Virtual lactation support shows promise in increasing breastfeeding rates

Virtual lactation support shows promise in increasing breastfeeding rates

Mothers who received access to virtual breastfeeding support (or telelactation) through a free app reported more breastfeeding than counterparts who did not receive such help among Black mothers, according to a new RAND study.

Researchers presented the results of the first large study of telelactation services and found that mothers who received access to video telelactation services reported slightly higher breastfeeding rates six months after birth than mothers who did not receive the service.

The study found that 70.6% of mothers who were given access to a telelactation app were breastfeeding at 24 weeks, compared to 66.8% of those who were not given access to the app. However, the results were not statistically significant.

The difference was much higher for black women. Among Black mothers who received access to free on-demand video visits, 65.1% reported breastfeeding, compared to 57.4% among Black mothers who did not receive access to these services.

The results will be published in the journal Jama Network Open.

Our results suggest that offering telelactation could be part of a comprehensive strategy to reduce racial disparities in breastfeeding rates. Telelactation has been positioned to have a meaningful impact on breastfeeding rates when paired with strategies to improve the use of the technology. “

Lori Uscher-Pines, the study's lead author and a senior policy researcher at Rand

Although continued breastfeeding provides health benefits for mothers and their infants, most people stop breastfeeding earlier than recommended, with members of minority groups having lower breastfeeding initiation and duration rates. For example, national surveys show that 49% of black infants are receiving breast milk at 6 months, compared to 61% of non-Hispanic white infants.

Telelactation, which supports parents with remote counseling and video lessons from trained lactation professionals, can increase access and convenience by allowing new parents to avoid traveling with their infants.

The use of telelactation has become widespread during the Covid-19 pandemic. 34% of mothers in the US reported video or telephone visits with lactation consultants in 2020-2021. Many insurers and public health programs now offer telelactation to augment or replace in-person breastfeeding support.

Despite this proliferation, little is known about the impact of telelactation on breastfeeding rates, how effectiveness may vary across populations, and its potential as a tool to mitigate breastfeeding disparities.

To better understand the issues, Rand researchers conducted a randomized controlled clinical trial of a widely used telelactation service (pacify Health) to examine whether such services could improve breastfeeding duration and exclusivity.

The pauses were set in the clinical trial of popular pregnancy apps that serve millions of users in the U.S. recruiting women in 39 states and territories with a lower density of certified lactation consultants in pregnancy tracking tools and educational content. All participants expressed intentions to breastfeed their babies.

More than 2,000 women were enrolled in the study in 2021 and 2022. Participants were randomly assigned to receive either a telelactation mobile phone app for free (treatment group) or an e-book on infant authorities (control group). All participants were followed for 24 weeks after birth.

The proportion of all participants who reported exclusive breastfeeding was 46.9% in the treatment group and 44.1% in the control group. The proportion of black participants exclusively breastfeeding was 42.7% in the treatment group and 33.9% in the control group.

Participants in the treatment group could decide whether and how often they wanted to use telelactation services. Among all participants who gained access to telelactation through the study, approximately half reported participating in video visits with a lactation consultant. The total number of visits attended by mothers did not vary significantly by race and ethnicity.

"We suspect that telelactation may have greater benefits among Black women because they have lower overall breastfeeding rates from baseline and may have access to in-person support for breastfeeding within their usual medical care," US-Pines said. “Offering telelactation may address a gap in access to professional support that may be broader among Black women.”

Researchers say future research should test standalone and multicomponent interventions to address parents' barriers to breastfeeding. Additionally, research should examine the cost-effectiveness of different telelactation models to inform implementation and payment decisions.

Support for the study was provided by the National Institute of Nursing Research.

Additional authors of the study include Kandice Kapinos, Molly Waymouth, Khadesia Howell, Gaby Alvarado, Rhianna Rogers, Kortney Floyd James and Maria Deyoreo, all of Rand; Kristin Ray of the University of Pittsburgh; Jill Demirci of the University of Pittsburgh School of Nursing; and Ateev Mehrotra of Brown University.

Rand's Social and Economic Wellbeing Department seeks to actively improve the health and social and economic well-being of populations and communities around the world.

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