Leveraging Existing Resources to Achieve Breastfeeding Equity

By Emily Bernard, IBCLC, NACCHO Consultant; Barb Hawkins Palmer, KCHD, Executive Director of Healthy Kent; Bonita Agee, Strong Beginnings, Education Coordinator; Teresa Branson, KCHD, Deputy Administrative Health Officer; and Chelsey Saari, KCHD, Project Director for Population Health & Accreditation Coordinator


Recognizing there was significant racial inequity in breastfeeding among African American mothers, the Kent County Health Department (KCHD), in Grand Rapids, Michigan, deemed the disparity unacceptable and convened a group of stakeholders to discuss this issue and ways to address it. Only 53% of African American mothers initiated breastfeeding, compared to 79% for white clients. Although there is a WIC program operated by KCHD and various additional maternal and infant health support services in the community, stakeholders determined that mothers would benefit more from receiving one-on-one breastfeeding-specific care. Using the well-documented success of peer mentor models, and with funds from NACCHO, KCHD formed a committee who worked in collaboration with the Healthy Kent Breastfeeding Coalition and the EMPower Hospital (Mercy Health Saint Mary’s), to create the Mothers Helping Mothers Breastfeed project, peer mentor home visiting program, in an effort to close the breastfeeding continuity of care gap for African American women.

Instead of developing a brand-new program and realizing the value of partnership, the project aligned with Strong Beginnings, a federal Healthy Start program, and their already established Breastfeeding Café support group, known as Helping Us Grow Strong (HUGS). Women participating in the project received weekly group support from other moms, mentors and lactation consultants at HUGS. The project partners also provided a culturally attuned training, Breastfeeding from an African American Perspective curriculum, for health professionals and related organizations.


About 35% of African American women in Kent County discontinue breastfeeding within the first month after delivery. A lack of awareness of local support services and the need for peer support may be reasons why they choose to discontinue breastfeeding. Prior to this project, information being provided to new mothers by healthcare professionals and related organizations about breastfeeding was largely unknown, and speculative at best.

Through a pre-implementation gap analysis with community members, local agencies and clinical professionals, KCHD identified that the community had limited accessible breastfeeding support services for new African American mothers and lacked culturally attuned lactation support providers. Many African American mothers reported that healthcare providers did not typically refer them to lactation care or supports. Furthermore, there was not a consistent and comprehensive resource guide detailing breastfeeding support services available to African American mothers within the Greater Grand Rapids area. Healthcare providers appeared to be giving inconsistent information, missing prime breastfeeding education opportunities during prenatal visits, and not regularly referring breastfeeding mothers to existing community resources.

This project had a short timeframe of 6 months and required an engaged multisector partnership to gather information, expand support, train and sustain the engagement. While KCHD had the desire to improve community breastfeeding rates among African American mothers they recognized the need for new and existing partnerships to effectively engage with African American breastfeeding mothers. To accomplish the project’s objectives, KCHD leveraged an existing infrastructure and key existing partnerships.


Informed by the gap analysis, which included a survey of healthcare professionals and a series of focus groups with African American mothers, KCHD identified three key strategies aimed to improve African American breastfeeding rates. The project focused on training healthcare staff, expanding an existing breastfeeding support program and developing a comprehensive breastfeeding resource guide.

KCHD recognized a gap in internal organizational capacity, appropriate skill set, and the level of cultural competency needed to support breastfeeding initiation among African American mothers. To address this gap, KCHD assembled a team which included a community program health educator, an International Board-Certified Lactation Consultant (IBCLC) and a Certified Lactation Consultant and former WIC Breastfeeding Peer Counselor, all of whom were African American women. These women then identified and mentored five Peer Breastfeeding Mentors from the Greater Grand Rapids community through the HUGS breastfeeding support group. Once trained, Peer Breastfeeding Mentors provided support for other African American mothers who were interested in initiating and sustaining breastfeeding, especially in the first four weeks following birth.


