Systems Based Practice: Breastfeeding AdvocacyGoal B

Learners will support and advocate for health systems and engagement strategies which promote and support breastfeeding as the cultural norm within the medical community and the community at large.

Learner Objectives

Research current laws protecting breastfeeding and identify opportunities to advocate for legislative policy changes
Investigate how different racial, ethnic, and cultural backgrounds can bring strengths and support systems in terms of breastfeeding
Identify the structural barriers to breastfeeding success that contribute to disparities in breastfeeding initiation and duration. Suggest strategies to overcome those barriers.
Describe how racism and implicit bias by healthcare providers impacts breastfeeding success for Black, Hispanic, Indigenous, and people of color.

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Essential Activities

Have learners review key literature regarding the impact of racism and implicit bias on breastfeeding disparities and discuss as a group. See example suggested references below.
- Robinson K, Fial A, Hanson L. Racism, Bias, and Discrimination as Modifiable Barriers to Breastfeeding for African American Women: A Scoping Review of the Literature. J Midwifery Womens Health. 2019 Nov;64(6):734-742. doi: 10.1111/jmwh.13058. Epub 2019 Nov 11. PMID: 31710173.
- Gyamfi A, O'Neill B, Henderson WA, Lucas R. Black/African American Breastfeeding Experience: Cultural, Sociological, and Health Dimensions Through an Equity Lens. Breastfeed Med. 2021 Feb;16(2):103-111. doi: 10.1089/bfm.2020.0312. PMID: 33591226; PMCID: PMC7891224.
- Jones KM, Power ML, Queenan JT, Schulkin J. Racial and ethnic disparities in breastfeeding. Breastfeed Med. 2015 May;10(4):186-96. doi: 10.1089/bfm.2014.0152. Epub 2015 Apr 1. PMID: 25831234; PMCID: PMC4410446.
- Gallo S, Kogan K, Kitsantas P. Racial and Ethnic Differences in Reasons for Breastfeeding Cessation Among Women Participating in the Special Supplemental Nutrition Program for Women, Infants, and Children. J Midwifery Womens Health. 2019 Nov;64(6):725-733. doi: 10.1111/jmwh.13031. Epub 2019 Aug 30. PMID: 31469235.
- Segura-Pérez S, Hromi-Fiedler A, Adnew M, Nyhan K, Pérez-Escamilla R. Impact of breastfeeding interventions among United States minority women on breastfeeding outcomes: a systematic review. Int J Equity Health. 2021 Mar 6;20(1):72. doi: 10.1186/s12939-021-01388-4. PMID: 33676506; PMCID: PMC7936442.
Have learners complete implicit bias training and have a class discussion about strategies to provide equitable breastfeeding care.

Additional Activities (Optional)

Objective #1 Advocating for Supportive Policies:
- Have learners attend a conference on breastfeeding related topics.
- Have learners attend advocacy training.
- Have learners connect with their local breastfeeding coalition or other organizations dedicated to increasing breastfeeding rates.
- Have learners send letters to legislators to advocate for state and local laws (family leave policies, work policies, breastfeeding in public, lactation services, and breast pump rental coverage laws). See the Center for WorkLife Law for state breastfeeding laws and the United State Breastfeeding Commission advocacy page for current breastfeeding legislation actions.
- Have learners give a presentation to pitch a new breastfeeding policy/program to the hospital administration. If there is already an active hospital breastfeeding committee, have learners attend meetings
- Read through the WHO code on marketing breastmilk substitutes and analyze which parts of this policy are upheld at the learner’s hospital.
Objective #2 Cultural Support Groups: Have a speaker from the local Le Leche League or an AAP Chapter Breastfeeding Coordinator speak in class.
Objective #3 & #4 Barriers and Strategies:
- Do a quality improvement project focused on implementing policies that support breastfeeding in maternity care units using quality improvement methodology.
- Have learners develop systems for follow-up of breastfeeding infants and mothers and referral to resources at their hospital- within the first 10 days after birth with access via text or phone

Learners can take this optional quiz to gauge their understanding of topics covered in this curriculum module.

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Medical Knowledge

Your learners will understand the anatomy of the breast, the physiology of lactogenesis and the challenges of breastfeeding.

Patient Care

Learners will be able to educate families about breastfeeding, provide peripartum breastfeeding support for routine care and common problems, recognize and be able to address breastfeeding challenges and special situations after discharge and throughout infancy and understand the unique needs of LGBTQ+ families as it relates to infant feeding.

Practice Based Learning

Learners will educate themselves and others about breastfeeding.

Interpersonal Communication Skills

Learners will communicate effectively with patients, families and other medical providers regarding breastfeeding as well as understand the concept of cultural humility and how to provide culturally effective breastfeeding care.