P3A092: Evaluation of a Clinic-based Lactation Initiative Utilizing Medical Assistants and Community Health Workers as Lactation Specialists to Improve Breastfeeding Success Rates in an Under-resourced Community

Background: The AAP and WHO both recommend six months of exclusive breastfeeding with continued breastfeeding for one year or longer. Exclusive breastfeeding and duration of breastfeeding for low-income women, however, is 28% below the general population and 28-43% below Healthy People 2020 targets. Dedicated lactation specialists such as certified lactation specialists (CLCs) and International Board-Certified Lactation Consultants (IBCLCs) play an essential role in education and support to new mothers wishing to breastfeed. Throughout the United States, there are 4.57 CLCs per 1000 live births and 3.79 IBCLCs per 1000 live births according to the Center for Disease Control and Prevention’s 2016 Breastfeeding Report Card. These numbers are lower in Arizona, with 2.19 CLCs and 3.75 IBCLCs per 1000 live births. In Cochise County, a large rural county along the United States-Mexico border in Southeast Arizona, 2020 rates decreased to 1.18 CLCs and 1.77 IBCLCs per 1000 live births.

With the goal of improving breastfeeding rates and the mother’s experience of breastfeeding, a community clinic started a lactation initiative that trained one local medical assistant and one community health worker as lactation experts known as breastfeeding coaches (BCs).

Methods: Two BCs were hired and underwent a 40-hour lactation training course by WIC in March 2022 and started seeing patients in April. The BC meet mothers in the patient’s home or in the clinic for continued lactation support until 6 months of age. BCs input all data into RedCap after each visit. Chiricahua’s research department was responsible for the program evaluation.

Results: From March to December 2022, the breastfeeding coaches had contact with 142 mothers of newborns. Table 1 highlights when the contact with these mothers occurred, the number of enrollees into the program, and then the number of visits completed by BCs.

Out of the 124 mothers who reported their feeding plan during the initial contact with a breastfeeding coach, approximately half (51.6%) planned to breastfeed exclusively. Yet as Table 2 shows, only 19% of infants were exclusively breastfed at the newborn visit although 85% were receiving some breastmilk. Table 2 also shows how the proportion of infants who received any breastmilk decreased over time and how a statistically-significant higher proportion of infants enrolled in the BC program received any breastmilk at the 1-month EPSDT visit and approached significance at the 4-month EPSDT visit compared to the infants not in the program.

Please note that numbers will be increased and updated by the time of abstract presentation as control group patients are recruited.

Conclusion: In low-resource communities, training local clinic staff to serve as lactation specialists can lead to improved breastfeeding rates through four months of age. Community clinics and organization should consider innovative approaches to supporting the lactation needs of mothers and infants.