Expanding upon an existing community program, HUGS, instead of building a new one allowed for rapid engagement of African American mothers. Five Peer Breastfeeding Mentors were trained during the 6-month project, and four started actively supporting mothers with in-person individual and group counseling, phone calls and text messaging support. In addition, a private virtual support group through Facebook was created for the Peer Breastfeeding Mentors as an additional form of mother-to-mother support. Each Peer Breastfeeding Mentor was equipped with a universal breastfeeding kit that was taken to all support encounters to standardize education and care. This resource kit, adopted from the Strong Beginnings program, contained a cloth breast and belly size models, visual educational materials and information on pumping and milk storage.

The Healthy Kent Breastfeeding Coalition, Mercy Health Saint Mary’s and KCHD also provided training as a component of this project. The one-day culturally attuned training, Breastfeeding from an African-American Perspective, created and developed by Bonita Agee (Strong Beginnings Education Coordinator), Latoyia Thomas (IBCLC), and Christine Stancle (former WIC Breastfeeding Peer Counselor and now Certified Lactation Counselor), all of whom are African American women, was attended by 100 participants from various healthcare and related organizations including hospital employees, community program staff, and community health workers who work primarily with women of color. The curriculum included topics such as the historical context of breastfeeding in African American communities, factors that contribute to disparities, and breastfeeding benefits and barriers. The training also identified multiple teaching opportunities for breastfeeding education during prenatal appointments and information on how to refer African American women to culturally appropriate support groups.

To enhance training and support, KCHD compiled a universal resource guide, launching it online in conjunction with the Healthy Kent Breastfeeding Coalition. It was also made available in hard copy for distribution among healthcare providers.

The extensive engagement of the Peer Breastfeeding Mentors and IBCLC expanded into the faith-based community and known community networks to increase families receiving support.

An unexpected and welcome outcome of this project is the additional financial support provided by the Healthy Kent Breastfeeding Coalition to build a sustainability plan for the activities started during the NACCHO project period. KCHD applied for a Michigan State Health Innovation grant that was awarded for one additional year of breastfeeding support through the Mothers Helping Mothers Breastfeed project.

Lessons Learned

For a 6-month grant period, the proposed work plan was ambitious. Conducting a gap analysis with African American mothers and healthcare staff was important for informing project activities and training needs. KCHD did not struggle with recruiting Peer Breastfeeding Mentors, however, did became aware of some barriers mentors face. Several of the Peer Breastfeeding Mentors faced health issues, childcare dilemmas and family difficulties similar to the women they were mentoring.

Peer Breastfeeding Mentors were often current or former clients of home visiting programs which contributed to their interest in serving in a mentor role for other women. This initiative furthered conversation and recognition that breastfeeding support services are multi-faceted, need to account for cultural considerations, should include staff that reflect the population served, and should be delivered in collaboration with existing programs and services like home visiting programs, WIC, and related services. When determining service needs and strategies for addressing those needs, it is essential to utilize an equity lens to reduce disparities in breastfeeding and improve overall health.



For more information, contact: Barb Hawkins Palmer, barb.hawkins-palmer@kentcountymi.gov

Public Health Policy: What to Watch in 2018

NACCHO’s government affairs team has provided a forecast of what to expect in public health policy in 2018. The decisions made in Washington this year will have a major impact on local health departments and on the public’s health. As always, NACCHO members and staff will work together this year to be the voice of local health departments. Below is a short list of the top things to watch this year. For the full list, go to https://www.naccho.org/advocacy/news. Continue reading

