resources (see next slide) Training for Healthcare workers Educational materials for minorities that are culturally competent Language Respectful of beliefs and practices The Commonwealth Fund Chartbook March 2008

10. 10 Racial and ethnic differences in getting neededmedical care are minimal for adults with medical homes;disparities decline substantially compared with adults withno regular source of care. Percentage of adults ages 18 to 64 reportingalways getting care they need when they need it Note: Having a medical home includes having a regular provider or place of care, reporting no difficulty contacting provider by phone, or getting advice and medical care on weekends or evenings, and always or often finding office visits well organized and running on time. Source: The Commonwealth Fund. Health Care Quality Survey. 2006. Chart 7-4

11. Breastfeeding Among Minorities Barriers Trends Practices that Work

12. Breastfeeding Rates in the target area http://www.cdc.gov/breastfeeding/data/reportcard.htm

13. Barriers to Breastfeeding Rural Populations African American Populations Lower income populations Higher rates of poverty Lack of resources that promote breastfeeding Lack of specialized services in hospitals or clinics to support Maternal and Child Health (Sparks 2010) Lack of individual and generational education about breastfeeding Lack of social support Lack of support from the work environment Cultural norms that support formula feeding and early feedings with solid foods(Chin, Myers, Magnus 2008)

14. Barriers to Breastfeeding Latin American Populations Lack of support from extended family Lack of support services that understand Latin American culture or traditions US cultural norms that support formula feeding through availability and marketing of formula Lack of communication with providers Language barriers (Denman-Vitale & Murillo, 1999)

16. Loving Support Project

18. WIC Incentives WIC mothers choosing to breastfeed are provided information through counseling and breastfeeding educational materials. Breastfeeding mothers receive follow-up support through peer counselors. Breastfeeding mothers are eligible to participate in WIC longer than non-breastfeeding mothers. Mothers who exclusively breastfeed their infants receive an enhanced food package. Breastfeeding mothers can receive breast pumps, breast shells or nursing supplementsto help support the initiation and continuation of breastfeeding By using incentives, WIC promotes breastfeeding and offers support for mothers who face financial challenges or work related barriers http://www.fns.usda.gov/wic/Breastfeeding/breastfeedingmainpage.HTM

19. WIC “Loving Support Makes Breastfeeding Work” Campaign Campaign sponsored by WIC and Best Start Social Marketing Used to promote breastfeeding in States Provides information on how other states have successfully implemented or expanded peer support breast feeding programs Provides information about training workers . Breastfeeding Peer Support – Implementation and Expansion Resource This document created by WIC shares the successes of several States WIC supported breastfeeding peer counseling programs Use the above link to access the document Also see the presentation on Peer Counseling http://www.nal.usda.gov/wicworks/Learning_Center/bfshowcase.pdf

20. Breastfeeding a Magical Bond of Love WIC initiative specifically designed to promote breastfeeding in Hispanic families. Created from a study that looked at the perceptions that Hispanic women have of breastfeeding in the United States Provides educational materials for mothers, fathers, and grandmothers in English and Spanish http://www.nal.usda.gov/wicworks/Learning_Center/support_bond.html

21. Promotional videos Video by Mississippi WIC is highly representative of minority populations in the State Highlight minorities populations breastfeeding Teenage mothers Single mothers Black, Hispanic and Asian mothers http://vimeo.com/13649529

22. Conclusions Using a diverse approach to addressing health disparities is an effective way to target programing Culturally competent training and practices help provide services that are sustainable and effective Barriers to Breastfeeding among minority populations may be seeded in cultural norms, lack of resources or lack of support services. WIC provides various services that could be replicated or improved upon to promote breastfeeding among diverse populations Key programs provides education, support and incentives