ENRICH Carolinas, a project that supports hospitals in improving maternity care practices for mothers and babies, will be expanded across North and South Carolina thanks to awards from The Duke Endowment totaling $5 million. Run by the Carolina Global Breastfeeding Institute (CGBI) housed in the UNC Gillings School of Global Public Health, ENRICH Carolinas provides technical assistance and training for hospitals, prenatal clinics and childcare facilities on how to create a friendlier and safer environment for all infants that supports breastfeeding.
The funding will allow the project, now in 19 counties, to expand and include support for all hospitals that provide maternity care at no cost to the facility, resulting in lifelong improved health for babies and their mothers for generations to come. This expansion will ensure that no matter where a family delivers in the Carolinas, they will get the quality care that supports optimal health outcomes for the birthing parent and their baby in an environment that enables breastfeeding, with a focus on informed decision-making and respect for parental choice.
“Our vision is to make sure that every family is provided the support that they need to achieve their feeding goals,” said Catherine Sullivan, CGBI’s director, ENRICH Carolina’s principal investigator, and an assistant professor of maternal and child health at the Gillings School. “This project has the potential to impact 178,000 births every year in the Carolinas.”
When the best care practices are fully implemented in a hospital, a facility can apply for a prestigious designation called Baby-Friendly. ENRICH Carolinas’ goal is to reach every baby born in the Carolinas, aiming to have 100% of the maternity care hospitals and birthing centers in North and South Carolina working on the implementation of these best practices by its fifth year either through the Baby-Friendly designation or a similar quality improvement program. If accomplished, North and South Carolina would become the first states to achieve that status.
“The hospitals are the anchor,” said Sullivan. “That’s where it all starts.”
To be designated Baby-Friendly by Baby-Friendly USA, a hospital must adhere to the World Health Organization’s Ten Steps to Successful Breastfeeding. These steps include discussing the importance of breastfeeding with pregnant women and their families, supporting skin-to-skin contact and enabling mothers and their infants to remain together and to practice rooming-in 24 hours a day. In a Baby-Friendly hospital, education on the safe preparation and feeding of formula is provided to mothers who have made an informed decision to use formula.
This project also represents a major step toward eliminating racial and ethnic disparities for outcomes related to breastfeeding-friendly practices. According to the Centers for Disease Control and Prevention, black infants are 21% less likely to have ever been breastfed than white infants. The CDC also indicates that black mothers experience maternal mortality at three to four times the rate of white women. Differences in the care provided based on race/ethnicity have been well documented. “Our project teams are going to go through racial equity training so that they can then provide appropriate guidance to the institutions they are serving,” Sullivan said.
Breastfeeding offers many benefits to both mothers and children, according to the WHO. Breast milk protects infants against infectious and chronic diseases and reduces infant mortality due to common childhood illnesses. In birthing mothers, breastfeeding reduces the risk of breast and ovarian cancer and contributes to their metabolic health and well-being. Based on these benefits, breastfeeding is considered the optimal means of feeding for the first six months of life.
Currently, 16% of North Carolina’s hospitals are designated as Baby-Friendly, while 45% have received the related state designation administered by the N.C. Division of Public Health. In South Carolina, which doesn’t have a state-run recognition program, 31% of maternity care hospitals are designated Baby-Friendly.
Families also need information and support before coming to the hospital to deliver their baby, as well as after going home and returning to life, school or work. CGBI offers a wide range of educational and support programs aimed at these timepoints, and ENRICH Carolinas brings them together in one project. “We’re calling it the enhanced baby bundle,” Sullivan said. Studies have shown that prenatal education about breastfeeding and a supportive environment throughout the pregnancy and postpartum period improve breastfeeding rates.