2017 LHD of the Year Award Winners Bridge the Gap between Clinical Medicine and Population Health

By Taylarr Lopez, Communications Specialist, NACCHO

Local health departments (LHDs) across the nation work tirelessly for the betterment of health, equity, and security for all people in their communities. Today, LHDs must develop strategic partnerships with traditional and non-traditional stakeholders that hold the power and resources to influence population health. NACCHO’s Local Health Department of the Year Award recognizes the outstanding accomplishments of LHDs across the country for their innovation, creativity, and impact on communities. The theme for the 2017 NACCHO Annual Conference was Public Health and Healthcare Linkages. NACCHO recognized four local health departments as recipients of the award at NACCHO Annual last July. This post share details about the winning LHDs’ work to cultivate strategic alliances to improve population health. Continue reading

Health Equity Matters: Bridging the Gap between Underserved Populations and Access to Care

By Umair A. Shah, MD, MPH, NACCHO President and Executive Director of Harris County Public Health in Houston, Texas

What is Health Equity?

Public health is built on the foundation that all people have a right to health. Health equity is the principle that every person should have the opportunity “to attain their full health potential,” regardless of social, economic or environmental conditions. Achieving health equity requires valuing all individuals and populations equally, acknowledging and repairing historical injustices, and investing in those communities. Across the United States, state and local jurisdictions have made it their mission to reduce and eliminate health inequities in their communities. There are many root causes of health inequities, including racism, class-based oppression, gender inequity, and other forms of systematic injustices. These create societal conditions that influence an individual’s health such as: the quality of education, housing, neighborhood environment, and employment opportunities leading to disproportionate health outcomes, to name a few. Continue reading

The Opioid Epidemic in 2018: Where Do We Go from Here?

By Ian Goldstein, Government Affairs Specialist, NACCHO

The Centers for Disease Control and Prevention (CDC) estimates that 91 people die daily due to an opioid overdose. The Trump Administration has declared curbing the opioid epidemic a major priority. In March 2017, the White House created the Commission on Combating Drug Addiction and the Opioid Epidemic, headed by New Jersey Governor Chris Christie. The President proclaimed a public health emergency in late October 2017, however, such a declaration does not allocate any additional funding towards efforts to control the epidemic. On November 1, 2017, the Commission sent a report to the President with 56 recommendations the Administration can take to combat the growing opioid crisis. Some of those recommendations include an expanded drug court system, educational requirements for prescribers, and a media blitz to spread the word about preventive services and treatment availability for substance use disorder. Moreover, the Administration’s Council of Economic Advisors now puts the cost of the epidemic at $504 billion. Continue reading

Story From the Field: Children’s Home Society of Florida

By Shannon Currie, MSL, Community School Director, Children’s Home Society of Florida and Harumi Reis-Reilly, MS, LDN, IBCLC, Lead Program Analyst, Breastfeeding Project, Safe, Healthy and Resilient Communities, NACCHO

Meeting Teen Moms Where They Are: An Innovative School-based Breastfeeding Program

Children’s Home Society and Commonsense Childbirth engaged the community of Pine Hills from community-based partnerships designed to demonstrate improvement in breastfeeding practices for registered participants in the early post-partum period, at 6 months and 12 months, as compared to 2013 statistical data collected from the Florida Department of Health. Children’s Home Society (CHS) of Florida provided Wellness Coaches to deliver peer lactation support and education through direct referral and online support through the Peer and Online Lactation Support (POLS) portal. Continue reading

2017 Maurice “Mo” Mullet Lifetime of Service Award Recipient Dr. Marty Wasserman Shares His Experience as Past NACCHO President and How He’s Navigated the Political Landscape in Public Health

Interview by Taylarr Lopez, Communications Specialist, NACCHO

NACCHO is pleased to recognize Dr. Marty Wasserman, MD, JD, as the recipient of the 2017 Maurice “Mo” Mullet Lifetime of Service Award. This award honors current or former local health officials for noteworthy service to NACCHO that has reflected the commitment, vigor, and leadership exemplified by Mo’s distinguished career. For nearly 40 years, Dr. Marty Wasserman has proved his commitment to public health through leadership positions in service of medically underserved communities.  Continue reading