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Making Breastfeeding Accessible for All

Woman with stroller on snow-covered sidewalk.

Babies are born to be breastfed, right? But we’ve got good evidence that mothers aren’t likely to begin or continue breastfeeding without access to breastfeeding support, promotion, and protection.

Serving rural communities

Not everyone can open a web browser or navigation device, type in “IBCLC near me” and access the breastfeeding support they need. For some, a “near me” lactation consultant may be 100 miles away.

Some rural communities, including those where I’ve lived and worked, have snow and treacherous wintry conditions along unplowed (and sometimes, unpaved) roads. That makes access to care very difficult, even if it’s within a reasonable distance. New parents with a tiny baby may feel it’s unrealistic to drive for hours to get help.

Breastfeeding advocates who live in rural communities might need to get creative and think outside of the box for ways to make care accessible for all. One possible option is telehealth.

Serving inner city communities

I’ve also worked in inner city hospitals. Sure, the lactation consultants are “nearby.” However, transportation to the hospital outpatient department, clinic, or doctor’s office is often a huge barrier.

Lactation services might not be on the bus line. And, taking an infant on city transportation, like a train or bus, may feel overwhelming for some parents. (As a professional, I found I needed to have a clear understanding of public transportation.)

It’s tempting to say, oh, offering in-home services is the answer. Maybe. My first question would be, will the inner-city population have a way to pay for those services? A better option would be for all of us to establish or volunteer at a Baby Café to increase access to breastfeeding promotion and support services.

If you live in or near the neighborhood being served, whether you’re certified or not, you can help get mothers access to breastfeeding support.

Serving the homeless and transient populations

Studies show that, “women and families are the fastest growing segments of the homeless population.” Those affected include women who are aged 15-44.  

It’s easy to assume that inability to pay for services is the main problem, but it’s bigger than that. One study showed that the unmet healthcare needs of this population were attributable to barriers such as not knowing where to go, long office waiting time, and being too sick to seek care.

In short, a major issue for these women is access to care. That’s not dissimilar to what we’ve learned about women who are eligible but don’t register for WIC.

Are you aware of the new specialty, “Street Medicine”? Certainly, transient, or homeless populations can benefit from the best practices in Street Medicine, including mobile clinic vans, electronic medical records, collaboration with hospitals and clinics, and social support.

Access to breastfeeding support, promotion, and protection, along with prenatal and postnatal care in general, could be a major part of the mission for Street Medicine.

Serving incarcerated mothers

In major medical centers, it wasn’t unusual to have incarcerated women admitted to our facilities. This situation created all sorts of issues related to privacy, bonding, mobility restrictions, and much more.

We’d like to think that the prison system would have some responsibility for ensuring the well-being of the unborn fetuses, who are of course innocent. Right?

The references in one article are woefully outdated, but point out that limited access to care, inadequate screening protocols (especially for sexually-transmitted diseases), and inadequate nutrition counseling, along with practices such as shackling, are serious concerns for childbearing women in prison.

Before and after hospitalization, there many issues of which you may be completely unaware. For example, what about access to breastfeeding support for interaction or instruction? Be sure to read this chilling account about life for pregnant inmates at Julia Tutwiler Prison in Alabama. Yet, to this facility’s credit, leaders there have instituted a doula program.

The number of women who are incarcerated is growing. Hence, internationally, there is a great need for more and more consistent guidelines for these women.

The National Commission on Correctional Health Care recommends that nursing women receive accommodations to maintain milk supply during custody. Providers can help with access to breastfeeding initiation and continuation by counseling women in custody.

This isn’t only about waving the flag for breastfeeding. It isn’t only about ethnic groups who are underserved, although that is certainly a problem. Access to perinatal services in general, and specifically breastfeeding, is a major public health problem that we must acknowledged — and tackle.

How do you help to create better access to breastfeeding support, protection, and promotion in your community? Share in the comments below.

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