Breastfeeding provides unique and profound maternal and infant health benefits. If 90% of US parent-
infant dyads breastfed exclusively for the first six months and supplemented through 12 months, 2600 excess
maternal deaths and 721 infant deaths could be averted each year. Despite these substantial health benefits
conferred by breastfeeding, only 45% of US birth parents meet this 6-month goal, and parents of color and
those in low income families face additional barriers to breastfeeding success, resulting in double the risk of
infant morbidity and mortality. Clinically-integrated breastfeeding peer counseling (ci-BPC) has been shown to
effectively promote racial and economic equity in breastfeeding outcomes. Despite the demonstrated
effectiveness of ci-BPC, there remain critical knowledge gaps regarding program design and costs. Thus, the
scientific objective of this K01 application is to evaluate the implementation of an effective ci-BPC program
and determine the essential program activities, identify significant patient-level and contextual factors relevant
to implementation, and determine the economic impact of ci-BPC for patients, health systems, and society.
Closing these gaps in knowledge will support wider adoption of ci-BPC by providing a framework for
implementation and evaluation. My central hypothesis is that ci-BPC counselling increases patient
breastfeeding knowledge and social support, leading to increased empowerment and reduced stress, and that
the improvements in breastfeeding rates conferred by ci-BPC will be associated with lower cost of healthcare
utilization for infants in the first 6 months post-delivery. Specifically, I aim: (1) To determine the essential
program activities of an effective hospital ci-BPC program, identify relevant contextual factors, and adapt the
program to optimize breastfeeding outcomes for Black and Latinx patients; (2) To determine whether the
adapted ci-BPC program is more effective at improving breastfeeding outcomes, attitude, knowledge, and
support compared to standard prenatal care, and (3) To determine patient, program, healthcare, and societal
costs for ci-BPC. This project will evaluate an innovative hospital-based ci-BPC program at NorthShore
University HealthSystem that has demonstrated significant reduction in breastfeeding disparities. My intimate
role with this ci-BPC program and my expertise in mixed-methods field-based and clinical research has
equipped me with the skills to undertake such a project, but I need additional mentorship and training in
implementation science, clinical intervention research, and healthcare economics. The training and research
are significant because disparities in maternal and child health in the US are growing, and an evidence-basis
is essential to replicate and scale up interventions that promote health equity. This innovative research will
generate novel data regarding ci-BPC program design and economic impact of ci-BPC that will inform broader
implementation of this intervention. This application is responsive to SEN NOT-HS-21-014: AHRQ Announces
Interest in Health Services Research to Advance Health Equity.
