At two months postpartum, only half of new mothers in Rhode Island are still breastfeeding despite experts recommending exclusive breastfeeding for at least six months. Since 89.3% of mothers in Rhode Island initiate breastfeeding, this sharp decline reflects a systemic failure of postpartum support.
In addition to lowering the risk of breast and ovarian cancer for mothers, breastfeeding benefits for babies include a strengthened immune system and reduced lifelong disease risk. Mothers who experience difficulty breastfeeding face higher levels of postpartum anxiety and depression. Increasing the availability and utilization of postpartum lactation support will improve newborn and maternal health outcomes for all women, especially low-income and minority mothers, while also reducing Rhode Island healthcare costs.
Lactation support is not a luxury, but rather an investment. Currently, Rhode Island has 24.4 certified lactation consultants per 100,000 childbearing-aged women, falling short of the national average. These consultants reduce infant illness and maternal complications. Hospitals that invest in lactation support programs reduce readmissions, improve quality metrics and lower per-patient expenditures. Insurers benefit from fewer claims for preventable care.
Black women, single mothers and those from low-income backgrounds are the least likely to utilize lactation support and display the largest degree of distrust in providers. Across Rhode Island, women in urban settings, along with those identifying as Black, Hispanic or American Indian, display lower breastfeeding continuity rates than the rest of the state. Barriers may include a lack of provider representation, limited culturally competent care and poor promotion in marginalized communities. The same groups sustain higher maternal morbidity and postpartum mental health crises.
Under the Affordable Care Act, the majority of insurance plans already cover lactation consultations. These consultations, however, remain underutilized. Improving breastfeeding outcomes starts with programs that educate women on what coverage is available to them. Rhode Island is one of the few states that licenses international board-certified lactation consultants, or IBCLCs. Although beneficial in improving the standardization and quality of care, licensing makes it more difficult to enter into the field due to strict clinical requirements, which perpetuates existing demographic gaps.
To overcome this gap, hospitals should fund IBCLC certifications and promote mentorship programs aimed at meeting clinical requirements for licensure, focusing especially on diversifying representation in the field. Hospitals must also simplify the referral process, plan for continued care in discharge appointments, and provide outreach in underserved communities to prevent the decline in breastfeeding continuity.
Although Rhode Island is a leader in breastfeeding initiation, it fails at supporting breastfeeding long term. Underutilization of covered preventative services increases healthcare expenditures and worsens outcomes. Training more IBCLCs is a win-win proposition, optimizing health coverage and promoting health equity.
Kathryn Ditrano is a senior studying biology and health policy and management at Providence College. She lives in Glen Head, N.Y.
