New York City public hospitals, the largest municipal hospital system in the nation, are emphasizing the benefits of exclusive breastfeeding 10 years after international health authorities began to stress the importance of breastfeeding globally.

The Big Apple is getting a little bit healthier for some of its most important residents–newborns and the mothers who give birth to them.

As the largest municipal hospital system in the country, delivering more than 22,000 babies every year, New York City public hospitals have taken important steps to improve the way they care for newborns and their mothers, creating a blueprint that has great potential ramifications for other urban centers and mothers across the country. In New York City, the number of mothers taking advantage of the health benefits of breastfeeding results in these hospitals having an even greater community impact and scores of healthier women. Mothers who breastfeed have lower rates of breast cancer and other forms of cancer, for example, and have an easier time losing weight gained during pregnancy.

For nearly two years, Dr. Benjamin Mojica, senior assistant vice president in community health promotion and public health services for the Health and Hospitals Corporation, has mandated that all 11 public hospitals create a baby-friendly atmosphere and emphasize the benefits of exclusive breastfeeding. These hospitals operate under the umbrella organization known as the Health and Hospitals Corporation. Each of them is required to promote breastfeeding and follow 10 steps outlined by UNICEF and the World Health Organization, as part of an initiative launched 10 years ago called the Baby Friendly Hospital Initiative, to provide an optimal environment for successful breastfeeding, Mojica said. That includes limiting infant formula marketing, initiating breastfeeding within the first hour of life and keeping mothers and babies in the same room.

Harlem Hospital last summer became the only city hospital to have met all the requirements to receive the official “Baby-Friendly” certification from the World Health Organization.

Across the United States, the Baby Friendly Hospital Initiative is gaining some ground, with 79 U.S. hospitals now enjoying the coveted “Baby-Friendly” stamp of approval, compared to 64 hospitals one year ago. The mean rate of exclusive breastfeeding initiation in such hospitals is 78 percent, far higher than the national mean of 46 percent, according to Baby Friendly Hospital Initiative USA. That means that more women are tapping into the varied health benefits of breastfeeding.

More New York City hospitals hope to join the ranks of those earning the official Baby-Friendly stamp of approval. “Our goal is to increase breastfeeding as the choice for nutrition for infants in the city,” Mojica said.

Encouraged by Harlem Hospital’s 2008 designation, Cindy Turner-Maffei, Baby Friendly Health Initiative USA National Coordinator, said great strides are being made toward creating a breastfeeding-supportive environment in all New York City public hospitals.

The new efforts include periodic site visits to ensure that magazines published by formula companies aren’t being distributed in municipal hospitals and that representatives from formula companies are not promoting their products, said Michael Lettera, senior director of administrative services in health promotion and public health services at the hospital corporation, whose office administers these visits. Additionally, all staff at municipal hospitals are trained in the promotion of breastfeeding. Nurses train for 18 hours and auxiliary staff, including housekeepers, train in a four-hour course. An International Board Certified Lactation Consultant is also on staff at each facility.

The results suggest encouraging gains. According to the corporation, 85 percent of all babies born in municipal hospitals in 2008 were breastfed at some point. This success also extends to New York City, which is boosting its breastfeeding rosters. The number of New York City babies that were breastfed at some point in their lives rose to 84 percent in 2005 from 70 percent in 2000, according to the Centers for Disease Control. Mojica hopes the efforts at city hospitals was a contributing factor to the increase.

Natasa Petrovska, 34, said she’s benefiting from the city’s new efforts.

A native of Macedonia, Petrovska moved to New York with her husband and daughter, but said she felt isolated upon first arriving in the United States. In Macedonia, where she said breastfeeding is the norm, she enjoyed the support of her family and the community, but now she needed a way to connect with other breastfeeding moms and health professionals here. The Elmhurst Hospital Center Lactation Clinic, a hospital corporation site, provided that space.

Petrovska said she “felt like family with them,” adding that “from the receptionist to the nurses, especially the doctors,” she felt at home.

Petrovska has had three more children since moving to Queens. In that time she has taken breastfeeding classes, met with a lactation specialist, was provided with a visiting nurse, and even got a free breast pump at the Elmhurst Lactation Clinic. Petrovska said she often reads something on the Internet, raising a million questions for her, and the Baby Friendly Hospital Initiative hospitals are “willing to answer them.”

One More Healthier Baby

Mojica said one requirement for the official Baby-Friendly designation that his office struggles with is declining free formula samples from companies and, instead, purchasing formula for mothers who request it during their stay at municipal hospitals.

Instead of infant bags from companies like Enfamil, municipal hospitals these days provide gift bags that contain breastfeeding instructions, educational materials, and “I Eat at Mom’s” onesies. The hospitals also loan breast pumps or help facilitate the process of acquiring them through insurance or for free through Medicaid.

Twenty-year-old Alicia Lewis-Howard delivered her second child, a girl named Karismah, at Harlem Hospital in mid-March. She said delivering at a Baby Friendly Hospital Initiative-designated hospital helped change her attitude and expectations regarding breastfeeding. When she had her first daughter, 1-year-old Aniyah, Lewis-Howard has only planned to breastfeed for one month.

“My aunt and everyone else was, like, it’s going to be painful,” Lewis-Howard said. However, the nurses at Harlem Hospital provided just the right amount of support to teach Lewis-Howard how to painlessly breastfeed. Lewis-Howard said the nurses offered to physically help her breastfeed, but she told them she wanted to do it herself.

“They directed me. They taught me to put the full areola in the baby’s mouth and not just the nipple, and I did it,” she said.

Not only was Lewis-Howard successfully able to nurse just minutes after her daughter Aniyah was born, but when she learned how breastfeeding had health benefits for her too, she chose to breastfeed for a full six months. Now, she plans to do the same with Karismah.

That’s one more healthier baby for New York City.

By Eisa Nefertari Ulen, published in Womens ENews, April 14, 2009