Healthy People 2010 included the goal of increasing breastfeeding duration to 6 months for 50% of all mothers.  Other professional and national health organizations and the Health and Human Services Blueprint for Action on Breastfeeding recommend that women breastfeed exclusively for six months.  Increasing breastfeeding among low-income women is a priority, as disparities exist.  Only 20.1% of low-income women (on WIC) breastfeed for six months compared to 40.7 % of more affluent women.  Consistent, comprehensive, culturally sensitive breastfeeding support increases duration of breastfeeding, thus offering well-documented health benefits often specifically appropriate for low-income women.  Breastfeeding relates to lower formula cost, lower health care costs, and breastfeeding may be less time consuming.  These cost savings can potentially offset costs of breastfeeding promotion.  Facilitating breastfeeding among low-income women includes comprehensive and culturally relevant support in the hospital, during the first week postpartum, and periodic support in the mother’s home.  Nearly 35% of low-income women stop breastfeeding within eight days of delivery.  Repeated contact with supportive persons such as peer counselors and nurses, affects the duration and exclusivity of breastfeeding practice after the immediate postpartum period.  However, support for low-income women has been neglected and not made available because of generally unsubstantiated claims that it is not cost effective.  For this project the broad long-term objective is to determine the net cost savings of improved breastfeeding outcomes resulting from a community health nurse/peer counselor  breastfeeding intervention.  The breastfeeding intervention will use an enhanced traditional community health nurse/peer counselor (referred to as the Breastfeeding Support Team) home visit, which is no longer usual care for contemporary community health nursing practice, along with in-hospital and telephone support.  The overall hypothesis is the intervention group will have improved breastfeeding outcomes and will demonstrate a net cost savings over usual care.

Specific aim 1:

Examine the effect of a Breastfeeding Support Team intervention on duration and exclusivity of breastfeeding in low-income mothers.

Hypothesis 1:

A Breastfeeding Support Team intervention will result in longer duration of breastfeeding, and a higher percentage of exclusive breastfeeding at 3 and 6 months.

Specific aim 2:

2.         Determine whether a Breastfeeding Support Team intervention is associated with a net cost savings.

Hypothesis 2a, 2b:

2a.       A Breastfeeding Support Team intervention will result in decreased direct costs (formula, health care utilization) and indirect costs (time) of caring for the infant.

2b.       At one-year, the cost savings associated with the intervention will exceed the cost of the intervention.