Improving Access to Breastfeeding Support: The Mother’s Milk Connection Project

Research Team

Urmeka Jefferson, Fellow & Principal Investigator, Rush University College of Nursing
Wrenetha A. Julion, Mentor, Rush University College of Nursing
Michael Schoeny, Statistician, Rush University College of Nursing

Project Period

7/1/2021 - 6/30/2024

Funding Source

Gordon and Betty Moore Foundation
Betty Irene Moore Fellowship for Nurse Leaders and Innovators


The American Academy of Pediatrics recommends exclusive breastfeeding for infants until approximately 6 months of age. Current breastfeeding initiation rates in the U.S. have reached 84%, but drastically decline to 25% for exclusive breastfeeding through 6 months of age. Significant racial and geographical disparities also persist despite breastfeeding promotion endeavors. Breastfeeding rates have fluctuated over the last 6 years with African American (AA) mothers consistently having the lowest rates of all mothers. In Illinois, White mothers initiate breastfeeding at a rate of 81% compared to 58% for AA mothers. This gap continues for exclusive breastfeeding through 6 months with a substantial decline to 20% for White and 9% for AA mothers. Although more White mothers initiate breastfeeding, many mothers of both races discontinue exclusive breastfeeding prior to 6 months. The significant decline in breastfeeding rates is in part attributed to mothers not receiving the help needed during the critical time immediately after birth. Breastfeeding is associated with reduced risk of sudden infant death syndrome, infections, and childhood obesity for infants and breast cancer for mothers. Considering the long-term benefits of breastfeeding to the health of infants and mothers, early cessation of breastfeeding is a public health crisis. It is essential to address low breastfeeding rates with interventions appropriate for all women. Even so, disparities in morbidity and mortality outcomes in AA infants suggest that it is particularly important that interventions resonate with the cultural and contextual experience of AA mothers.

In order to increase breastfeeding initiation and duration and reduce disparities, evidence suggests that strategies should include a multimodal approach combining several successful interventions such as education with peer and professional support. Communities with the lowest breastfeeding rates are less likely to have access to successful evidence-based interventions, thereby compounding the deleterious impact on mothers and infants. Therefore, I developed the Mother’s Milk Connection (MMC) app to bridge the gap in breastfeeding support from hospital to home and promote convenient access to community services. The MMC app is inclusive of components that provide education, a feeding log, peer support, and video conferencing with a breastfeeding professional. A mobile website and app prototype were developed and tested in a pilot study by 17 breastfeeding mothers. Mothers valued ready access to all components of the app that they could use when needed. Peer support was identified as being most useful followed by the electronic breastfeeding log to record feedings and infant output. Suggestions for improvements included enhanced tracking for pumped breast milk, infant weight, breastfeeding goals, a unique user ID for peer support chats, and providing access during pregnancy. A user-centered design demonstrated that mothers found the use of mHealth technology for breastfeeding support to be highly acceptable. To promote health equity, additional upgrades are needed to customize education for improved health literacy and conduct formal usability testing with AA mothers.

The goal of this project is to refine the MMC app, conduct formal usability testing, and evaluate use in a primary care setting. A feasibility study will be conducted to explore recruitment, retention, utilization, protocol quality assurance, fidelity monitoring, and preliminary breastfeeding outcomes. After the project is finished, we anticipate establishing a mHealth breastfeeding care coordination model that combines multiple services essential for breastfeeding support. Our model can impact breastfeeding disparities, prevent illness, and promote health. Next steps would be to seek funding (i.e. NIH R01) for a RCT to test the effectiveness of the MMC app on breastfeeding outcomes.

The study will be conducted in 2 phases. Phase 1 (Aim 1) will employ a user-centered design process to ensure the app design is efficient, engaging, error tolerant, and easy to learn. In phase 2 (Aims 2 & 3), an explanatory sequential mixed method study guided by the theory of planned behavior will be conducted to assess delivery of the MMC intervention and data collection. Specific Aim 1: To evaluate usability of the MMC app. The MMC app will be reconstructed to include suggestions identified in the pilot study. Dr. Enid Montague will conduct a heuristic evaluation to review the interface and compare it to usability principles. AA breastfeeding mothers will be recruited from lactation and healthcare clinics to participate in usability testing. Quantitative and qualitative data will be collected to evaluate user performance and satisfaction. Specific Aim 2: To examine feasibility of the MMC mHealth intervention in a clinic setting. Primigravida women at 35-40 weeks’ gestation will be recruited from a primary clinic to use the MMC app prenatally through 6 months postpartum. Secure online surveys will be used to collect demographic data, infant feeding intentions, attitudes, self-efficacy, and breastfeeding initiation, duration, and exclusivity. Descriptive statistics will be used as indicators of feasibility and to describe the sample. Specific aim 3: To explore participant experiences of the MMC mHealth intervention. Qualitative data will be collected by individual interviews to identify factors that influence use of each component of the MMC app, data collection time point intervals, and study burden.