SGCTA at Five Years: Catherine Sullivan

Catherine Sullivan is a Breastfeeding Coach with EMPower (Enhancing Maternity Practices) Breastfeeding. Catherine discussed the Health Care Action Areas of the Surgeon General's Call to Action to Support Breastfeeding during the August 23 virtual town hall meeting. Below is a transcript of her responses:

What accomplishments from the five years since the SGCTA are you most excited about? Did these efforts target or affect disproportionately impacted populations, i.e., those with the greatest disparities in breastfeeding rates? If so, how?

I wanted to disclose that I do run a Pathway 2 lactation training program, so I know the good pieces of that and the bad pieces of that. We just had excellent progress around maternity care. If you look back at 2011, the 2010 goals for increasing facilities that implement recommended practices, mainly Baby-Friendly practices, our goal for 2020 was 8.1 and our baseline was at 2.6.

There has been quite a bit of effort and money invested in maternity care practices over the last few years. One of the things we do at CGBI is we facilitate a national collaborative for advancing the Ten Steps. And, if we look back to 2011, we had 13 states that were working on state recognitions around maternity care, they were doing something around maternity care, pushing hospitals toward Baby-Friendly designation. Then, by 2013, there were 42 states. So, just in that group, that’s enormous growth that we’ve had. We’ve also had funded projects. CDC funded Best-Fed Beginnings. And, I wrote it down, because I wasn’t quite sure of the statistics, but 72 or the 89 hospitals had achieved Baby-Friendly designation by April of this year, and I’m sure there have been a few more.

The EMPower project that I work with, we’re helping 94 hospitals in 23 states along their Baby-Friendly pathway. For our hospitals, we’ve really tried to look at high-hanging fruit, and look at higher Medicaid hospitals, hospitals that are in rural areas serving very needy families.

The other exciting thing in maternity care is we’ve actually seen the mPINC scores go up. That’s the Maternity Practices in Infant Nutrition and Care survey that CDC puts out, in the odd years and then the reporting comes out in the even years. When you go back and you look at 2011, the national mPINC score was 65, and, as of this week, on the report card, it’s 79. So, we’ve seen massive change in maternity care practices. To Action 11, there are 28,000 IBCLCs in the world, and 15,000 of them are in the U.S. That’s an increase of 2,175, but this is an area where we have some pretty big equity issues. So, even though we’ve had a big increase, is it necessarily the people that would serve the most needy women? It’s a good thing, and it’s also a concern. 

Considering the focus of the USBC and the field on advancing equity in breastfeeding support, what is missing from the SGCTA that you see as an important priority for the next five years?

I have a couple thoughts on this. In maternity care we’ve really been using the “raise all boats” approach to equity and really need to hone it in on looking at maternity care facilities that are serving the most vulnerable populations and really focus in on them. A great model in the state of Mississippi is that Blue Cross Blue Shield is really mandating that hospitals improve their maternity care practices or they will cease to be paid for delivering babies. I think that’s one piece that is missing. I think that if we engaged all major insurers in this way that would make a huge difference. It would become the norm, rather than this elite award that maternity care centers are achieving.

The other piece of that is that all accrediting agencies. The Joint Commission has breastfeeding measures, but some of the other accrediting agencies of hospitals don’t have those measures. In the Maternity Care Practices Constellation for USBC that’s something that has been prioritized as an action area for us. It would be nice to see it in the Surgeon General’s Call to Action.

I think around the basic support standards for providers, we also are missing that piece of what’s happening in the clinic maternity care.  Yes, we’re covering it in the hospital pretty well. I mean, we’re making massive improvements. But, what about in that clinic where duration is essential? And, working with the pediatrics and the family medicine practices and the OB practices to make sure that the care that they’re providing is evidence-based, and they aren’t marketing formula unnecessarily. And, that there’s some standard that they’re being held to as well in terms of their roles and responsibilities in this area. I think that’s a big thing.

And then, everybody fits at this table, because moms need all kinds of help. They don’t just need an IBCLC, they need all levels of help, peer counseling, certified counselors, they need all of it. The thing that I’m most concerned about in this area is the opportunities for women of color or men who want to get into this field. There’s gender equity issues. There’s really limited availability of programs, especially Pathway 2 and Pathway 3 programs. The access is very low. The ability to get those programs paid for is very hard for participants. People that really want to further their education and want to continue in that field. And again, not saying that it’s absolutely necessary for every family that we serve. But, if they want to be in that field, we have to find ways to make the education and the requirements accessible to the folks that want to do it.

Looking at the whole (both existing action areas and any new ones suggested), which three implementation strategies do you think would have the greatest impact if prioritized over the next five years? How could these strategies best apply an equity approach?

One thing I would like us to do is use equity tools when we are planning new grants. Or, with new funding opportunities, ensure that we are applying an equity lens tool to it and using that equity tool in writing our proposals, and in pretty much everything that we do. Because, that is the piece that has been missing. Again, in this area of health care, it’s kind of been a “raise all boats” approach, and we need to do something differently if we’re going to really make an impact on the most vulnerable populations.


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