The Importance of Family Engagement in Breastfeeding Programs

August 27, 2021 | Deborah Backman

Family with young girl and breastfeeding newborn

Every August, national, state, and local breastfeeding stakeholders celebrate National Breastfeeding Month by engaging each other and the public in conversations about changes needed to build a landscape of breastfeeding support. The 2021 theme for National Breastfeeding Month is “Every Step of the Way,” which envisions a world in which all families are supported at every step along the infant feeding journey. Given evidence showing the crucial role of family members in influencing breastfeeding decisions, efforts to support breastfeeding must engage family members in addition to birthing people.

Despite the American Academy of Pediatrics recommendation to exclusively breastfeed infants for the first six months after birth and continue for one year, most infants do not exclusively breastfeed or continue breastfeeding. For example, fewer non-Hispanic Black infants are ever breastfed compared with non-Hispanic Asian, non-Hispanic white, and Hispanic/Latinx infants. The proportions of Hispanic/Latinx and non-Hispanic Black infants who are exclusively breastfeeding at three and six months is also significantly lower compared to non-Hispanic White and non-Hispanic Asian infants. One barrier frequently reported by low-income Black, Indigenous, and parents of color is inadequate family and social support. However, research shows that engaging family members in initiatives can make breastfeeding easier for new parents by improving social, emotional, and practical supports, which results in improved outcomes.

Partners play important roles in breastfeeding decisions. Research indicates that educating fathers about lactation significantly improved breastfeeding exclusivity and reduced the risk of problems. Interventions that educated fathers also resulted in improvements in father support for breastfeeding problems and maternal knowledge about and attitudes towards breastfeeding. A father’s emotional support, responsiveness to needs and decisions, assistance with household and childcare tasks, and assistance with difficulties can also improve outcomes.

Other family members, such as parents and grandparents, can influence breastfeeding decisions and serve as role models, especially in systematically marginalized populations such as African American communities. Birthing and parenting people often cite advice from family members as a reason for their infant feeding decisions. Qualitative research indicates that new African American parents can receive both positive and negative feedback regarding breastfeeding from parents and grandparents, which illustrates the importance of lactation education across multiple generations. A study of low-income African American women indicated that women who initiated breastfeeding were more likely to have had a mother who breastfed, to have been breastfed themselves, or to have had a relative who breastfed.

Engaging Families in Breastfeeding Support: State and Local Highlights

In Colorado and Tennessee, state health agencies and community-based organizations are exploring families’ perceptions of breastfeeding and engaging families in initiatives.

As part of ASTHO’s Breastfeeding Learning Community, the Center for African American Health (CAA Health) and Families Forward Resource Center (FFRC), in partnership with the Colorado Department of Public Health and the Environment, are engaging fathers to improve lactation support for Black families in the Denver metropolitan area. CAA Health and FFRC, both of which are Black-led organizations, held panel discussions and presentations on fatherhood and breastfeeding as part of a Black Breastfeeding Summit in July 2020 and a health equity summit in June 2021. During the 2020 summit, Black fathers discussed barriers to being active participants in their children’s lives, such as incarceration and financial challenges. This discussion improved participants’ understanding of how such barriers could impact breastfeeding.

The 2021 summit featured a partner inclusion panel, which educated partners about breastfeeding rates, benefits for infants and parents, human milk storage and handling, supporting partners in expressing milk and direct breastfeeding, and assessing whether infants were receiving adequate nutrition. Partners also discussed their own experiences supporting breastfeeding. Additionally, CAA Health and FFRC provided Certified Lactation Educator (CLE) training to 12 people of color, including two Black fathers. Moving forward, FFRC is planning to hold additional conversations about breastfeeding, barriers to support, and parental mental health with FFRC’s staff-run support groups.

In Memphis, Tennessee, the Black-led Breastfeeding Sisters That Are Receiving Support (BSTARS) organization provides education and support among Black families and other families of color through in-person meetings, social media, and peer-to-peer interactions. BSTARS holds monthly meetings at a local library, where Black and other pregnant and parenting women of color and their families enjoy a shared dinner while discussing topics related to self-care and barriers to breastfeeding. Meeting facilitators also encourage participants to share their breastfeeding stories, including successes and stressors. The program encourages all family members to attend these meetings, at which women and their families ask questions and receive advice from healthcare and lactation support providers. During the pandemic, the organization held its monthly meetings via Facebook Live. The organization also provides follow-up services to participants as needed and holds educational events and community baby showers where families can receive free items such as strollers. BSTARS incorporates input from community members into their activities and offers all activities and services to families free of cost.

Looking Ahead

The influence of family members in breastfeeding decisions and the engagement of family members of birthing and parenting people can significantly improve breastfeeding outcomes, especially among systemically marginalized populations. Specifically, family members’ advice, emotional support, sensitivity to mothers’ needs, and assistance with household tasks, childcare, and managing problems can improve breastfeeding exclusivity and reduce problems. Educating fathers about breastfeeding can also improve self-efficacy by increasing family knowledge about and positive attitudes toward breastfeeding. As current research focuses on mothers and fathers, more research is needed to expand understanding of how other types of partners and family members influence breastfeeding outcomes among LGBTQ+ individuals.

State and local breastfeeding initiatives, like those in Colorado and Tennessee, are successfully engaging family members through discussion groups and educational events. These initiatives support continuity of care throughout the breastfeeding journey by improving support for new parents in their own homes and among their family networks. Given the importance of family engagement in advancing continuity of care—and its effectiveness in improving breastfeeding outcomes for systemically marginalized populations—it is critical for state and local initiatives to engage all types of family members at every step of the breastfeeding journey.