*This is a guest post written by Divya Kumar, ScM, CLC, CPD
I recently read this article at Fit Pregnancy, which enumerates 7 steps that women can take to ensure breastfeeding success. It’s an excellent piece, full of applicable tips that women can bring to their breastfeeding journey.
The reality is, however, a woman’s health-related choices and behaviors are shaped by the socioeconomic and cultural context of her life and the choices available to her. If we want to improve a mother’s success with breastfeeding, we must look at her challenges within that context. As a postpartum and lactation professional with a public health background, I think about improving breastfeeding outcomes not only through information and education, but also through changes in our healthcare policies and systems. As a complement and companion to the aforementioned piece, here are 7 systemic interventions that promote breastfeeding success.
1. Paid parental leave. While the United States is the only developed nation that doesn’t guarantee paid leave for new parents, the three states that do offer paid parental leave have seen positive impacts on women’s careers and on the economy as a whole. Moreover, state-mandated paid leave has not impacted most employers’ bottom lines. What if women didn’t have to make decisions about breastfeeding based on their need to return to work outside the home? An earlier return to full-time work may reduce a mother’s ability to meet her breastfeeding goals, and many women I work with experience challenges maintaining breastfeeding once they are at work again.
2. Insurance coverage of lactation support. The Affordable Care Act (ACA) requires insurance plans to cover breastfeeding support and supplies. However, the requirements, restrictions, and coverage of different insurance plans vary greatly, and women’s options may in reality be quite limited. Moreover, the ACA does not cover Medicaid plans– rendering lactation support far less accessible to disenfranchised women. In their Guide to Breastfeeding Interventions, the CDC specifically calls for state Medicaid programs to fully cover lactation support services. Since economically disenfranchised women can be at a higher risk for negative perinatal health outcomes (such as prematurity), they may benefit from extensive, financially accesible lactation support
3. Community Doula Programs. Another approach to increasing the accessibility of perinatal support to low income women is through implementing Community Doula Programs such as the Chicago Doula Project. These programs utilize doula support in a myriad of ways– in community health centers, during the actual birth, and with home visits. In underserved populations at risk for negative perinatal health outcomes, community doula programs can have a large positive impact. For example, women working with the Chicago Doula Project experienced lower c-section rates and much higher breastfeeding rates compared to women in a control group. As the body of research supporting these programs continues to grow, policy makers should prioritize funding for these initiatives.
4. Integration of lactation support into pediatric care. If we want to support women as they breastfeed, meeting them where they (literally) are—in the pediatrician’s office– in the first days and weeks of their children’s lives reduces barriers and increases timely access to care. I work at a local community health center as part of a state-funded pilot program and meet with all new moms and provide comprehensive perinatal support, including lactation help, as part of their pediatric appointments—as early as three days postpartum. Numerous women have said, “I would have quit breastfeeding if you hadn’t walked into that room and helped me right then and there when my baby was four days old!”
5. Cultural competence. The gap between black and white infant breastfeeding initiation rates and duration has narrowed, but black infants have consistently lower numbers in both categories. Also, lactation professionals are not a diverse group. Moms of color may feel most comfortable with a professional of their own racial/ethnic background who shares the vast, deep well of cultural history– and racism– that permeates our social world. Kimberly Seals Allers, a journalist who writes about breastfeeding among women of color, states so eloquently, “Can white certified lactation consultants help bridge the racial gap in breastfeeding rates? Perhaps, with a lot of cultural training. Could more African American consultants get us there much faster? Absolutely.” We as professionals must build diversity in our own ranks to combat cultural barriers to accessing care. Community Doula Programs, for example, are built upon culturally appropriate peer-to-peer support and employ trusted community members as doulas.
6. Accessibility of lactation services and breastfeeding groups. Who runs the local breastfeeding group? What neighborhood is it in? Is it accessible by public transportation? Can moms come to a group after work or on a weekend? Minimizing barriers by offering free or low-cost groups at a familiar, accessible location can increase a woman’s willingness and ability to utilize these services. Community health centers are good locations for support groups; moreover, if insurance would pay for this support service, then lactation professionals could be employed by the health center. Women would not have to pay out of pocket, and no one would lose money. See how all of this fits together?
7. Yes, we provide breastfeeding education to women, but we could make it more accessible by integrating it into existing systems of healthcare. The CDC outlines some excellent suggestions for where to implement such integrations, such as into Early Intervention and Healthy Start programs, parenting classes for adolescents, and health programs geared towards women of childbearing age. In addition, insurance companies could cover the cost of breastfeeding education classes. But we as a culture could also benefit from education about breastfeeding. Wider integration of breastfeeding education moves us towards collective support of support breastfeeding women. This culture shift encourages us to stop giving dirty looks to women who breastfeed in public, to tell Facebook that images of nursing moms are not “obscene” and should not be blocked and to integrate pictures of nursing moms into books of families and new parents.
Divya Kumar has a Masters in public health and is certified as a postpartum doula and lactation counselor. She connects postpartum support to public health with the goal impacting healthcare programs and systems to better support new moms and families. In 2013, she developed a state-funded perinatal support pilot program in four community health centers in Massachusetts and currently provides perinatal support for women and families at Southern Jamaica Plain Health Center, one of the four pilot sites. In addition, she facilitates support groups for new parents and brings honesty, compassion, camaraderie, and humor to her work with new families.