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Keenan-Devlin LS, Smart BP, Hirschhorn L, Meier P, Jefferson U, Solomonides A, Wang CE, Handler A, Silver RK, Borders AEB. Clinically Integrated Breastfeeding Peer Counseling to Promote Breastfeeding Equity. Am J Perinatol 2024; 41:e2313-e2325. [PMID: 37494586 DOI: 10.1055/s-0043-1771255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
OBJECTIVE This study aimed to determine whether clinically integrated Breastfeeding Peer Counseling (ci-BPC) added to usual lactation care reduces disparities in breastfeeding intensity and duration for Black and Hispanic/Latine participants. STUDY DESIGN This study is a pragmatic, randomized control trial (RCT) of ci-BPC care at two ci-BPC-naïve obstetrical hospital facilities in the greater Chicago area. Participants will include 720 patients delivering at Hospital Site 1 and Hospital Site 2 who will be recruited from eight prenatal care sites during midpregnancy. Participants must be English or Spanish speaking, planning to parent their child, and have no exposure to ci-BPC care prior to enrollment. Randomization will be stratified by race and ethnicity to create three analytic groups: Black, Hispanic/Latine, and other races. RESULTS The primary outcome will be breastfeeding duration. Additional outcomes will include the proportion of breastmilk feeds during the delivery admission, at 6-week postdelivery, and at 6-month postdelivery. A process evaluation will be conducted to understand implementation outcomes, facilitators, and barriers to inform replication and scaling of the innovative ci-BPC model. CONCLUSION This research will produce findings of relevance to perinatal patients and their families, the vast majority of whom desire to provide breastmilk to their infants and require support to succeed with their feeding goals. As the largest RCT of ci-BPC in the United States to date, this research will improve the quality of evidence available regarding the effectiveness of ci-BPC at reducing disparities. These findings will help patients and stakeholders determine the benefits of accepting and adopting the program and inform policies focused on improving perinatal care and reducing maternal/child health disparities. This study is registered with Clinical Trial (identifier: NCT05441709). KEY POINTS · Ci-BPC can promote racial breastfeeding equity.. · Ci-BPC has not been tested as a generalized lactation strategy in prior trials and is underused.. · This RCT will identify if ci-BPC can reduce breastfeeding disparities for Black and Hispanic patients..
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Affiliation(s)
- Lauren S Keenan-Devlin
- Department of Obstetrics and Gynecology NorthShore University HealthSystem, Evanston, Illinois
- Department of Obstetrics and Gynecology, University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | - Britney P Smart
- Department of Obstetrics and Gynecology NorthShore University HealthSystem, Evanston, Illinois
| | - Lisa Hirschhorn
- Medical and Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Paula Meier
- Department of Women, Children and Family Nursing, Rush University College of Nursing, Chicago, Illinois
| | - Urmeka Jefferson
- Department of Women, Children and Family Nursing, Rush University College of Nursing, Chicago, Illinois
| | | | - Chi Ed Wang
- Research Institute, NorthShore University HealthSystem, Evanston, Illinois
| | - Arden Handler
- Community and Health Sciences, University of Illinois Chicago School of Public Health, Chicago, Illinois
| | - Richard K Silver
- Department of Obstetrics and Gynecology NorthShore University HealthSystem, Evanston, Illinois
- Department of Obstetrics and Gynecology, University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | - Ann E B Borders
- Department of Obstetrics and Gynecology NorthShore University HealthSystem, Evanston, Illinois
- Department of Obstetrics and Gynecology, University of Chicago Pritzker School of Medicine, Chicago, Illinois
- Institute for Public Health and Medicine, Northwestern University Center for Healthcare Studies, Chicago, Illinois
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Awosemusi Y, Keenan-Devlin L, Martinez NG, Yee LM, Borders AEB. The role of clinic-based breastfeeding peer counseling on breastfeeding rates among low-income patients. BMC Pregnancy Childbirth 2024; 24:312. [PMID: 38664768 PMCID: PMC11044488 DOI: 10.1186/s12884-024-06395-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 03/05/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Despite the benefits of breastfeeding (BF), rates remain lower than public health targets, particularly among low-income Black populations. Community-based breastfeeding peer counselor (BPC) programs have been shown to increase BF. We sought to examine whether implementation of a BPC program in an obstetric clinical setting serving low-income patients was associated with improved BF initiation and exclusivity. METHODS This is a quasi-experimental time series study of pregnant and postpartum patients receiving care before and after implementation of a BPC program in a teaching hospital affiliated prenatal clinic. The role of the BPC staff included BF classes, prenatal counseling and postnatal support, including in-hospital assistance and phone triage after discharge. Records were