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Design and implementation of a citywide breastfeeding promotion program: the New York City approach.
FAMILY AND COMMUNITY HEALTH. 1990 Feb; 12(4):71-8.Breastfeeding has regained more popularity in the US since 1970, but there has been a definite disparity in its resurgence among minority, poor, and less educated mothers. This article outlines the history of breastfeeding prevalence in the US and New York City as an introduction to explaining the design and implementation of New York City's breastfeeding promotion program. In 1982, the Steering Committee to Promote Breastfeeding in New York City was generated and it designed task forces to address each of their defined barriers to breastfeeding promotion (e.g. lack of relevant data, centralized compilation, data analysis, health care professional education, inhibitory practices by hospitals and ambulatory services, public misinformation, and unsupportive public policy). The Research Task Force, Professional Education Task Force, Hospital Practices Task Group, Policy and Legislation Task Group, and Public Information Task Group were outlined and some policies, strategies, and practices they have enacted were described. Some of their accomplishments include: educational kits on breastfeeding for health care professionals, guidelines for work-site health and nutrition programs for pregnant and lactating workers, research on the economics of breastfeeding, breastfeeding information posters on the subway, and establishment in 1984 of a breastfeeding coordinator in each municipal hospital. These strategies demonstrate a successful model for breastfeeding promotion in large urban areas as seen by the rise in breastfeeding at the time of newborn discharge from New York City hospitals.
Journal of Social History. 1985 Spring; 18(3):399-411.The transition from resistance to acceptance of birth control in the US can be characterized as a 3 stage process, with each period facing its own issues and choices. The 1st stage -- the fight over birth control in the early 20th century -- has been documented by historians like James Reed, Linda Gordon, and David Kennedy. A 2nd stage, approximately the years from 1936-60, has not been fully explored although the period was crucial in shaping the current system of contraceptive health care. This discussion focuses on this transitional period, particularly its 1st decade, 1936-47. Physicians' attitudes, as revealed through American Medical Association (AMA) policy and a national survey conducted in 1947, are considered in relation to reported data on clinic and private practice. This evidence reveals that despite the liberalization of laws and public opinion in the mid-1930s, contraception did not become widely available until after 1960 -- the beginning of the 3rd stage in the history of American contraception -- and that the restriction of birth control information during the period was traceble in large part to the medical profession. Analysis of the 1936-47 decade, particularly with regard to the concerns of doctors, provides a framework for understanding the forces that affected contraceptive health care in the mid 20th century and suggests conditions that continue to shape the politics of birth control. In 1936, when the AMA's committee on contraception submitted its 1st report, it was clear that legal and public opinion had moved decisively toward more liberal attitudes concerning birth control. In 1937 the AMA passed a qualified endorsement of birth control, indicating that the organized medical profession as represented by the AMA held views on birth control at the beginning of the 2nd stage that were more conservative than those of most middle-class Americans. Its conservatism was challenged by lay groups who threatened to circumvent standard office practice if physicians failed to modify their views. Public opinion and behavior thus had a demonstrable effect on medical attitudes. 10 years after the AMA resolution a suvey found that more than 2/3 of physicians approved of contraception for any married women who requested it. The 1937-47 period witnessed 2 important changes in medical attitudes toward contraception: the profession's public, though cautious, endorsement of birth control; and the apparent adoption of liberalized standards for the prescription of contraceptive materials. The period also was a time of tremendous growth for the new birth control clinics that offered services to women who could not afford private care. Available evidence suggests that physicians' attitudes toward contraception, and particularly toward birth control clinics, were more important than either laws or public opinion in limiting the availability of those contraceptives considered most efficient (and most compatible with sexual pleasure) between 1936-60.
Family Planning Perspectives. 1983 Nov-Dec; 15(6):279-81.3 national and 2 statewide polls on abortion attitudes were conducted in the U.S. during 1983. 3 of the surveys show some increase in public approval of legal abortion. The Gallup Poll is 1 of these. It is based on interviews with 1558 men and women aged 18 and older in 300 US localities. Approval of abortion rose from 75 to 81% between 1981 and 1983; while the proportion who said abortion should be illegal in all circumstances declined from 21 to 16%. The California Poll--a survey of Californians 18 and older--found a considerably higher proportion approving of "allowing abortion when a mother desires it during the first 3 months of pregnancy" than the Gallup Poll (69% versus 50%). 30% said they disapprove (compared with 43% in the Gallup Poll). As length of gestation increases, however, approval declines. The Iowa poll--a telephone survey of randomly selected Iowans aged 18 or older--found that 89% believe that all or some abortions should be legal. This represents a slight increase from 83% when the question was last asked in 1978. The National Opinion Research Center, in its most recent survey of 1599 adults 18 or older, found that between 1982 and 1983 there was an average decline of 6.5 percentage points in public support for legal abortions. A national poll undertaken by Penn and Schoen for The Garth Analysis was conducted among 1010 registered voters. The sample was weighted to match the US electorate by age, income, and sex. It found that 57% of voters "oppose a constitutional amendment to prohibit almost all abortions." The proportion opposed to such an amendment had declined, however, from 67% a year earlier; the proportion favoring an antiabortion amendment has risen from 28 to 36%. A majority oppose the cutting off of public funding of abortions for poor women.
Demography. February 1970; 7(1):53-60.A survey of 134 adult women, in a small and isolated American community, living in a limited-income family housing project suggests that the view of continued population growth as a problem is more strongly held than the view that the couple has a responsibility to limit its fertility because of overpopulation. Concern with population growth is only loosely associated with acceptance of the attitude of individual responsibility. Among subgroups of respondents, Catholics were more likely to hold a negative attitude toward population growth than to possess the individual responsibility view. They exhibited a correlation between the 2 attitudes. Protestants were distinguished by no difference in or correlation between the acceptance of the 2 attitudes. A correlation between the attitudes was especially pronounced among Catholics with high achievement values. The author suggests that measures explicitly intended to control population growth probably cannot be adopted until there is a strong correlation between the 2 attitudes.(Author's, modified)