Breast for Success: A Community-Academic Collaboration to Increase Breastfeeding Among High-Risk Mothers in Cleveland.

Abstract

Exclusive breastfeeding is the optimal method of infant feeding. However, breastfeeding rates are notable for profound health disparities, for example, among inner-city African American women. Community-academic partnership offers an opportunity to intervene. To describe a targeted breastfeeding intervention anchored on community health worker (CHW) home visits to high-risk expectant mothers in Cleveland, Ohio, and to identify specific intervention components that increase the chances (odds) of a mother breastfeeding. We used a community-based participatory research (CBPR) approach and partnered with the Cleveland Department of Public Health MomsFirst Project and Community Endeavors Foundation, Inc., to create a culturally competent breastfeeding education program that "piggy backed" onto MomsFirst programming. Intervention components assessed include those delivered by CHWs (interactive modules and opportunity to select a doula) and by a lactation counselor (pre and postpartum phone calls, post-partum home visits). The 602 women who received any intervention component and reported a feeding outcome at 1 month postpartum were a mean age of 22.2 years, 514 (85.4%) were African American, 555 (92%) were unmarried, and 311 (52.4%) had not graduated high school. In multivariate analysis, odds of any breastfeeding were increased by receipt of curricular modules (odds ratio [OR], 1.11; 95% confidence interval [CI], 1.05-1.17, for each additional module) and by a postpartum visit (OR, 3.79; 95% CI, 2.06-6.96), and odds of exclusive breastfeeding were significantly increased by a postpartum visit (OR, 2.03; 95% CI, 1.13-3.63). Through community-academic partnership, we identified intervention components that significantly increased the odds of breastfeeding in this high-risk population and can inform future collaborations.