Improving Access to Medical Lactation Support and Counseling: Building the Case for Medicaid Reimbursement

Abstract

Objectives While the Affordable Care Act improves access to lactation services for many women across the US, low-income mothers in states without Medicaid expansion lack coverage for lactation support. As these states consider individual Medicaid reimbursement policies, the availability, effectiveness, and cost-benefit of lactation services must be evaluated. We conducted such an analysis for low-income mothers in North Carolina (NC), providing a model for other states. Methods First, we analyzed the distribution of NC International Board Certified Lactation Consultants (IBCLCs) and county-level breastfeeding rates among low-income infants. Logistic regression was used to examine the association between IBCLC density and six-week breastfeeding duration. Finally, state advocates collaborated on a cost-benefit analysis of Medicaid coverage of IBCLCs. Results Maps of the NC breastfeeding support landscape indicate that IBCLCs are available to provide services to low-income women across the state. Compared to counties with no IBCLCs, those with high IBCLC density were found to have a six-week breastfeeding prevalence ratio of 1.20 (95% CI: 1.12, 1.28). Medicaid reimbursement of IBCLCs showed an estimated annual cost savings of $2.33 million. Conclusions In one state without Medicaid expansion, we found that breastfeeding support resources are available across the state, high density IBCLC support is associated with increased breastfeeding by low-income mothers, and services are cost-effective. Our model for Medicaid reimbursement in NC provides a framework for states to improve equity in access to optimal lactation support.

Positive Emotions During Infant Feeding and Breastfeeding Outcomes

“…While breastfeeding rates in the Southeast are lower compared with other regions of the United States, breastfeeding rates in North Carolina are the highest in this region, with approximately 85% of women ever breastfeeding and 27% exclusively breastfeeding at six months (Centers for Disease Control and Prevention, 2018). Women living near Chapel Hill have been found to have greater access to Baby-Friendly Hospitals and IBCLCs compared with women in other areas of the state (Liberty, Wouk, Chetwynd, & Ringel-Kulka, 2019;Wouk, Chetwynd, Vitaglione, & Sullivan, 2016). Women were recruited for this study from study fliers and obstetric or psychiatric visits at clinics affiliated with the University of North Carolina Hospital, a Baby-Friendly hospital, between May 2013 through April 2017.…”

Geographic Access to International Board-Certified Lactation Consultants in Pennsylvania

“…Grubesic and Durbin (2016) similarly reported a positive association between IBCLCs per capita and county-level breastfeeding initiation rates in the state of Kentucky. Wouk, Chetwynd, Vitaglione, and Sullivan (2017) found that that a higher density of IBCLCs was associated with higher breastfeeding rates at 6 weeks in North Carolina. These correlations in cross-sectional analyses are not proof of causation-increased proximity and density of IBCLCs may be associated with higher breastfeeding rates due to higher community socioeconomic status or more breastfeeding-friendly medical communities.…”

Sex Differences in the Social Ecology of Breastfeeding: A Mixed Methods Analysis of the Breastfeeding Views of Expectant Mothers and Fathers in the Us Exposed to Adversity

“…Moreover, mothers in low-income populations experience shorter maternity leaves and inflexible employment environments, which ultimately shorten breastfeeding duration (US Department of Health and Human Services, 2011). This effect is especially true for women experiencing high psychosocial distress (Guendelman et al, 2009) and for those who lack lactation support (Wouk et al, 2017). For women, factors that are associated with higher levels of breastfeeding include whether the mother was breastfed herself (Dunn et al, 2015), whether the father of the infant is supportive of breastfeeding (Alexander et al, 2010b) and availability of lactation support (Wouk et al, 2017).…”

“…This effect is especially true for women experiencing high psychosocial distress (Guendelman et al, 2009) and for those who lack lactation support (Wouk et al, 2017). For women, factors that are associated with higher levels of breastfeeding include whether the mother was breastfed herself (Dunn et al, 2015), whether the father of the infant is supportive of breastfeeding (Alexander et al, 2010b) and availability of lactation support (Wouk et al, 2017). Lack of education about the benefits of breastfeeding is another possible contributor to low breastfeeding rates in low-income populations.…”