reviewed at each of 3 time points: immediately before the hire of the BPC staff (2008), 1-year post-implementation (2009), and 5 years post-implementation (2014). The primary outcomes were rates of breastfeeding initiation and exclusivity prior to hospital discharge, secondary outcomes included whether infants received all or mostly breastmilk during inpatient admission and by 6 weeks post-delivery. Bivariable and multivariable analyses were utilized as appropriate. RESULTS Of 302 patients included, 52.3% identified as non-Hispanic Black and 99% had Medicaid-funded prenatal care. While there was no improvement in rates of BF initiation, exclusive BF during the postpartum hospitalization improved during the 3 distinct time points examined, increasing from 13.7% in 2008 to 32% in 2014 (2009 aOR 2.48, 95%CI 1.13-5.43; 2014 aOR 1.82, 95%CI 1.24-2.65). This finding was driven by improved exclusive BF for patients who identified as Black (9.4% in 2008, 22.9% in 2009, and 37.9% in 2014, p = 0.01). CONCLUSION Inpatient BF exclusivity significantly increased with the tenure of a BPC program in a low-income clinical setting. These findings demonstrate that a BPC program can be a particularly effective method to address BF disparities among low-income Black populations.
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Affiliation(s)
- Yetunde Awosemusi
- Women's Health of Las Colinas, Medical City Healthcare, 6750 N MacArthur Blvd, Suite 100, Irving, TX, 75039, USA.
| | - Lauren Keenan-Devlin
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, 2650 Ridge Ave, Walgreen Building Suite 1507, Evanston, IL, 60201, USA
- Department of Obstetrics and Gynecology, University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Noelle Griffin Martinez
- Department of Family and Community Medicine, University of California San Francisco, 995 Potrero Avenue Ward 83, San Francisco, CA, 94110, USA
| | - Lynn M Yee
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, 250 E. Superior St, Suite 5-2145, Chicago, IL, 60611, USA
| | - Ann E B Borders
- Department of Obstetrics and Gynecology, NorthShore University HealthSystem, 2650 Ridge Ave, Walgreen Building Suite 1507, Evanston, IL, 60201, USA
- Department of Obstetrics and Gynecology, University of Chicago Pritzker School of Medicine, Chicago, IL, USA
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Rhodes EC, Zahid M, Abuwala N, Damio G, LaPlant HW, Crummett C, Surprenant R, Pérez-Escamilla R. Experiences of breastfeeding peer counseling among women with low incomes in the US: a qualitative evaluation. BMC Pregnancy Childbirth 2024; 24:120. [PMID: 38336607 PMCID: PMC10854050 DOI: 10.1186/s12884-023-06213-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 12/17/2023] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Person-centered breastfeeding counseling is a key but often overlooked aspect of high-quality services. We explored women's experiences of the Breastfeeding Heritage and Pride™ program, an evidence-based breastfeeding peer counseling program serving women with low incomes in the United States. METHODS This study was conducted through an equitable community-clinical-academic partnership and guided by the World Health Organization (WHO) quality of care framework for maternal and newborn health, which highlights three domains of positive experiences of care: effective communication; respect and dignity; and emotional support. In-depth interviews were conducted with a purposive sample of women participating in the Breastfeeding Heritage and Pride™ program. Women were asked to describe their experiences with the program including examples of when good quality counseling was or was not provided. Each interview was conducted in English or Spanish, audio-recorded, and transcribed verbatim. Data were analyzed using reflexive thematic analysis. Once themes were generated, they were organized according to the three care experience domains in the WHO quality of care framework. RESULTS Twenty-eight in-depth interviews were conducted with a racially/ethnically and socio-economically diverse sample of women. Three themes described effective communication practices of peer counselors: tailoring communication to meet women's individual needs; offering comprehensive and honest information about infant feeding; and being timely, proactive, and responsive in all communications across the maternity care continuum. Two themes captured why women felt respected. First, peer counselors were respectful in their interactions with women; they were courteous, patient, and non-judgmental and respected women's infant feeding decisions. Second, peer counselors showed genuine interest in the well-being of women and their families, beyond breastfeeding. The key theme related to emotional support explored ways in which peer counselors offered encouragement to women, namely by affirming women's efforts to breastfeed and by providing reassurance that alleviated their worries about breastfeeding. These positive experiences of counseling were appreciated by women. CONCLUSIONS Women described having and valuing positive experiences in their interactions with peer counselors. Efforts to expand access to high-quality, person-centered breastfeeding counseling should, as part of quality assurance, include women's feedback on their experiences of these services.
