1. Breastfeeding Matters:
an intervention to
increase breastfeeding
behaviors within high-
risk communities
By Jovan Freeman,CLC
American College of Education

2. Objectives
This presentation will:
• Review infant feeding recommendations
• Identify the benefits/importance of breastfeeding
• Identify the barriers of breastfeeding
• Review the role and responsibilities of Health Educators
• Discuss the WE Breastfeed program initiative

3. TestYour
Knowledge

4. FACT or FALSE?

5. FACT or FALSE
Infants who are not breastfed have a higher
risk of mortality

6. FACT or FALSE
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The World Health Organization (WHO)
recommends exclusively breastfeeding for
the first 6m of life and then offer
complementary foods with breastmilk until
the age of 2.

7. FACT or FALSE
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The American Academy of Pediatrics (AAP)
recommends that breastfeeding continue for
at least 12 months, and thereafter for as
long as mother and baby desire.

8. Breastfeeding
Overview

9. Usual Feeding Recommendations
• 0-6 months – Breastmilk or iron-fortified formula
• 6 months – continue as above and add “solid” foods
– Texture progression:
pureed
mashed – some lumps
chopped – a little more lumps
tiny pieces of table food – no bigger than a pea
• After 12 months – can add honey and whole cow’s milk

10. Breastfeeding Benefits
10
• Mother’s Benefits:
• Helps the uterus return to pre-pregnancy size faster
• Less likely to develop breast cancer, ovarian cancer and osteoporosis
• Saves Money
• Saves Time
• More Accessible/ Travel-Friendly
• Triggers/Releases Relaxation Hormones
• Baby's Benefits:
• Promotes brain development
• Antibodies in colostrum and mature milk will help protect baby against common illnesses
(colds, ear infections, diarrhea etc.) and allergies and chronic illnesses such as obesity.
• Promotes proper jaw development and preservation of permanent teeth
• Other Benefits:
• Environmentally Friendly
• Encourages emotional bonding

11. HEALTHY PEOPLE 2020 Goals (CDC,2013)
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12. CDC Guide to Strategies to Support Breastfeeding Mothers and Babies (CDC,2013)
Maternity
Care Practices
Support
Breastfeeding
in the
workplace
Peer
Breastfeeding
Program
Professional
Education
Access to
professional
support
Access to
breastfeeding
education
and
information
Social
Marketing
Access to
breastfeeding
in early care
and
education
Address the
marketing of
infant formula
The CDC has created a recourse of 9 strategy suggestions to
encourage innovative ideas for achieving increased breastfeeding
behaviors nationwide.

13. In a peer review article aimed to “review the literature on racial and ethnic disparities in
breastfeeding rates and practices…” the article reveals concerns regarding ethnic group and the
healthy People 2020 goals, with emphasized increased concerns to African American breastfeeding
trends.
Research Findings:
1) “African American women have the lowest rates of breastfeeding initiation, as well as
continuation at 6 months and 12 months, compared with all other racial/ethnic groups in the
United States”
2) “Mothers with lower rates of breastfeeding tend to be young, low-income, African American,
unmarried, less educated, participants in the Supplemental Nutrition Program for Women,
Infants, and Children (WIC), overweight or obese before pregnancy, and more likely to report
their pregnancy was unintended
3) “Minority women are disproportionately affected by adverse health outcomes, which may
improve with breastfeeding”
Healthy People 2010 and 2020 Goals and Centers for Disease Control and
Prevention Data from 2007 on Racial and Ethnic Breastfeeding Initiation and
Continuation Results

14. o Breastfeeding (BF) is Natural, NOT Instinctive.
o Generational gap (Cadwell and Turner-Maffei, 2017)
o Moms’ insecurities: unsure about their abilities; scared of failure
and pain
o Feeding issues: latch problems/sore nipples
o Lack of information/support for returning to Work/School: too
much time, lack of support/ mom insecurities
Barriers to Breastfeeding (Freeman,2017)

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Health Educator: There are different types of health educators. Health educators may work in a health care
settings such as a clinical institution, a public health organization, or within a community/educational institution.
Health Educator are important because they are able to understand health issues, and provide/present health
information to individuals, and/or groups of individuals in a way that is understandable to diverse individuals,
and encourages a positive health outcomes.
Examples of Health Educators
• Physicians
• Nurses
• Dietitians
• Teachers
• Psychologist
• Lactation Consultants (IBCLC)
• Certified Health Educator Specialists (CHES)

16. 16
How Do Health Educators Help Communities Succeed?
1) Understand behavior
diversity (Ex: culture/
barriers to
breastfeeding)
2) Build respectable,
reputation as a gateway
to assess, analyze, and
implement health
interventions
Ex: (WIC or “WE
Breastfeed Program”)
3) Increase the
program’s impact by:
• Engaging stakeholders
• conduct program evaluations
to determine the efficiency
and effectiveness of the
program/intervention

17. 17
WithThis information In Mind, We present….

