Association of Insurance and Exclusive Breastfeeding Rates in the Immediate Postpartum Period [13K]
Authors: Mas Jade , Pardanani Setul 
Published: April 2018

INTRODUCTION:
According to the WHO, 38% of infants are exclusively breastfed. Numerous studies suggest benefits of breastfeeding for both mother and infant. For mothers, breastfeeding is associated with less perceived pain after delivery and confers reduced risks of ovarian cancer. For infants, breastfeeding has been linked to increased intelligence tests, lower incidence of obesity, type two diabetes, as well as reduced gut inflammation. At Stamford hospital, our bilingual Lactation Consultants perform daily rounds on all postpartum patients who are amenable to their services. According to quality metrics data collected by Lactation Consultants, patients who receive care at our resident clinic have lower exclusive breastfeeding rates as compared to private patients. While the socioeconomic status, parity, age and race are acknowledged as possible influences, this study aims to associate whether insurance type influences exclusive breastfeeding rates at the Stamford Hospital.

METHODS:
The Lactation Consultants collect deidentified breastfeeding data. This information includes delivery date, mode of delivery, whether infant was breastfed, formula fed, both breast and formula fed and whether infant was excluded from exclusive breastfeeding rates secondary to refusal of participation from mother or if infant was admitted to the ICU. For the purpose of this study, maternal information was collected from the hospital EMR using the medical record number of the infant from February 2016 to March 2017. Maternal information included type of insurance, ethnicity, parity prior to current delivery, whether infant was born term or preterm and to which obstetric practice the patient received care from at time of admission for labor.

RESULTS:
A total of 1,910 patients were included in the Lactation Consultation database. Mothers who gave birth to twins were only counted as one dataset. One hundred ten patients were either missing breastfeeding information or were missing maternal data and were excluded from the study. One hundred sixty patients were admitted to the NICU and were excluded from the study. A total of 1,640 were included in the study. There were 838 patients that were exclusively breastfeeding and 802 patients not exclusively breastfeeding. (174/577) 30.2% of Husky/Medicaid/Self Pay patient exclusively breastfed; (664/1,063) 62.5% of Private patients exclusively breastfed; (58/260) 22.3% of Clinic patients exclusively breastfed; (780/1,380) 56.5% of Private patients exclusively breastfed.

CONCLUSION:
Although other reasons for a difference in exclusive breastfeeding rates may include age, parity, and term versus preterm delivery, when solely based on whether patients have private health insurance, as opposed to Husky or Medicaid, there is a clear contrast. Patient who carry private insurance have an exclusive breastfeeding rate of 62.5% whereas patients who carry Husky or Medicaid have a 30.2% exclusive breastfeeding rate. The total number of patients with private insurance within each group correlated with total number of patients who exclusively breastfed within each group. This suggests that mothers who do not have private insurance, or who have Husky or Medicaid, may be less likely to exclusively breastfeed in the immediate postpartum period. This may suggest this population could benefit from intervention, i.e. counseling during prenatal visits. By identifying at risk groups, we can aim to decrease socioeconomic barriers and improve patient outcomes.