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Affiliation(s)
- Elizabeth C Rhodes
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA, 30322, USA.
- Yale School of Public Health, 135 College Street, New Haven, CT, 06510, USA.
| | - Mahrukh Zahid
- Yale School of Public Health, 135 College Street, New Haven, CT, 06510, USA
| | - Nafeesa Abuwala
- Yale School of Public Health, 135 College Street, New Haven, CT, 06510, USA
| | - Grace Damio
- Hispanic Health Council, 175 Main Street, Hartford, CT, 06106, USA
| | | | - Carrianne Crummett
- Saint Francis Hospital and Medical Center, Trinity Health Of New England, 114 Woodland Street, Hartford, CT, 06105, USA
| | - Rebecca Surprenant
- Saint Francis Hospital and Medical Center, Trinity Health Of New England, 114 Woodland Street, Hartford, CT, 06105, USA
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Diaz LE, Yee LM, Feinglass J. Rates of breastfeeding initiation and duration in the United States: data insights from the 2016-2019 Pregnancy Risk Assessment Monitoring System. Front Public Health 2023; 11:1256432. [PMID: 38192551 PMCID: PMC10773697 DOI: 10.3389/fpubh.2023.1256432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 12/04/2023] [Indexed: 01/10/2024] Open
Abstract
Introduction While breastfeeding rates in the United States have been increasing, they remain low by international standards with substantial racial, income and education disparities. This study uses recent population-based data to analyze sociodemographic differences in breastfeeding initiation, duration, and exposure to information and education. Methods We used the 2016-2019 Pregnancy Risk Assessment Monitoring System (PRAMS) to compare breastfeeding duration among a representative population from 43 states and the District of Columbia. We modeled the likelihood of never initiating breastfeeding by respondent's age, race and ethnicity, language, marital status, household income, educational attainment, parity and insurance status. We also compared sources of information and education for respondents who never breastfed to those who breastfed up to 6 months. Results Among 142,643 new mother respondents, representing an estimated population of 7,426,725 birthing individuals, 12.6% never breastfed, 60.4% reported breastfeeding at 3 months and 54.7% at 6 months. While 75.8% of college graduates reported breastfeeding at 3 months, this was only 37.8% of respondents with high school or less. Among those with the lowest six-month rates were non-Hispanic Black participants (36.3%) and those age < 20 (25.5%). Respondents with Medicaid coverage for their delivery were 25% more likely to have never breastfed than the privately insured. Respondents reporting household income <$20,000 were 57% more likely to have never breastfed as compared to those with household income>$85,000. While 64.1% of those breastfeeding at 6 months reported receiving information from "my" doctor', this was only 13.0% of those who never breastfeed. Discussion Improved breastfeeding rates could have significant effects on reducing health disparities in the United States. Clinical and public health policy initiatives need to include culturally sensitive breastfeeding education before and after childbirth, with psychological and direct support from obstetrics and primary care providers. Health plans should support home and community-based in-person and telelactation consulting services. Public policies such as paid family and medical leave and workplace accommodations will also be critical. Given the huge implications of breastfeeding rates on the development of infant immune defenses and a healthy microbiome, improving breastfeeding rates should be a much more important public health priority in the United States.
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Affiliation(s)
- Laura E. Diaz
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Lynn M. Yee
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Joe Feinglass
- Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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