7FG3HIGGJKLM.(F121N1LA.$L.8LO3LP.DGGJKLM.#PF3PGMQ.P1.824F1RG./KOG. %1SFHG.*F3TG0P1FQ. K*+#3'%`?%J#&j4'-+*0S%a-ADS%OVCS%W`W% % KEY CONCEPTS LIFE COURSE THEORY: 5-7

OBJECTIVES

Provide an overview of the life course theory (LCT) and the importance of integrating breastfeeding promotion within the life course discourse.

Concept Timeline %

Definition Health develops across a lifetime influenced by factors that may improve or diminish health%

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Life course theory (LCT) posits that health is influenced by social, economic, and environmental factors across a lifespan that, when applied to a population level, may contribute to our understanding of why health disparities among vulnerable populations persist6-8. A lifetime of socioeconomic disparities exacerbates health risks with exposure to an increasing number of risk factors and decreasing number of protective factors at critical and sensitive periods in an individual’s life as well as across generations8-12. From the life course perspective:

Breastfeeding is simultaneously a risk reduction and a health promotion strategy Life course goals: - Optimize health across the lifespan for all people - Eliminate health disparities across populations %

Timing%

BACKGROUND

Strong evidence supports the association of breastfeeding with improved health outcomes across the lifespan for both the mother and her child1-5.

Longitudinal intervention: -  Bi-generationally (mother and child) -  Extends across multiple life stages

Strategic integration of breastfeeding support and promotion into every level of the maternal and child health pyramid

Direct Health Care Services: ! Case Managers provide health education on breastfeeding and support to pregnant and postpartum women!

Vertical intervention: -  Maximize provider (case manager) role to enhance linkages with specialized services and community partners in lactation and support, from prevention to treatment

Describe how each LCT concept was integrated into the design of an infant feeding strategy for low-income minority women and infants. Present how breastfeeding can be strategically planned into program activities at each level of the Maternal and Child Health (MCH) pyramid.

Application to an Infant Feeding Strategy

MATERNAL CHILD HEALTH PYRAMID

Environment%

Equity%

Adverse events during critical periods of biological development have greater impact due to vulnerable nature of the life stage (i.e. In utero, infancy, early childhood, puberty, pregnancy)%

Enhance supports to maximize benefits of breastfeeding during infancy: Critical Breastfeeding Periods - Prior to delivery -  24 – 48 hours postpartum (in hospital) -  1 week postpartum (in home) -  2 weeks postpartum (phone support)

Environmental factors influence health and development of individuals and populations %

Horizontal intervention: -  Build provider capacity to address environmental factors that influence breastfeeding success (use Infant Feeding Plan) -  Enhance provider capacity to provide and follow through with community based referrals

Disparities in life circumstances lead to disparities in health %

Population and System-level changes: -  Maximize access to information across a lifetime in support of breastfeeding -  Maximize supports and resources to populations with limited financial resources, low health literacy levels, and limited English proficiency

REFERENCES 1. León-Cava N, Pan American Health Organization. Food and Nutrition Program, LINKAGES Project. Quantifying the benefits of breastfeeding: A summary of the evidence. Food and Nutrition Program, Pan American Health Organization; 2002. 2. Kong SKF, Lee DTF. Factors influencing decision to breastfeed. Journal of Advanced Nursing. 2004;46(4):369-379. 3. Ip S, Chung M, Raman G, Trikalinos TA, Lau J. A summary of the agency for healthcare research and quality's evidence report on breastfeeding in developed countries. Breastfeeding Medicine. 2009;4(S1):17-30. 4. McLeod D, Pullon S, Cookson T. Factors influencing continuation of breastfeeding in a cohort of women. Journal of Human Lactation. 2002;18(4):335. 5. Gartner LM, Morton J, Lawrence RA, et al. Breastfeeding and the use of human milk. 6. Kotelchuck M, Amy F, eds. Rethinking MCH: The life course model as an organizing framework (concept paper). U.S. Department of Health and Human Services, Health Resources and Services Administration; 2010. 7. Halfon N, Hochstein M. Life course health development: An integrated framework for developing health, policy, and research. Milbank Quarterly. 2002;80(3):433-479. 8. Lu MC, Halfon N. Racial and ethnic disparities in birth outcomes: A life-course perspective. Maternal and Child Health Journal. 2003;7(1):13-30. 9. Brunner E, Marmot M. Social organization, stress, and health. In: Marmot M. and Wilkinson R. (eds.), Social determinants of health. Oxford University Press, Oxford. 1999;2:6-30. 10. Hertzman C. The lifelong impact of childhood experiences: A population health perspective. Daedalus. 1994;123(4):167-180. 11. Hertzman C, Power C, Matthews S, Manor O. Using an interactive framework of society and lifecourse to explain self-rated health in early adulthood. Social Science & Medicine. 2001;53(12):1575-1585. 12. Kuh D, Ben-Shlomo Y. A life course approach to chronic disease epidemiology. Vol 2. Oxford University Press, USA; 2004.%

Enabling Services: ! Coordination of care and services including referrals to WIC, housing, lactation specialist, local breastfeeding groups!

Population-Based Services: ! Target breastfeeding promotion to high risk communities including pregnant and postpartum women, partners, and family supports! Infrastructure Building Services: Provide ongoing training to build case manager capacity to promote breastfeeding, conduct quality improvement initiatives to enhance breastfeeding services, establish policies to integrate and prioritize breastfeeding into standard of care, improve quality of breastfeeding data information systems

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LCT is a framework to integrate breastfeeding as an intervention that optimizes health across the lifespan for all people, particularly vulnerable populations, and contributes to the elimination of health disparities. However, breastfeeding remains relatively low across all U.S. populations and most significantly among Black women and children. MCH programs can strengthen impact and quality of services by prioritizing the promotion of breastfeeding as an approach to reduce risk and promote protective factors, especially among highrisk populations. CONTACT Elaine L. Fitzgerald, DrPH, MIA, CLC Boston University School of Public Health Community Health Sciences [email protected] %