18. WE
Breastfeed
WE Breastfeed is a breastfeeding promotive program geared to helping
faith-based organizations and religious institutions establish a ministry
which will support and promote breastfeeding amongst their peers.
(Freeman,2017)
In theory, we are training trusted volunteers/community figures who will
encourage mothers to consider and/or continue breastfeeding. Thus,
closing the generational gap, altering stigmas surrounding breastfeeding,
and providing a supportive environment for healthier families within the
community. (Freeman,2017)

19. 19
• Statistics show that African American families are in close niche with religion-based
establishments. 1-3 women who identify as African American/Black attend church a
minimum of 15 times a year. (Freeman,2018)
• The number attributes to religious and non-religious purposes which include weekly
service gatherings, food bank services, and community events that involves musical
productions, preparing children for back-to-school, and other annual festive-prompt
gatherings. (Freeman,2018)
How can WE Breastfeed generate change in the ethnic Community?

20. 20
Health Intervention Details (Freeman,2017)
• The program proposed uses the Community Group Mapping theory to address the scenario’s
issue.
• The trainees become a critical resource of their church and community overall. With their new-
found knowledge and platform, they will connect their peers to valuable bf information and
encourage healthy infant feeding practices.
• This will generate more conversation and increase the likelihood of breastfeeding behaviors
amongst the urban community.
• We Breastfeed will encourage the transformational leadership style, as is most effective in
supporting community development and program acceptance. The instructors will be
encouraged to utilize their lives and personality to influence behavioral change, recruit new
health advocates, and create a culture of awareness.

21. 21
Community/Group Mapping Application of
WE Breastfeed (We Breastfeed to trainee)
Empowerment: WE Breastfeed looks to encourage WHO recommendations and
improve the health status of communities by offering education and resources to
implement a community program/initiative project within religious-based
establishments.
Critical Consciousness: The BF peer ministry acts as a support group for families
interested in breastfeeding and positively change perception about the topic.
Community Capacity: The BF peer ministry gained the attention of many and
quickly begins to grow
Issue Selection: There is a rise in infant mortality rate in African Americans
babies, and a lack of breastfeeding interest/support
Participation and Relevance: BF peer ministry group plan their own agenda
based on their needs, share progress, encouragement, and awareness of
resources.(Freeman, 2017)

22. • Lethargy
• Restless and fussy after feeding
• Feeding fewer than 8 times in 24hrs
• Weight loss exceeding 7% in first 5 days
• Continued weight loss (past day 5)
• Cannot observe sucking or hear active
swallowing during a feeding
• Stirring
• Mouth Opening
• Turning head
• Seeking/Rooting
• Active/ Alert but not rooting or bringing
hands to face (1mo+)
• Readily falls into deep sleep (newborn)
• Happy, appears content
Signs of UnderfeedingEarly Hunger Signs Sighs of Satiety
Sample Educational
Topics

23. Breastfeeding Basics – Latch
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Sample Educational
Topics

24. Baby Feeding & Bowel Movement Norms
Birth:
Milk- Colostrum
Baby- will be awake 1st hr.
after birth (bf opportunity)
Diapers: 1 Wet; no stools
First 12-24hr:
Baby will consume
1-2 tsp of colostrum
each feeding
Diapers: 2 Wet; 1
stool (thick,
tarry/black)
3-5days
Milk: Color change to
white
Feeding frequency
increases (8-12x/day)
Body: Breast feels full
and may leak
Diapers: 3-5 wet and
2-3 Loose to seedy
yellow colored stools
4-6 Weeks
Milk: White
Baby undergoes
growth spurt-
feeding frequency to
30 min increments
Body: Breast soften
when emptied
Diapers: 6-8 wet and
2-3 infant stools/day
Sample Educational
Topics

25. How?
• The WE Breastfeed initiative will incorporate 5 of the 9 suggested
strategies to increase breastfeeding behavior within high-risk
populations
Take Away Message:
Peer
Breastfeeding
Program
Professional
Education
Access to
professional
support
Access to
breastfeeding
education
and
information
Social
Marketing
Breastfeeding in African American Churches leads to normalizing
breastfeeding behavior within high-risk populations.

26. 26
References
Cadwell, K. and Truner-Maffei, C. (2017) Pocket Guide for Lactation Management 3rd Edition. East Sandwich, Massachusetts,
USA: Healthy Children Project, Inc.
Center for Disease Prevention and Health Promotion (2017) Retrieved from:
https://www.cdc.gov/breastfeeding/policy/hp2020.htm
Centers for Disease Control and Prevention(2013) Strategies to Prevent Obesity and Other Chronic Diseases: The CDC Guide to
Strategies to Support Breastfeeding Mothers and Babies. Atlanta: U.S. Department of Health and Human Services. Retrieved
from https://www.cdc.gov/breastfeeding/pdf/BF-Guide-508.PDF
Freeman, Jovan (2017) WE Breastfeed. Program Proposal PowerPoint.
Jones K. M., Power M. L., Schulkin J., and Queenan. (2015) Racial and Ethnic Disparities. Breastfeed Medicine. 10(4): 186–196.
doi: 10.1089/bfm.2014.0152
U.S. Department of Health and Human Services (2011)Your Guide to Breastfeeding For African American Woman, Washington,
DC, USA: Office on Woman’s Health Services