National Health Outreach and Engagement Conference 2024

Gallo, S, and Fogelman, A.
Professional organizations recommend breastfeeding for at least the first two years of life as it
is protective for both maternal and infant health. Southern states in the United States (US) have
the lowest breastfeeding rates nationally. There are disparities with breastfeeding as
ethnic/racial minorities and rural populations are less likely to breastfeed compared to their
White and urban counterparts. Breastfeeding education and support has been shown to increase
breastfeeding rates and help overcome barriers. Extension is a resource to support breastfeeding
and improve infant health. This session will provide an overview of current breastfeeding trends
and lactation support services in the US. Additionally, we will highlight findings from our
observational study which examined the relationship between access to lactation support,
breastfeeding rates, and infant mortality, and identified geographic gaps in access to support
services in Georgia (GA) and North Carolina (NC). We used publicly available county-level
characteristics on breastfeeding initiation rates and infant mortality rates. The following
lactation support services were identified for each county: International Board Certified
Lactation Consultants (IBCLCs), La Leche League groups, breastfeeding peer counseling
programs through WIC (Special Supplemental Nutrition Program for Women, Infants, and
Children), and Baby Friendly hospitals. Counties were further characterized by rural-urban
status using Rural-Urban Continuum Codes (RUCCs), and vulnerability using the
CDC/ATSDR-Social Vulnerability Index (SVI). Multiple linear regression models were
constructed for breastfeeding initiation and infant mortality rates as a function of the four
support service availability types and the two population-level correlates of both outcomes.
Maps were created to evaluate geographic distribution of breastfeeding and infant mortality
rates and breastfeeding resources. Regression models predicted: 1) IBCLCs and WIC sites
were most significantly associated with increased breastfeeding initiation rates. 2) Numbers of
IBCLCs were significantly associated with lowering infant mortality. 3) The higher the SVI
score of a county, the lower the initiation rates, and the higher the infant mortality rates. Maps
showed the regions most in need of breastfeeding support included North East NC, South NC,
and South West GA. Our data support increasing the number of IBCLCs and WIC peer
counselors as a priority for the identified underserved areas. Introducing more breastfeeding
resources to the most vulnerable counties may increase breastfeeding initiation rates and lower
infant mortality rates over time.