Telelactation and Breastfeeding Outcomes among Low-~Income Mothers in Mississippi: A Retrospective Cohort Study

Aaron Thomas Hunt


New mothers are recommended to exclusively breastfeed their infants for the first six months to provide optimal health for infant and mother. However, only 13.0% of mothers in Mississippi reached this milestone among infants born in 2015, which was far below the Healthy People 2020 objective of 25.5%. One factor that impacts breastfeeding success is access to certified lactation consultants, but low-income women may lack access due to an inadequate number of providers, unreliable transportation, rural location, or cost. The use of “telelactation” programs, which provide access to lactation consultants via video conferencing on internet connected devices, has been suggested as a potential solution to overcome these barriers. This prompted the Mississippi Women, Infants and Children Program (Mississippi WIC Program) to provide participants with free access to the Pacify “telelactation” application, which provides 24-hour access to video conferencing sessions with International Board Certified Lactation Consultants (IBCLC) via smartphones. Between June 2016 and May 2018, all pregnant and postpartum women enrolled in WIC were provided the opportunity to freely download the Pacify application. A retrospective cohort study was conducted to evaluate breastfeeding duration and exclusivity among women downloading the application compared to women not utilizing the application. Only women that initiated breastfeeding were included in the study due to the focus of the application in providing breastfeeding support. Rates of any breastfeeding (minimally, partially, and fully) and exclusive breastfeeding (fully) were compared between groups. Data were analyzed with logistic regression to compare rates of any or exclusive breastfeeding at three and six-months between groups. A total of 10,912 women were included in the study, of which 819 (7%) downloaded the Pacify application. Women downloading the Pacify application had significantly higher rates of any breastfeeding at three months (odds ratio [OR] 1.74, confidence interval [CI] 1.50-2.03) and six months (OR 2.01, CI 1.71-2.36) and exclusive breastfeeding at three months (OR 2.47, CI 2.09-2.92) and six months (OR 2.06, CI 1.64-2.59) even after controlling for confounding demographic factors. The number of times the Pacify application was used was not significantly associated with any (p=0.14) or exclusive (p=.049) breastfeeding at six months. This study demonstrated a positive association between downloading the Pacify application and breastfeeding duration and exclusivity. However, uptake of the application was low and increased number of calls was not significantly associated with breastfeeding. The results of this study may also be overestimated due to selection bias. These findings may not be generalizable to higher-income populations, or even other WIC populations. This study was significant because it was to explore the impact of a “telelactation” program on breastfeeding rates among low-income women enrolled in a WIC program, and the first conducted in the state of Mississippi. The results can be used by WIC programs, public health professionals, and policy makers when designing programs to improve access to lactation consultants among low-income or rural populations. Future research should utilize randomized controlled trials among populations with low access to IBCLCs to determine the effectiveness of the application in improving breastfeeding rates, knowledge, attitudes, and behaviors.