Reaching Teen Moms with Breastfeeding Education & Support

Historically, breastfeeding rates among teens are lower than other subsets of women in the U.S. The decision to breastfeed can seem overwhelming for young parents struggling to balance multiple priorities. Although many organizations work to improve breastfeeding rates, few offer programs tailored to teen moms. TOPS instituted systemic and environmental changes to meet teen needs.

Teen Outreach Pregnancy Services (TOPS) is a community based organization with multiple service locations in Arizona. For 15 years, TOPS has served primarily low income, minority households who are vulnerable to poor health outcomes. TOPS receives 300 new enrollments annually, and at any given time, approximately 500 young women are actively engaged in the program. Teens and young adults are provided with education and tools required to make informed decisions about pregnancy, parenting, and sexual health. TOPS focuses on addressing structural barriers that prevent teen moms from breastfeeding, while creating stronger support networks in the community for young women and their families. While there is limited data on teen breastfeeding rates in the state of Arizona, the most recent data from the 2014 National Immunization Survey indicates that women under age 20 initiate breastfeeding at 58.6%, which is significantly below the national average of 80% for all women. Breastfeeding duration also represents a challenge among teens, 29.2% of women surveyed nationally reported breastfeeding for12 months, but among those under 20 it was less than 5%. Across all core breastfeeding indicators, adolescent mothers have depressed breastfeeding rates. This data likely persists throughout Arizona, and anecdotal evidence from TOPS corroborates this assertion.

Through a cooperative agreement between the Centers for Disease Control and Prevention (CDC) and the National Association of County and City Health Officials (NACCHO), TOPS received funding to increase the availability of evidenced based peer and professional lactation support services to pregnant and parenting adolescents in their service communities of Pima and Maricopa counties. Through a set of policy, system and environmental changes, TOPS sought to normalize breastfeeding by updating education materials, enhancing staff capacity, and building community partnerships to strengthen care continuity. Updating policies through formal memorandum of agreements allowed for enhancement of partnerships with the Pima County Health Department, the Arizona Breastfeeding Coalition, the Nurse Family Partnership Home Visiting Program, the Women, Infant and Children (WIC) agency, and several local hospitals. Cross promotion of activities with the Pima County Health Department and the Arizona Breastfeeding Coalition led to increased awareness of the services available to teen moms in the community. Partner hospitals assisted with flyer distribution, patient referrals to TOPS lactation consultants, and provision of meeting space for TOPS pregnancy and childbirth classes. These policy and system shifts enabled TOPS and WIC to develop a mutually beneficial partnership that increased interagency referrals.

During the 17-month breastfeeding demonstration project, TOPS provided lactation promotion and support services to 388 teen moms. Ninety-one percent of these moms initiated breastfeeding, which is substantially higher than the national teen average. TOPS hosted 194 support groups, and extended drop-in lactation support to the surrounding community through its partnerships. By training nurses, health educators, and a broad section of frontline staff in breastfeeding promotion and support, TOPS increased its organizational capacity and enhanced the service environment to support adolescent moms with breastfeeding. Three staff members became International Board Certified Lactation Consultants (IBCLCs). The pregnancy curriculum was revised to include a comprehensive breastfeeding education component. Data collection systems were updated, enabling staff to document client breastfeeding status at hospital discharge, during home visits, and at monthly check-ins. Through education, partnering and creating system and environmental shifts, TOPS reached moms early in their pregnancy and provided support to allay fears and misconceptions about breastfeeding. One 17 year old participant stated, “I came from a family that formula fed all the kids. Breastfeeding was something I never really knew was an option. They allowed me to understand the benefits to breastfeeding. They also helped me get my family to support that decision.”

The systemic shifts instituted by TOPS contributed to the success of the project by increasing availability of breastfeeding promotion and support services. Effective use of social media and texting allowed adolescent parents to readily obtain virtual breastfeeding support. TOPS breastfeeding messages, which were specifically tailored to young adults, proved effective, and the updated pregnancy curriculum allowed for early education and normalization of breastfeeding. Organizations targeting adolescents for lactation support or other health services should offer care through multiple support systems and utilize diverse messaging platforms with communications crafted for youth. Leveraging resources from multiple institutions and forging partnerships within the community-based organizations play important roles in ensuring sustainability of breastfeeding support programs. To improve the overall service environment, it is critical to earmark funds for breastfeeding professional development opportunities for all staff without limitations to IBCLCs only. Availability of both peer and professional staff contribute to higher rates of breastfeeding. While breastfeeding barriers faced by teens are not entirely different from those experienced by older women, adolescents often do what their friends are doing. Organizations should promote successes, as every successful breastfeeding story can influence another girl’s decision to breastfeed and create a culture of acceptance and preference for breastfeeding.