Dear Amy,

What a great opportunity to highlight breastfeeding promotion---and even
more important, SUPPORT---to the HMOs, and with the weight of NJ AAP behind
you, too!

Add this to your list of links, and take a look at it yourself:

www.4woman.gov/owh/pub/breastfeeding/

This is a 100-page booklet put out by the AAHP--American Association of
Health Plans--in 2001 as part of their series on women's health issues. It
starts with a message from Surgeon General David Satcher and was sponsored
by DHHS and the Office on Women's Health. Best of all for your purpose, it
is THE HEALTH PLANS themselves talking, so your audience should sit up and
take notice of that!

You can download a PDF to save on your home computer. You can print out a
copy to take with you to the meeting. 

The book spotlights eight health plans that support breastfeeding for their
enrolled members and three that have breastfeeding benefits for their own
employees. While it's a bit long on descriptions and verbiage, there are
some data there too if you look carefully. Given the publication date, these
are probably from the 1990s. 
On page 79, Aetna says it had a return on investment of $2.18 for every
dollar they spent on their program for their own employees. On page 61, one
of the Kaiser plans shows a 13% to 23% increase in bf rate at various ages
from 2 weeks to 6 months in the three years since starting to cover
breastfeeding care for their enrolled mothers.

As for the presentation, I'd make it simple and very clear. I don't think
you need to spend much if any time establishing that bf babies and mothers
are healthier. I'd hit the research that demonstrates healthcare savings,
starting with the Ball and Wright study from 1999, Pediatrics 103:4,
supplement 870-76.

Then I'd list a few concrete things HMOs can do--a list to choose from.
Three interventions that make sense to me:

1. info for mothers/families--cover prenatal attendance at bf classes, LLL
meetings, and WIC; supply written info on bf that doesn't come from formula
companies. In NJ we really need info in many languages. Is this something
that you want to pitch to them?...translation of a basic and accurate
"how-to" booklet for mothers?

2. access to supportive care--this means making sure practitioners are well
trained in bf management and counseling skills; providers follow approved
standards of practice for bf care; breastfeeding is assessed by someone who
knows what they're looking at before hospital DC; babies have a covered
visit to see a pediatrician or visiting nurse within 72 hours of hospital DC

3. coverage for an appropriate (hospital-grade) double pump for any mom with
a baby in the NICU, from the minute mom is discharged until a week or two
after the baby is discharged (if needed) to help the baby transition to full
breastfeeding. Probably rental of an accurate scale for pre- and post-feed
weights at home, too.

The final point I would make is that Promotion without adequate Support is a
recipe for failure. They can't just TELL women to breastfeed. If they want
breastfeeding to happen, they have to ENABLE women to overcome the hurdles
that women have to leap in order to get off to a good start. Since a lot of
those hurdles are set up right in the health care system itself, it makes
sense for this branch of the health care system to do what it can  to help
moms get over them...or even better, to take them down! The HMOs have made
huge changes in the way health care is delivered over the past few decades,
so why not turn that power towards helping moms and babies do something
that's good for them AND for the health care system too.

You've got a win-win proposition for them.

Chris Mulford, RN, IBCLC
LLL Leader Reserve
working for WIC in South Jersey (Eastern USA)
Co-coordinator, Women & Work Task Force, WABA
 
 

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