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.
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, firstname.lastname@example.org