Breastfeeding Appraisal

The researchers followed earlier study leads by equaling initiation of breastfeeding and formula fed exclusively to equal 1. Along with analyzing other breastfeeding durations including months spent breastfeeding before formula and age child received first formula fed. Also concluded from the earlier studies what maternal and household characteristics encourage the action of breastfeeding and differences in geographic campaign on breastfeeding promotion. The researchers “Control variables included child sex, race, and ethnicity; mother’s age, education, and marital status; and household participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (ever) and number of children” (Gurley-Calvez, Bullinder, & Kapinos,

2018, p. 278). This is appropriate because it would allow Gurley-Calvez, Bullinder, and Kapinos to see if there were any trends in the variables that showed more or less of a breastfeeding duration.
Results
In order to get the results the researchers obtained they appropriately analyze data using a regression-adjusted difference- in- difference test for pre and post periods of the ACA 2012 policy change. It measures data from a natural experiments control group (Medicaid mothers and children) and treatment group (privately insured mothers and children) before an intervention (before the policy change) and after the intervention (after the policy change). Meaning they analyzed the differences before and after the ACA 2012 policy change between privately insured and Medicaid insured mothers and children. Analysis of when breastfeeding was initiated and at what age, how many months, and first formula fed. This method was appropriate to use because the researchers wanted to see the difference between how many mother and children privately insured and Medicaid breast-fed before and after the ACA policy change in 2012.
The regression-adjusted test shows summary statistics through percentage and means in Table 1. No p-value is seen in Table 1. Table 1 clearly presented, “Privately insured mothers were more likely to report ever breastfeeding (84%) than were Medicaid mothers (69%)” (Gurley-Calvez, Bullinder, & Kapinos, 2018, p. 279). Researchers would conclude that mothers with private insurance were also found to have breast fed two months longer, initiated formula later, and fed less formula than those with Medicaid insurance.
Table 2 clearly displays the first differences and the difference-in-difference evaluations for all the results pre and post periods of the ACA 2012 policy change. A large increase in breastfeeding initiation was seen with both groups post policy change but Medicaid was slightly greater of an increase, which is statistically significant because Medicaid mother and children didn’t report breastfeeding as much as privately insured mother and children, as seen in Table 1. Researchers concluded that about 0.83 additional months were spent by privately insured mothers and children in the post period, and was statistically significant (P=.001), time after the ACA 2012 policy change. However, Medicaid mother and children during breastfeeding duration post period was only 0.26 months, not as significant (with no p-value stated). Inclusive, Medicaid and privately insured mother and children went up 0.74 months in duration of breastfeeding.
In addition, the researchers added a Table 3 with suggested results with mothers covered with Medicaid in states that expanded Medicaid to be affected by the ACA 2012 policy change. Not all states with Medicaid mandated to the ACA 2012 policy change at that time but if they did the results in Table 3 would’ve resulted in more of the control group (Medicaid mother and children) having access to the lactation devices resulting in a better outcome of an increase in breastfeeding rates. The additional states would have given an effect of an additional 0.80 months in duration of breastfeeding, much larger impact than Table 2 of 0.74 additional months.
Overall, the regression-adjusted difference-in-difference test was a powerful analytic method to use.

The analysis helped the control and treatment group find means and percentage differences between the Medicaid and privately insured mothers and children before and after the ACA 2012 policy change. All values were analyzed and interpreted to find if the policy changed helped increase breastfeeding rates and duration. Findings were all adequately summarized, along with mentioning whether the values were statistically significant or nonsignificant to the study’s research. The findings from this study were reported to correlate with other studies experimenting the effects of interventions on promoting breastfeeding. As well as, addressing the results to the same study and gave sufficient information needed for evidence-based practice. After reviewing the results from the study on, Effectiveness of primary-care based interventions to promote breastfeeding: Systemic evidence review and meta-analysis for the U.S. preventive services task force, Gurley-Calvez et al. (2018) concluded from the meta-analysis of that study in comparison to their study that, “breastfeeding-support services increased breastfeeding duration by 8 to 11 percentage points” (p. 280). The ACA 2012 policy change did help increase the duration of breastfeeding, which is what the researchers were motivated to

see.
Discussion
All major findings were interpreted and discussed within the context of the study’s conceptual framework.

It was correctly concluded that with the ACA 2012 policy change, that implements coverage on lactation support services for Medicaid and privately insured mothers and children, helped increased both the number of months spent breastfeeding and just breastfeeding with no formula. According to Gurley-Calvez, Bullinder, and Kapinos (2018), the rate increased from 0.57 to 0.74 months, seen as being clinically significant towards the goal of the ACA policy change (p. 280). This justifies a causal inference that the supports of a no cost lactation devices help prolong the duration of breastfeeding. Limitations didn’t bias nor impact the internal findings of the study. The only limitations identified were the researchers not knowing the type of birth the mother had, small age group of 19 to 23 month old children, and the insurance the mothers had before the ACA policy change. However, these limitations did not significantly affect the results. The findings cannot be generalized to all people because sample included only Medicaid and privately insured mother and children in 25 states such as Michigan, New York, California, Washington, just to name a

few.
The researchers indicated that although most direct levels of intervention of breastfeeding initiations are in the hospital that federal and state insurances are beginning to become a complimentary alterative to initiation of breastfeeding as well. The study on, Breastfeeding support and early cessation, express that the insurances giving access to mothers for lactation devices whether it be because the mother wants to go back to work, latch problems, pain, or insufficient milk supply has been a major impact in helping mothers breastfeed longer (Lewallen, Dick, Flowers, & et al., 2006, p. 166-172).
General Issues
This report was overall well written and organized. It expressed significant and nonsignificant findings in ample detail to get the point across. It would have been nice to have an abstract in the beginning with the introduction to have more of baseline of what the report was about before having to read completely through it. The reports findings could be accessible to practicing nurses who are looking for studies that prove that lactation devices help improve the length of breastfeeding time.
The researchers have confidence in their findings that the ACA 2012 policy change had help prolong the length of breastfeeding. However, Gurley-Calvez, Bullinder, and Kapinos (2018), do believe they should have extended the age group used to observe more of the full breastfeeding duration of older toddlers (p. 282). I do have confidence in the truth-value I believe that the age group chosen could not have caused a bias during the studies results. The age group 19 to 23 months was an appropriate age because they’re at an age where breastfeeding and formula feeding were most likely introduced to the child. This age group allowed the mother’s answering the survey questions give a true answer of when they started breastfeeding, how long, and if/when they started formula feeding.
The study does contribute meaningful evidence that can be used in nursing practice. It emphasizes the benefits that insurance does give to mothers if they have difficulty breastfeeding or don’t have the time to. The lactation devices help prolongs the length of breastfeeding for the working mother but give the benefits of the nutrients to the growing child. The longer a mother breastfeeds the better a child health outcomes will be and this study shows that ACA 2012 policy change was the right federal state decision to make to help mothers get access to the lactation devices. Overall, the policy change help provide longer duration of breastfeeding to the child even as the mother worked in the work force.