P3.046: Parent and Provider Breastfeeding Needs Assessment: A Mixed Methods Approach

Background: Breastfeeding initiation and continuation in the U.S. are disparately lower in minoritized populations. The DC Breastfeeding Coalition and DC Health collaborated to conduct a comprehensive needs assessment to identify breastfeeding support, barriers, and resource gaps from the perspective of Washington, DC birth parents and providers.

Methods: Washington, DC residents with children < 2 years old completed an online survey (n=224). A Qualtrics panel recruited 104 residents, and the study team recruited 120 from areas with minoritized and/or marginalized families. An additional 64 birth parents participated in 15 virtual focus groups. Three of the focus groups were held in Spanish. Sixty-eight providers (maternal and child healthcare providers, WIC staff and lactation support providers) completed an online survey about their experiences providing breastfeeding support.

Results: Almost all parents who completed the survey reported that they had ever breastfed (96.4%) and 49.6% reported that they “breastfed only”. The majority (89.7%) of parents breastfed in the hospital and 54.0% reported that their baby received formula in the hospital. Many reported difficulty breastfeeding in the hospital (38.3%) and after hospital discharge (39.7%). The top barriers to getting breastfeeding support were cost and location of support, and lack of childcare. Of the 28.6% who stopped breastfeeding earlier than they wanted, the reasons cited included breastfeeding pain (50.0%), perceived insufficient milk (35.9%), return to work/school (31.3%), and inability to get help when needed (29.7%). Respondents reported that more assistance in the pediatric clinic (45.3%), better access to breastfeeding support (42.2%), more support at work (29.7%), and home visits (28.1%) would have helped them breastfeed longer.
Common themes from focus group participants included their inadequate knowledge about how to manage common breastfeeding challenges, lack of education by providers, and desire for financial support for breastfeeding supplies. Spanish-speaking participants discussed the challenges of being an immigrant without social support.
Obstetric and pediatric providers cited insufficient time (45.0%) and the absence of lactation experts in their practice (60.0%) as barriers for providing breastfeeding support. Eleven IBCLCs completed the survey and reported that families insured by Medicaid had challenges obtaining breast pumps and access to covered providers who perform frenotomies. Barriers reported by WIC employees included the need for parents to return to work early post-partum, lack of support and access to breast pumps.

Conclusion: Both parents and providers recommended better access to lactation specialists, more provider education and more time providing breastfeeding support during clinic encounters. Parents recommended more comprehensive prenatal education and coverage of breastfeeding supplies. Further analysis is being conducted to identify specific policies that could address these and other identified gaps in breastfeeding support.