By Harumi Reis-Reilly, MS, LDN, IBCLC, and Nikia Fuller-Sankofa, MPH, MPA
National Breastfeeding Month’s purpose is to bring awareness to breastfeeding as a powerful public health intervention, and the need for increased promotion, protection, and support of breastfeeding. Despite overall increases in breastfeeding rates as shown in the most recent years of the Centers for Disease Control and Prevention’s (CDC) National Immunization Surveys, there is an unjust, persistent race-based gap between white and black babies’ breastfeeding initiation rates. For instance, among infants born during 2010–2013, the breastfeeding initiation rates between black and white infants had a 17.2% difference. The gap for the 12-month breastfeeding mark between white and black babies increased from 9.7% among infants born during 2003–2006, to 13.7% among infants born during 2010–2013 (Anstey, 2017). Likewise, babies born from low-income mothers also experienced lower overall rates of breastfeeding than higher income babies (CDC, 2017). These inequities place these socially disadvantaged women and babies at higher risk for poor postnatal outcomes and chronic conditions, and may as well be a substantial contributor to the beginning of lifelong health inequities. (Johnson, 2015).
Why are there disparities?
These inequities can be attributed to several factors highlighted in the Surgeon General’s Call to Action to Breastfeeding (2011), including lack of breastfeeding knowledge, unsupportive providers, unsupportive cultural and social norms, poor family and social support, unsupportive workplace and childcare environments, and aggressive infant formula advertisements.
Furthermore, black and low-income mothers are disproportionately affected by unsupportive policies and systems that affect their ability to breastfeed. They usually experience additional structural barriers, such as early return to work into workplaces unsupportive of breastfeeding and the lack of access to high-quality lactation support services in the community. It includes limited access to birthing facilities with evidence-based breastfeeding practices and access to trained lactation support providers in the community. In addition, low-income women encounter obstacles related to time constraints juggling multiple priorities to meet basic needs, transportation, and financial capacity to pay for breastfeeding supplies and support, which often results in sub-optimal or no lactation care.
What can community-level organizations do to help reduce these disparities?
Local-level organizations such as local health departments (LHD) and community-based organizations (CBOs) have connections within their communities and are likely to be experienced in service delivery; therefore, these agencies are uniquely positioned to promote breastfeeding and provide support services in the community. In designing programs to increase access to skilled lactation support, service providers need to ensure that breastfeeding support services are consistent, frequent, and predictable, and not offered reactively, in which women are responsible for initiating the contact. Support should be tailored to the specific needs of the population group served.
What has NACCHO done to promote, protect, and support breastfeeding?
During NACCHO’s Reducing Breastfeeding Disparities through Peer and Professional Support Project, 72 grantee organizations provided over 72,000 supportive encounters with families, and helped to create over 3,000 support groups. To achieve this, they used several strategies to enable program accessibility such as providing transportation, incentives, food, and childcare, as well as integrating and co-location lactation support services at one convenient location, so families have a one-stop shop, instead of having to attend multiple programs in different locations. In addition, organizations created some systemic changes in organizational policies, systems, and within the environment to ensure continuous, sustainable access to services.
For more lessons learned, barriers, facilitators, and stories of the projects, access the free journal articles in the Social Justice Issue of the Journal of Human Lactation.
“Breastfeeding in the Community: Sharing Stories on Implementations That Work,” highlights the work of 19 project grantees.
In “Breastfeeding in the Community: Addressing Disparities Through Policy, Systems, and Environmental Changes Interventions,” the authors share practice-oriented strategies for agencies seeking to implement community-level breastfeeding interventions through public health policy, systems, and environmental change approaches.