Human Milk Feeding in San Francisco County

Landscape analysis of breastfeeding Breastfeeding coalition building

The issue: Disparities in breastfeeding rates

UCSF California Preterm Birth Initiative (PTBi) produced a landscape analysis for the San Francisco Department of Public Health that outlines the strengths, resources, and needs of the community with regard to human milk feeding. This work included identifying the community-based groups, hospitals, outpatient clinics, child care centers, and individuals that are authentically engaging with Black mothers and birthing people. The project team also engaged those who are passionate about improving lactation rates in their community. Now these individuals and organizations have been identified, the work to understand the challenges and barriers to successful human milk feeding can begin as the Department of Public Health relaunches the San Francisco Breastfeeding Coalition.

Nationally, approximately 84% of women breastfeed. However, per the 2020 CDC Breastfeeding Report Card, only 47% and 27% of mothers were still exclusively breastfeeding three months and six months after birth, respectively. In San Francisco, 94% of mothers surveyed intended to breastfeed after birth, and 70% of those women hoped to exclusively breastfeed. Yet, the most recent Maternal Infant Health Assessment (2016-2018) shows that after three months postpartum, 87% of mothers in San Francisco were still breastfeeding, but only 39% were exclusively breastfeeding.

When these data are explored even further, disparities and inequities become apparent. Black women in San Francisco breastfeed at much lower rates than Hispanic, Asian/Pacific Islander, and white mothers. Only, 67% of Black mothers are feeding human milk to their infants three months after birth in San Francisco, compared to 82% of Hispanic mothers, 86% of Asian/Pacific Islander mothers, and 91% of white mothers. These rates are even lower when comparing exclusive breastfeeding rates.

The team interviewed:

Hospital administrators, clinicians, and those involved with care at hospitals,
Community-based organization leadership, lactation consultants, and program managers, and
Parents who gave birth in San Francisco County in the past five years

Key Findings

Provider education around lactation feeding greatly varies depending on the provider’s specialty area and on their personal interests.
Due to inconsistency in education and training relating to lactating practices, many providers and workers who work with families have very different perspectives and approaches to supporting families.
While providers’ approaches to patient education and support varied widely, almost all had a strong desire to provide or recommended culturally-congruent, prenatal discussions that normalized breastfeeding for the birthing person, their families, and communities.
Returning to work was identified as a challenge and barrier faced by new moms and postpartum people, with little actualization of legal protections and low provider knowledge about supporting these families.

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