A 50-Year Commitment to American Indian and Alaska Native Women.

Since 1970, the American College of Obstetricians and Gynecologists' Committee on American Indian and Alaska Native Women's Health has partnered with the Indian Health Service and health care facilities serving Native American women to improve quality of care in both rural and urban settings. Needs assessments have included formal surveys, expert panels, consensus conferences, and onsite program reviews. Improved care has been achieved through continuing professional education, recruitment of volunteer obstetrician-gynecologists, advocacy, and close collaboration at the local and national levels. The inclusive and multifaceted approach of this program should provide an effective model for collaborations between specialty societies and health care professionals providing primary care services that can reduce health disparities in underserved populations.

The effort to increase breast-feeding. Do obstetricians, in the forefront, need help?

OBJECTIVE: To assess the knowledge, training and attitudes of obstetricians concerning management of breast-feeding. STUDY DESIGN: A survey was sent to 1,200 fellows of the American College of Obstetricians and Gynecologists; 397 practicing obstetricians responded. RESULTS: Obstetricians who were satisfied with their patients' behavior (69.5%) estimated that on average > 70% of their patients planned to breast-feed, while those who were unsatisfied (21.4%) estimated that < 60% of their patients planned to breast-feed. African American race and eligibility for Medicaid both appear to predict low rates of breast-feeding among patients. Most physicians considered that they were very well qualified to treat mastitis, prescribe maternal medications and advise their patients regarding contraception. They were less certain of their qualifications regarding educating their patients about breast-feeding and aiding them in solving breast-feeding problems. Personal breast-feeding experience was a significant predictor of female physician confidence. Four of 10 physicians regarded their residency training as inadequate in terms of breast-feeding management. CONCLUSION: The perceptions of obstetricians regarding breast-feeding practices of their patients appear consistent with national surveys. Obstetricians consider counseling their patients and managing breast-feeding care to be important parts of their clinical responsibilities, but further training and educational materials are warranted.