Analyzing A Framework of Breastfeeding & Lactation Support in the United States

Early breastfeeding cessation is common in the United States (US); despite a breastfeeding initiation rate of 85%, only 27% of infants born in 2022 met the evidence-based recommendation of six months of exclusive breastfeeding. This has widespread negative impacts on maternal and child health, including increased rates of chronic disease morbidity and mortality. Evidence-based practices at the individual, community, and system level – broadly referred to as “breastfeeding support” – have been shown to facilitate breastfeeding establishment and reduce rates of early cessation. However, there is considerable variation in the literature regarding what constitutes breastfeeding support, and a paucity of discussion of the concept of access to comprehensive breastfeeding support.This dissertation addresses that gap by examining how breastfeeding support can be conceptually defined, structured and accessed. It presents three academic papers, bookended by introductory and summary chapters. The guiding research questions are: 1) what is a comprehensive definition of “breastfeeding support” as it currently exists in the US, 2) what are the roles of perinatal healthcare providers in ensuring access to longitudinal breastfeeding support, and 3) how do a sample of mothers who are at risk for early breastfeeding cessation perceive their access to perinatal breastfeeding support? Chapter One offers background to situate the concepts of breastfeeding establishment, breastfeeding support, and breastfeeding duration within the context of the perinatal healthcare system in the US. The first paper details a concept analysis of the term “breastfeeding and lactation support” using Rodger’s Evolutionary Method of Concept Analysis (“breastfeeding support” was updated to “breastfeeding and lactation support” (BFLS) during the analysis process). It concludes that BFLS is a web of actions provided across the perinatal period by various people, institutions, and organizations. Collectively, these actions promote breastfeeding as a healthy and accessible infant feeding option, provide physical and emotional assistance and knowledge regarding how to initiate and maintain breastfeeding, and protect mothers' rights and abilities to breastfeed while maintaining employment. The second paper uses scoping review methodology to explore specific roles of various perinatal professionals in offering BFLS. It identified several overlapping and/or poorly defined roles, highlighting the need for stronger collaboration and care coordination among perinatal care professions. The third paper reports on a qualitative study exploring how to operationalize the concept of access to BFLS, taking mothers’ perspectives into account. The study focuses on a sample with known risk factors for early breastfeeding cessation: those who are breastfeeding for the first time and are Medicaid-insured. Chapter Five offers a synthesis of the body of work and directions for further research and implementation. Overall, this body of work highlights the need for better communication, collaboration, and intentionality in ensuring families’ access to comprehensive BFLS. It offers theory-based exploration of concepts for families, communities, and perinatal care providers to consider when appraising and strengthening systems of BFLS.

Author dc:creator

• Acquaye, Stephanie, N.

Advisor dc:contributor.advisor

• Spatz, Diane, L

• Nursing
• Obstetrics and gynecology

Language dc:language.iso

en

Repository record dc:identifier.uri

https://repository.upenn.edu/handle/20.500.14332/62386

OAI identifier oai:identifier

oai:repository.upenn.edu:20.500.14332/62386