Fighting Breastfeeding Disparities with Team-Based Care

Despite Increasing Breastfeeding Initiation, Significant Disparities Exist

In the United States, 83% of infants overall are ever breastfed. Yet research clearly shows the health disparities that lie behind this number. Only 74% of non-Hispanic Blacks are ever breastfed. Among infants born in 2016, 39% of Black families reported exclusively breastfeeding through 3 months compared to 53% of white families. In the U.S., Latina families are likely to initiate breastfeeding, but only 18% practice exclusive breastfeeding. And over half of American Indian women reported stopping breastfeeding – or never starting – because of concerns about having to return to work or school.

In order to support all families in reaching their individual breastfeeding goals, awareness of the disparities and why they occur can help us, as health care providers, identify opportunities to address barriers and improve the care we provide to our patients.

Why are There Disparities and What Can Be Done?

The reasons for racial and ethnic disparities are multifactorial, including: social, cultural and historical influences; limited prenatal education; inconsistent quality of information provided by health care providers; and barriers to accessing care.

Lack of information

One literature review of African American women and breastfeeding identified that an important issue was the limited information regarding breastfeeding being shared by their health care providers. As health care providers, we have a responsibility to provide accurate information about breastfeeding to all families. Most medical schools do not provide sufficient lactation education, but there are ample resources available to improve your own breastfeeding knowledge, including our own The First Weeks course, where we share practical skills and approaches to support breastfeeding during the critical first weeks postpartum.

Access to culturally relevant lactation support

To receive accurate information and navigate difficulties, families need ready access to lactation support. Yet studies have shown that both health care providers and families report limited access to culturally supportive, breastfeeding knowledgeable resources in the community. Furthermore, studies identify that assumptions from health care professionals that a family is less likely to breastfeed may impact the likelihood of referral; a literature review found African American women were less likely to receive referrals for support and more limited assistance when problems were encountered. Ideally multi-level layers of culturally appropriate, practical breastfeeding support is needed. As healthcare professionals we have the opportunity to facilitate this support. 

Immediate, timely access to support

Through team-based care, routinely integrated into our office visits, we can automatically increase access and provide families with routine breastfeeding education. Our studies show that this care can be effective in different clinic settings, from a suburban practice to an urban Federally Qualified Health Center. Part of the beauty of team-based care is the ability to adapt to your individual practice needs. Ideally, collaboration is with, and breastfeeding support is provided by, someone in the community.

Think outside the box to address care gaps

The limited access to International Board Certified Lactation Consultant (IBCLCs) in some communities raises concern for access. Team-based care could help serve as a training ground for IBCLCs. If you have a member of your community interested in becoming an IBCLC they could start as a Certified Lactation Counselor (CLC) and then obtain clinical hours while providing breastfeeding support in your clinic to help address the barrier of obtaining the needed clinical hours. This type of mentorship opportunity can be critical to address educational gaps. This does not address the barrier of the cost of college level courses, but perhaps your clinic could consider a tuition reimbursement plan. We need creative solutions and different training options to think outside the box.

Additional recommendations to address disparities

Recommendations for improving breastfeeding rates and decreasing disparities include increasing prenatal breastfeeding support and education, ongoing support by health care professionals at delivery, and ongoing support postpartum. Studies have shown the benefit of developing community-based initiatives so that support is culturally appropriate, especially in Black, Indigenous, and people of color (BIPOC) communities. Options include an increase in comprehensive, culturally appropriate support throughout the perinatal period; community-based breastfeeding peer counselors; and increased professional lactation training for health care providers from the community along with increased access to IBCLCs of color. 

Look to others for examples

One program which provides concrete steps to help address health inequities is the Michigan breastfeeding plan. It identifies three phases to improved breastfeeding access:  before pregnancy & preconception; during pregnancy & delivery; and after pregnancy & postpartum. The plan includes critical steps such as building a team around breastfeeding families to improve continuity of care and facilitating collaboration between health care providers and breastfeeding support providers.

In Tennessee, the Breastfeeding Sisters That Are Receiving Support (BSTARS) is an example of community collaboration with health care providers, birth workers, and lactation support providers that has increased breastfeeding support, education, and training of lactation support providers (LSP) from the community. 

Building the team: Team-based care – an opportunity to help!

Team-based lactation consultant/primary care provider care can help address disparities by providing multidisciplinary support within a community.  Team-based care can address the barriers of access and limited time within primary care visits to provide counseling.  It has the potential to be an avenue to train more IBCLCs of color, which will help increase diversity and culturally appropriate care within the field of lactation. The 4th trimester is a critical time period of support for breastfeeding families and improving support and access at the primary care practice remains an important step in the effort to support families in reaching their individual goals.