By Harumi Reis-Reilly, MS, LDN, CHES, IBCLC, Lead Program Analyst, NACCHO, and Katie Galloway, MBA, RD, LD, IBCLC, Dakota County WIC Program

Dakota County Public Health Department (DCPHD) in Minnesota, a 2017 NACCHO Model Practice awardee, built upon their comprehensive breastfeeding program and implemented a rapid referral system to expand access to critical lactation care to low-income families. Through the Reducing Breastfeeding Disparities through Peer and Professional Support grant, DCPHD increased participation by 68% in prenatal breastfeeding classes and more than doubled their rapid-response lactation visits.

DCPHD provides many services to the large underserved members of its community, especially pregnant women and new mothers. For example, in 2010, about 33% of babies born were to low-income women on Minnesota’s Medicaid Program. Dakota County WIC participants started breastfeeding at high rates (85%) in 2013, however only 38% of them were still breastfeeding at six months. While breastfeeding initiation among African

Americans in the Dakota County WIC program are among the highest in Minnesota, there are concerning inequities related to the exclusively breastfeeding rates. For instance, according to the WIC database, African American clients are more than four times less likely to exclusively breastfeed than white, non-Hispanic women.

One of the reasons for low exclusivity breastfeeding rates among African American moms was the limited availability of affordable lactation support services in Dakota County. Hospitals and medical providers outsource prenatal and postpartum breastfeeding classes and support services to for-profit businesses, whose fees pose a financial barrier that prevents low-income families from receiving appropriate breastfeeding education and support. Due to staffing limitations and inadequate lactation training for public health professionals, there are few affordable breastfeeding services available in the area.

Although DCPHD’s family health nursing staff regularly promoted breastfeeding, only 8% of its staff had have completed advanced breastfeeding training. While all DCPHD WIC staff was trained at the Certified Lactation Counselor (CLC) level, staff and clinic scheduling constraints made it difficult to provide adequate support.

Prior to NACCHO funding, DCPHD led the Breastfeeding-Friendly Health Department initiative, designed to improve the breastfeeding environment and increase organizational capacity to support breastfeeding. This initiative was piloted in ten local health departments (LHD) in the state. Pilot sites implemented the ten-step protocol, including supportive policies and use of champions as outlined in the Breastfeeding-Friendly Health Department Toolkit. This program has been successful and is now recognized as a Model Practice, receiving the 2017 NACCHO Award due to its contribution to the overall improvement of public health through effective evidence-based practice methods. Watch their presentation here: Link to Dakota Presentation.

In 2015, with funds from NACCHO and the Centers for Disease Control and Prevention (CDC), DCPHD enhanced its comprehensive breastfeeding program by implementing a new component: the rapid response system. This initiative provided advanced lactation support by trained public health nurses within 24 hours of referral. The program addressed critical gaps in breastfeeding support services for African American, low-income, and underserved communities in Dakota County.

DCPHD works cooperatively with the Dakota County WIC program to support prenatal breastfeeding classes, since most DCPHD clients who are pregnant women and new mothers are also WIC participants. DCPHD also worked with Dakota County’s 360 Communities, a faith-based organization, and the Community Action Program to provide breastfeeding education training to home visitors with the goal of increasing the provision of lactation education among nursing mothers.

DCPHD was able to meet the identified community needs of access to immediate, critical support through the implementation of the rapid-response to lactation referrals. DCPHD increased organizational capacity by training 60 staff members on basic and advanced lactation management. This increased number of available trained lactation support providers led to greater availability of free-of-charge breastfeeding classes throughout the community, and a 68% increase in participation in classes. In addition, the rapid referral system more than doubled the number of rapid-response lactation visits (from 2.8 to 6.9 visits/month) during the grant period.

In addition to training public health nurses who visit clients, DCPHD was also able to build on the capabilities of additional home visitors, enabling them to provide basic lactation support and make appropriate referrals to sustain breastfeeding.

Since Dakota County already had a foundation of supportive policies and systems in their Breastfeeding-Friendly Health Department before NACCHO’s grant, they were able to build upon this supportive environment and quickly implement additional components to its program. The key factors in their success were the supportive leadership within the organization, the previously built foundation of implemented policies and systems, and prior key partnerships with WIC and a home visiting agency.

For more information, contact: Katie Galloway, MBA, RD, LD, IBCLC; Dakota County WIC Program; [email protected]