The Problem
Breastfeeding is widely known as the preferred method for feeding infants. While breastfeeding rates have increased in recent decades, they remain below recommendations set by the American Academy of Pediatrics and other health organizations, in particular when it comes to duration and exclusivity (Oliveira, 2019). It has been said that over 800,000 yearly deaths of children under five globally could be prevented if ideal breastfeeding practices were carried out (Dennis et al., 2019). The benefits of breastfeeding are widespread, for both mothers and infants. Breastfeeding can help improve women’s negative health outcomes, which disproportionately affect minority women (Jones et al., 2015). For example, breastfeeding can help lower risk of type 2 diabetes, hypertension, hyperlipidemia, and cardiovascular disease (Jones et al., 2015). Women who breastfeed are also more likely to lose weight after the birth of their child, compared to women who formula-feed. This is particularly important for African American and Hispanic women, as those communities tend to have higher rates of overweight and obesity, which can lead to additional health problems (Jones et al., 2015). Women who do not breastfeed are also at a higher risk of breast and ovarian cancer (Stuebe, 2009). Benefits for the baby include lowered risk of obesity during childhood and defense against infections through protective factors present in breast milk (Jones et al., 2015; Stuebe, 2009).
The Priority Population
However, there are many obstacles that women experience, which can have negative effects on breastfeeding rates. These are even more pronounced for low-income, minority mothers. Young, low-income, African American, unmarried, and less educated mothers tend to be most at-risk for lower rates of breastfeeding (Jones et al., 2015). Having to return to employment, inconvenience, embarrassment, and more make breastfeeding particularly difficult for this group. Less flexible work hours are another barrier, which make nursing and pumping much more difficult (Santhanam, 2019). Additionally, there may be a lack of social support and language or literacy barriers among this population (Jones et al., 2015). All in all, pregnant, low-income, minority mothers, and their infants, are at a higher risk for negative health outcomes because they are less likely to breastfeed. Because this group is more at-risk, this program will focus on pregnant, low-income, minority women to help reduce this gap. The program will partner with a local WIC chapter in New York City in order to recruit women to participate in the program. Length of breastfeeding among participants of WIC is lower than non-participants, indicating that they may be appropriate candidates for this intervention. Even though WIC promotes breastfeeding messaging, they offer free formula which may undermine that messaging (Dieterich, 2013). As such, they may be motivated to partner with Fed for the Future to increase breastfeeding rates as this is one of their goals.
The Solution
This program, called Fed for the Future, will aim to increase breastfeeding rates and length of breastfeeding through in-person lessons, which will include lectures, videos, group discussions, and more, combined with postpartum telephone support, to help lower barriers to breastfeeding and increase self-efficacy. The program will be led by myself, a Nutrition Education Specialist, and a lactation consultant and will take place at the Eastside Chinatown WIC facility in New York City. The program will happen at 24-28 weeks of pregnancy and consist of 4 weeks of lessons (one per week), with telephone follow-ups with the lactation consultant at 2 weeks and 3 months postpartum. Week 1’s lesson will consist of a general overview: benefits of breastfeeding, how-to breastfeed and infant cues, and a DVD showing breastfeeding mother’s testimonies. Week 2 will focus on tips and tricks: positioning and attachment, pumping, and nutrition to support adequate milk supply. Week 3 will be a group discussion around common barriers to breastfeeding (i.e. returning to work), misunderstandings/misconceptions, and how to overcome these. Finally, week 4 will focus on social support. Participants will be joined by their partners, a family member, or friend, etc. so they can learn how to best support the breastfeeding mother – thus, addressing multiple levels of influence. Additionally, online resources will be provided to the participants so they can access information at home, outside of program hours. As a result, we would expect to see breastfeeding rates and length of breastfeeding increase among this population.
Benefits
There are many benefits to breastfeeding for both mother and baby, as listed above. However, there are also many societal benefits, including environmental advantages since breastfeeding requires no packaging and does not create pollution, therefore less waste. Additionally, there are cost savings for the government and families through lowered healthcare, health services, and medical expenses since breast-fed babies are less likely to need medical care. Similarly, there are insurance savings for parents and employers. There is lowered absenteeism at work as a result of lowered incidence of children’s illnesses, leading to increased productivity. Food expenses are also lowered since breastfeeding replaces formula. This equates to a savings between $800-$1,200 per year for one child’s family (The Mother and Child Health and Education Trust, 2016).
