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Addressing Maternal and Child Health Inequities Through Care

Yale Public Health Magazine, Focus: Spring 2022
by Kathleen O’Connor Duffany and Natasha Ray


Through the CDC-funded Racial and Ethnic Approaches to Community Health (REACH) program, the Community Alliance for Research and Engagement (CARE), co-housed at Southern Connecticut State University (SCSU) and the Yale School of Public Health (YSPH), works with community partners and residents to address health inequities related to nutrition, physical activity and access to community clinical care. A primary focus of our nutrition initiative is supporting parents in their intentions to chest/breastfeed.

While the science is clear on the important health benefits of breastfeeding for infants and mothers, new mothers can face a number of barriers to both initiating and continuing breastfeeding. These barriers include poor health care provision and lack of access to lactation support services (due to lack of transportation, childcare duties, recovery from birth and inflexible work hours). Additional barriers come in the form of workplace policies that do not meet lactation accommodation requirements, cultural norms against public breastfeeding and a lack of laws guaranteeing paid maternity leave.

While studies have shown there are no racial or ethnic differences in intentions to breastfeed between non-Hispanic white mothers and non-Hispanic Black mothers, the ability to meet those intentions does differ. Black mothers face additional barriers to breastfeeding that are rooted in systemic racism, including a lack of appropriate representation in outreach materials; a lack of representation among breastfeeding support service providers; a legacy of violence and oppression related to the role of wet nurses in the context of slavery; and a disproportionate rate of preterm births among Black women, which makes breastfeeding more complicated. Excess stress associated with bias, discrimination or racism experienced particularly by Black people, and the aggressive marketing of infant formula in Black communities also present barriers to Black women. It is important to acknowledge how the racial inequities we see in breastfeeding today cannot be separated from their historic roots in slavery and the persistent and systemic racism that has followed.

To identify structural barriers to breastfeeding among communities of color and inform future initiatives, CARE’s students, staff and faculty are working with our community partners and residents on a variety of studies.

What follows is a summary of some of those studies.

Study Summaries

Moms & Dads Breastfeeding Focus Group

The New Haven Breastfeeding Task Force, currently co-led by Natasha Ray (New Haven Healthy Start) and Danielle Blakney, LPN, IBCLC, and including community partners such as New Haven’s Women, Infants, and Children programs, requested a study to explicitly hear from Black/African American moms in New Haven on their breastfeeding experiences to guide efforts at the local level. CARE conducted multiple focus groups, using Barrier Analysis methodology mapped to a socioecological framework to identify and support interventions at multiple levels. The project was led by Victoria Tran, MPH ’21, Amelia Reese Masterson, MPH ’13, Tomeka Frieson, Yale College ’21, and Frankie Douglass (Community Health Worker) in close partnership with New Haven Healthy Start and the New Haven Breastfeeding Task Force Community Advisory Board.

As a parallel study, focus groups with Black/ African American dads are underway to hear their experience with breastfeeding and feeding their infants. Barriers and facilitators to engagement will be mapped to identify interventions at the intra- and inter-personal levels, with a focus on the institutional, community and societal levels. In partnership with the New Haven Breastfeeding Task Force and driven by Doug Edwards of Real Dads Forever and Natasha Ray of New Haven Healthy Start, CARE’s Jasmine Rios, M.P.H. ’22, is co-designing this study.

Statewide communications campaign

In partnership with the Connecticut Department of Public Health and with the support of a CDC SPAN grant, focus groups are being conducted in New Haven, assessing materials for a statewide “It’s Worth It” breastfeeding campaign to ensure that breastfeeding messages and materials resonate with and reflect the views of women of color. Debbie Vitalis, YSPH postdoc ’21, deputy director of CARE at SCSU, and three CARE M.P.H. students—Beatriz Duran-Becerra,’22, Devina Buckshee,’23, and Amina Mutalib, ’23—are leading this process. Results will be reported for integration into the statewide campaign.

Kathleen O’Connor Duffany, Ph.D., is director of Research and Evaluation for the Community Alliance for Research and Engagement (CARE), co-director of the Yale-Griffin Prevention Research Center, deputy director of the Office of Public Health Practice, and an assistant professor of Clinical Public Health (Social and Behavioral Sciences) at the Yale School of Public Health. O’Connor Duffany is principal investigator for all CARE studies noted.

Natasha J. Ray, M.S., is director of New Haven Healthy Start, chair of the Center for Research Engagement at the Equity Research and Innovation Center, and community lecturer at OPHP at the Yale School of Public Health.

Breastfeeding Equity Training Module

A Roots in Racial Inequities in Breastfeeding training module is being developed and piloted for health care providers to address inequities and biases related to the delivery of care and services to support breastfeeding. In an initial review of a proposed physicians’ training module to support breastfeeding, CARE partners and YSPH’s Womxn of Color for Maternal and Child Health student organization identified areas of the training that needed revision and areas that required an explicit equity lens. The feedback was integrated into the current physicians’ training module, and an extended module focused on the effect of biases and structural racism was requested. A CARE team led by Tomeka Frieson, Yale College ’21, Victoria Tran, M.P.H. ’21, Simileoluwa Falako, M.P.H. ’22, Amelia Reese Masterson, M.P.H. ’13, and Frankie Douglass (Community Health Worker) drafted the module, and a wide array of New Haven-based hospital and community providers and moms provided comment on the module. Providers from the Yale Schools of Public Health, Medicine and Nursing and Yale New Haven Hospital also reviewed. The feedback from these groups guided a co-design of the module that will be piloted with health care providers this summer. Eventually, the module will be available for inclusion in health care training programs (e.g., medical and nursing schools), as well as in-service training at hospitals and pediatricians’ offices locally and nationally.

Breastfeeding Care for Latina Women

"New mothers can face a number of barriers to both initiating and continuing breastfeeding.”

In partnership with Elizabeth Rhodes, postdoc ’22, and with the support of a grant from the National Institutes of Health’s National Heart, Lung, and Blood Institute, CARE staff members Sofia Morales (YSPH) and Genesis Vicente (SCSU), along with Leslie Brown (CARE Community Research Fellow/CHW) and Elyse VanderWoude, M.P.H. ’22, interviewed 21 Latina women with low incomes in Greater New Haven about their breastfeeding care experiences. The interviews focused on the women’s experiences during prenatal, birth and postpartum visits and ways to improve their care experiences. The findings will be used to design interventions to make breastfeeding care for Latina women more equitable and person-centered.

Findings from all of the above studies will be presented to the community, local hospitals and local organizations to better address needs and inequities in New Haven. CARE is also partnering to support breastfeeding-friendly business designations, increase the number of public lactation spaces and increase awareness of breastfeeding benefits, rights and policies throughout New Haven. Our Community Readiness Assessment, conducted first in the summer of 2021, with plans to be conducted again in three years, will assess change over time.

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