Using an equity lens in the implementation of interventions to protect, promote, and support optimal breastfeeding practices

Geodemographies of Breastfeeding Support

BACKGROUND

Mother-to-mother breastfeeding support organizations provide important information and guidance for helping mothers initiate and maintain breastfeeding, postpartum. However, the availability of this support is limited by a constellation of barriers, including race, culture, socioeconomic status, and geography.

RESEARCH AIMS

To identify the geodemographic composition of communities where breastfeeding support was available from the mother-to-mother support organizations Breastfeeding USA and La Leche League, identify underlying issues of equity, and highlight locations where more support resources may be needed.

METHODS

The locations of mother-to-mother support meetings were collected by ZIP code (N = 180) and were combined with a geodemographic database and exploratory spatial data analysis to explore the compositional characteristics of communities served (N = 1,173).

RESULTS

Significant gaps in the geographic distribution of breastfeeding support existed. While many metropolitan areas benefited from numerous mother-to-mother support groups and peer counselors, the geographic footprint of this support favored communities that were white, affluent, and suburban.

CONCLUSION

Spatial analytics combined with geodemographic analysis provide a unique perspective into the diverse landscape of mother-to-mother breastfeeding support groups at a local level. Our results highlighted inequities in the distribution of support provided and prescriptive guidance regarding where more resources may be needed.

Practice of breastfeeding in quilombola communities in the light of transcultural theory

OBJECTIVES

to identify factors that interfere with the practice of exclusive breastfeeding in quilombola communities.

METHODS

qualitative research based on the Transcultural Theory proposed by Madeleine Leininger, performed with quilombola mothers. For data collection, we used the semi-structured interview, conducted from June 2018 to January 2019. Content analysis was guided by the interactive model of Miles and Huberman.

RESULTS

it was revealed that intergenerational cultural myths and customs interfere with breastfeeding practice, and identified the influence of professional nurses on best breastfeeding practices.

FINAL CONSIDERATIONS

cultural and intergenerational factors favor early weaning and expose the child to illness.

Vulnerable mothers' experiences breastfeeding with an enhanced community lactation support program

The Canada Prenatal Nutrition Program (CPNP) provides a variety of health and nutrition supports to vulnerable mothers and strongly promotes breastfeeding but does not have a formal framework for postnatal lactation support. Breastfeeding duration and exclusivity rates in Canada fall well below global recommendations, particularly among socially and economically vulnerable women. We aimed to explore CPNP participant experiences with breastfeeding and with a novel community lactation support program in Toronto, Canada that included access to certified lactation consultants and an electric breast pump, if needed. Four semistructured focus groups and 21 individual interviews (n = 46 women) were conducted between September and December 2017. Data were analysed using inductive thematic analysis. Study participants reported a strong desire to breastfeed but a lack of preparation for breastfeeding‐associated challenges. Three main challenges were identified by study participants: physical (e.g., pain and low milk supply), practical (e.g., cost of breastfeeding support and maternal time pressures), and breastfeeding self‐efficacy (e.g., concern about milk supply and conflicting information). Mothers reported that the free lactation support helped to address breastfeeding challenges. In their view, the key element of success with the new program was the in‐home visit by the lactation consultant, who was highly skilled and provided care in a non‐judgmental manner. They reported this support would have been otherwise unavailable due to cost or travel logistics. This study suggests value in exploring the addition of postnatal lactation support to the well‐established national CPNP as a means to improve breastfeeding duration and exclusivity among vulnerable women.

Achieving Breastfeeding Equity: A Study of a National Breastfeeding Initiative

BACKGROUND

Equity in breastfeeding could reduce excess morbidity and mortality among children and mothers of color. Few programs that support breastfeeding have been evaluated for their capacity to create equity. The aim of this study was to assess the extent to which a diverse set of national breastfeeding programs actively promoted equity.

SUBJECTS AND METHODS

Qualitative data collection was conducted between December 2012 and July 2013 by visits to 29 of 58 breastfeeding programs selected by the funder. Programs underwent a site visit with open-ended interviews of staff. Investigators used Atlas.ti software to code data and content analysis of qualitative evaluation data. Key categories and themes were identified to answer the questions: how do the programs conceptualize equity? and how do the organizations operationalize an approach to equity?

RESULTS

Programs had widely divergent and often limited conceptualizations of equity. Nine categories describe the equity approaches' programs used. The social, political, and environmental contexts in which programs operated varied in the degree of challenge they pose for implementing equity-focused breastfeeding methods. We found only a few programs that matched the social, cultural, and economic realities and context of women of color.

CONCLUSIONS

Breastfeeding equity programs need to explicitly define and envision outcomes, and need to identify equity inhibiting policies and practices. Equity attainment is more likely to emerge from institutional transformational processes that collaborate with the populations at risk. These findings have implications for other programs addressing equity in health.

Using group model building to develop a culturally grounded model of breastfeeding for low-income African American women in the USA

AIMS AND OBJECTIVES

To identify barriers and supporting factors for breastfeeding, and the dynamic interactions between them, as identified by low-income African American women and lactation peer helpers.

BACKGROUND

Stark breastfeeding disparities exist between African American mothers and their White counterparts in the USA. This pattern is often replicated across the globe, with marginalised populations demonstrating decreased breastfeeding rates. While breastfeeding research focused on sociocultural factors for different populations has been conducted, a more dynamic model of the factors impacting breastfeeding may help identify effective leverage points for change.

DESIGN

Group model building was used as a grounded theoretical approach, to build and validate a model representing factors impacting breastfeeding and the relationships between them.

METHODS

Low-income African American women (n = 21) and lactation peer helpers (n = 3) were engaged in model building sessions to identify factors impacting breastfeeding. A two-cycle process was used for analysis, in vivo and axial coding. The final factors and model were validated with a subgroup of participants.

RESULTS

The participants generated 82 factors that make breastfeeding easier, and 86 factors that make breastfeeding more challenging. These were grouped into 10 and 14 themes, respectively. A final model was constructed identifying three domains impacting breastfeeding: a mother's return to work or school, her knowledge, support and persistence, and the social acceptance of breastfeeding.

CONCLUSIONS

This study documented the sociocultural context within which low-income African American women are situated by identifying factors impacting breastfeeding, and the dynamic interactions between them. The model also provided various leverage points from which breastfeeding women can be supported.

RELEVANCE TO CLINICAL PRACTICE

Postpartum nurses are critical in supporting breastfeeding practices. To be most effective, they must be aware of the factors impacting breastfeeding, some of which may be unique to women based on their culture.

ABM Position on Breastfeeding-Revised 2015

The Academy of Breastfeeding Medicine is a worldwide organization of physicians dedicated to the promotion, protection, and support of breastfeeding and human lactation. Our mission is to unite into one association members of the various medical specialties with this common purpose.