Estimates based on 90% of infants being exclusively breastfed for the first 6 months of their lives indicate a possible savings of at least $111.6 million in Federal Medicaid as a result of the health benefits associated with breastfeeding. There would also be an estimated $9.1 billion in health-related cost savings through reductions in medical costs, nonmedical costs, and the costs of early death. This is due to reductions in maternal diseases and pediatric diseases (Oliveira, 2019).
Success of the Program
There are many similar interventions that saw success in this area, indicating this program will also be successful. For example, a meta-analysis showed increased rates of breastfeeding initiation among women who received education and support from healthcare professionals and non-healthcare professional counselors and support groups, compared to standard care (Balogun et al., 2016). Another meta-analysis found better breastfeeding outcomes for up to 6 months postpartum among mothers who received theory-based interventions, specifically focused on self-efficacy and planned behavior (Chipojola et al., 2020). As such, these theories will be incorporated into the program. It has also been found that interactive programs which include mothers in conversations are effective, so this will be a focus of the program as well (Hannula et al., 2008).
References
Balogun, O. O., O'Sullivan, E. J., McFadden, A., Ota, E., Gavine, A., Garner, C. D., Renfrew, M. J., & MacGillivray, S. (2016). Interventions for promoting the initiation of breastfeeding. The Cochrane Database of Systematic Reviews, 11(11), CD001688. https://doi.org/10.1002/14651858.CD001688.pub3
Chipojola, R., Chiu, H. Y., Huda, M. H., Lin, Y. M., & Kuo, S. Y. (2020). Effectiveness of theory-based educational interventions on breastfeeding self-efficacy and exclusive breastfeeding: A systematic review and meta-analysis. International Journal of Nursing Studies, 109, 103675.
Dennis, C. L., Shiri, R., Brown, H. K., Santos Jr, H. P., Schmied, V., & Falah‐Hassani, K. (2019). Breastfeeding rates in immigrant and non‐immigrant women: A systematic review and meta‐analysis. Maternal & Child Nutrition, 15(3), e12809.
Dieterich, C. M., Felice, J. P., O'Sullivan, E., & Rasmussen, K. M. (2013). Breastfeeding and health outcomes for the mother-infant dyad. Pediatric Clinics of North America, 60(1), 31–48. https://doi.org/10.1016/j.pcl.2012.09.010
Hannula, L., Kaunonen, M., & Tarkka, M. T. (2008). A systematic review of professional support interventions for breastfeeding. Journal of Clinical Nursing, 17(9), 1132-1143.
Jones, K. M., Power, M. L., Queenan, J. T., & Schulkin, J. (2015). Racial and ethnic disparities in breastfeeding. Breastfeeding Medicine: The Official Journal of the Academy of Breastfeeding Medicine, 10(4), 186–196. https://doi.org/10.1089/bfm.2014.0152
Oliveira, V., Prell, M., & Cheng, X. (2019). The economic impacts of breastfeeding: A focus on USDA’s Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Economic Research Service, 261.
Santhanam, L. (2019, August 30). Racial disparities persist for breastfeeding moms. Here's why. PBS. Retrieved February 28, 2023, from https://www.pbs.org/newshour/health/racial-disparities-persist-for-breastfeeding-moms-heres-why#:~:text=Black%20women%20breastfeed%20their%20babies,breastfeed%20her%20child%2C%20experts%20said.
Stuebe A. (2009). The risks of not breastfeeding for mothers and infants. Reviews in Obstetrics & Gynecology, 2(4), 222–231.
The Mother and Child Health and Education Trust. (2016, June 16). Benefits of Breastfeeding for the Environment and Society. Ten Steps to Successful Breastfeeding. Retrieved March 14, 2023, from http://www.tensteps.org/benefits-of-breastfeeding-for-the-environment-society.shtml