By Allison Gallegos-Jeffrey and Spencer Stein, Maternal, Child, Family Health Services

Although most infants receive some breast milk, they are not exclusively breastfeeding or continuing to breastfeed as long as recommended. In an effort to improve breastfeeding rates, San Diego County’s Racial and Ethnic Approaches to Community Health (SDREACH) is increasing the number of lactation educators at health centers for underserved areas, such as Federally Qualified Health Centers. These facilities work to reduce and prevent chronic disease among low-income, uninsured, homeless, migrant and rural residents by improving nutrition, increasing physical activity, and connecting clinical organizations to community programs. 

“Appointments are more accessible, making it possible to address any concern or complication right away, helping to prevent more severe complications,” said Gina Parra, a certified lactation education and manager of women’s health at Family Health Centers of San Diego.

Grant funding allowed SDREACH to train more than 100 individuals to become certified lactation educators. As a result, clinics were better able to deliver breastfeeding consultations and support to those who are pregnant and/or postpartum. During the COVID-19 pandemic, lactation educators adapted care delivery to include virtual visits, providing another way to support mothers and babies. In the last three years, there have been more than 5,000 lactation visits at clinics partnering with SDREACH. At Family Health Centers of San Diego, there are now seven lactation educators, each of whom has averaged 100 appointments every month.

Disparity in Breastfeeding Rates

The American Academy of Pediatrics recommends that children be exclusively breastfed for the first six months and continue to breastfeed with complementary foods for two years or beyond. Breastfeeding is an important source of nutrition and can also reduce the risk of mothers and babies developing chronic diseases. While eight in 10 infants receive some breast milk, less than half of infants born in the United States are exclusively breastfed through three months of age, according to the American Academy of Pediatrics. 

In San Diego County, breastfeeding rates differ dramatically among racial and ethnic groups. After delivery, fewer than seven in 10 African American parents report exclusively breastfeeding; fewer than eight in 10 Hispanic parents report exclusively breastfeeding at this same time; in comparison, more than eight out of 10 White parents exclusively breastfeed, the highest rate among all racial and ethnic groups, according to the California Department of Public Health.  

Several factors play a role in whether and how long babies are breastfed, including education, encouragement, and the availability of medical support in the first week after birth when breastfeeding issues most commonly arise. Employment-related factors, including time for and access to clean and safe places to breastfeed, may also affect this. Under the Providing Urgent Maternal Protections for Nursing Mothers Act (PUMP Act), which was signed into law Dec. 29, 2022, employers of all types must provide break time and a private space other than a bathroom for lactating workers to express milk for the first year of their child’s life. 

Immediately after delivery, hospitals provide some level of breastfeeding education, but many mothers have reported that this education was brief and insufficient. Certified lactation educators are breastfeeding support professionals trained to assist women with the normal course of breastfeeding. They teach classes, run breastfeeding support groups, and provide general training and counseling. Lactation educators are in high demand at community health clinics to provide ongoing breastfeeding education and support. 

Lactation Appointments Are Up

At Family Health Centers of San Diego, lactation-related appointments have increased by about 300 each month compared to before the COVID-19 pandemic. In addition, more patients are completing their appointments since virtual visits overcome many of the barriers that new mothers face in trying to get an in-person visit. Appointment completion has increased by 20 percent after initiating virtual visits. 

Easy access to breastfeeding support helps new mothers with challenges that arise early in the postpartum period. This increases the likelihood that mothers will continue to breastfeed their babies and improves health outcomes for both mothers and babies. 

This program enabling real-time virtual breastfeeding support is a best practice that can easily be adopted by other health clinics.

Photo: A lactation educator provides a demonstration via telehealth at Family Health Centers of San Diego.