March 27, 2019

Home Visiting Supports Mothers, Infants

In the United States, home visiting agencies can play a critical role improving rates of breastfeeding.

For mothers and their newborn babies, few practices are considered as beneficial as breastfeeding. For example, breastfed children are less likely to develop asthma and Type 2 diabetes, and mothers who breastfeed have a lower risk of breast and ovarian cancers. In fact, the benefits are so significant that the American Academy of Pediatrics recommends infants only be given breast milk during their first six months.

And yet, despite these benefits, slightly less than one quarter of all infants in the United States are breastfed exclusively until the age of six months. Research has also revealed that non-Hispanic black women, Latinas, teens, and low-income women of all backgrounds all have lower rates of breastfeeding.

“A lot goes into a mother and infant’s ability to be successful at breastfeeding,” says Elaine Fitzgerald Lewis, a maternal and infant health expert at EDC. She believes these disparities are caused by several factors, including restrictive work policies, a lack of social support for new mothers, and the absence of Baby-Friendly® hospitals in minority and low-income communities.

“The reality is that some of the most vulnerable families we see are single mothers who have to go back to school or work within a couple weeks of giving birth,” says Fitzgerald Lewis.

But research is providing new insights into how Maternal, Infant, and Early Childhood Home Visiting (MIECHV) programs can deliver gains in breastfeeding. Specifically, when these home visiting programs embarked on collaborative, continuous efforts to improve services to support breastfeeding, they saw increases in rates of the practice among the families they served.

Between 2013 and 2016, EDC’s Home Visiting Collaborative Improvement and Innovation Network (HV CoIIN), which is funded by the Health Resources and Services Administration, conducted a continuous quality improvement (CQI) project, for which Fitzgerald Lewis served as a faculty expert. The HV CoIIN recruited 16 home visiting agencies in seven states, and using the CQI process, helped them develop a plan for testing practices for improving the rates of breastfeeding among new mothers served by these agencies.

“Home visiting programs are ideal for promoting breastfeeding because many work with women from pregnancy up through the child’s fifth birthday,” says Fitzgerald Lewis. “The earlier a woman makes the intention to breastfeed, the more likely she will be to initiate the practice.”

She adds that the support provided by home visitors “is critical to ensuring a mother meets her infant feeding goals.”

Each participating agency agreed to address the five components shown by research to improve the initiation and retention of breastfeeding practices:

  • Reliable and effective policies for breastfeeding
  • Competent and skilled workforce to support breastfeeding
  • Strong community linkages to breastfeeding support systems
  • Active family involvement in infant feeding practices
  • Comprehensive data-tracking system for breastfeeding

Over a 24-month period, local agency staff and parent leaders collaborated with the HV CoIIN team and faculty—including home visiting and breastfeeding experts, model developers, and state health leaders—to implement changes in their home visiting practices. At the end of the two-year period, home visiting agencies reported the following increases:

  • 14% overall increase in the number of infants who were ever breastfed
  • 3.5% increase in the number of infants exclusively breastfed until 3 months
  • 3% increase in the number of infants exclusively breastfed until 6 months

Fitzgerald Lewis believes that these positive results can be scaled up more broadly because MIECHV programs are now available in all 50 states, Washington, D.C., and five territories. In fact, EDC is trying to do just that, with a new five-year effort that will reach 25 states and territories and up to 250 local communities.

This effort, as well as slowly rising rates of breastfeeding since 2009, leaves her feeling encouraged.

“In general, we have seen a consistent, slow trend of increasing initiation, duration, and exclusivity of breastfeeding in the U.S.,” Fitzgerald Lewis says. “And that’s positive. That’s a shift in our culture.”