Experiences of Lactation Support Among Medicaid-Insured Mothers in Louisiana

Louisiana's breastfeeding rates are lower than most states, and even lower among its Medicaid members. Louisiana's Medicaid program does not cover outpatient lactation services, although expanded access to lactation providers could increase breastfeeding exclusivity and duration for women of diverse backgrounds. The purpose of this study was to explore the views of stakeholders in lactation support for Louisiana's Medicaid-insured women and increase our understanding of current barriers and opportunities to improving outpatient lactation support and decrease racial disparities in breastfeeding.

Focus groups included lactation providers, breastfeeding Medicaid members, maternal and child health clinicians, and maternal health program staff from Medicaid Managed Care Organizations. Participant recruitment occurred in each region of the state. Focus group topics included breastfeeding supports, challenges, systemic barriers, and best practices. Two researchers independently analyzed focus group transcripts and coded them thematically.

Six focus groups were conducted with 44 total participants. Four themes emerged from discussions including: (1) financial barriers, (2) systemic and logistical issues, (3) remote care and social media, and (4) social and emotional isolation. Participants described barriers in each category that contributed to early breastfeeding cessation and preventable social and emotional distress.

Louisiana's lactation providers have training, experience, and desire to improve breastfeeding rates, but Medicaid-insured mothers lack access to this workforce. By understanding the current challenges experienced and strategies employed by lactation professionals and their clients to connect to one another, future policies may be developed that facilitate the delivery of timely and appropriate lactation support.