2023 HSR&D/QUERI National Conference

1081 — Facilitators and Barriers to Breastfeeding in Veterans Using VA Maternity Benefits

Lead/Presenter: Jill Inderstrodt,  COIN - Indianapolis
All Authors: Inderstrodt J (Richard L. Roudebush VA Medical Center), Stryczek KC (VA Northeast Ohio Healthcare System) Vargas S (Miriam Hospital & Brown University Medical School) Crawford JN (Albuquerque VA Medical Center) Hooker T (Office of Health Equity, Veterans Health Administration) Kroll-Desrosiers AR (Central Western Massachusetts Healthcare System) Mattocks K (Central Western Massachusetts Healthcare System)

As with other specialty health care, the VA outsources obstetric care to community providers. However, the VA coordinates this care via designated maternity care coordinators (MCCs). Included in MCC services is lactation assistance, including breastfeeding support and supplies. The current study builds on previous breastfeeding research to describe the facilitators and barriers to breastfeeding experienced by Veteran mothers.

This secondary analysis of qualitative data was obtained from the COMFORT study, a national study conducted between May 2015 and March 2021 of Veteran mothers’ experiences with pregnancy and MCC support at 13 VA facilities. Qualitative data analyzed in the current study (n = 339) came from open-ended breastfeeding-related questions. Data were coded using deductive and inductive content analysis within a matrix framework to capture respondents’ experiences with barriers and facilitators to breastfeeding initiation and duration. The data were aggregated across sites and participants, then compared using demographic and other variables (race/ethnicity, living situation, deployment experience).

Many respondents expressed wanting to breastfeed. Knowledge of one’s ability to breastfeed or previous breastfeeding was associated with the decision to initiate. The most cited facilitators were the baby’s health and breastmilk as “better than” formula. Some participants noted family and spousal support as facilitators, and several respondents expressed appreciation for the VA’s provision of breastfeeding supplies. Respondents who had discontinued breastfeeding cited a lack of ability to breastfeed and/or physical or emotional factors as barriers. These barriers included perceived low milk production, postpartum depression, maternal health conditions, breast/nipple pain, and latching difficulties. White women were more likely than Latinx or Black women to cite the VA as a source of breastfeeding support, and Latinx women were least likely to identify cost as a benefit. Participants who had been deployed reported more challenges to breastfeeding and provided more detail about these barriers.

This study reinforces prior research showing that self-efficacy and social support influence breastfeeding practices, suggesting that facilitators common in the civilian context transfer to Veteran populations. It also reinforces findings of a previous study using COMFORT data in which unadjusted models showed living alone to be associated with a decrease in breastfeeding. Also consistent with prior research are findings that decreased self-efficacy and ameliorable physical challenges are commonly cited as barriers to breastfeeding in this Veteran population. Physical, emotional, and social support barriers can by addressed by MCCs through lactation support and connecting Veterans with one-on-one services. This study also speaks to the possible resilience of Veteran mothers who have been deployed: previously-deployed mothers in this study cited more and complex breastfeeding challenges, but were shown in extant studies to be more likely to breastfeed. Previously-deployed mothers could offer insight into the resilience factors at play in extended breastfeeding.

Although the VA MCC program has been codified via the Protecting Moms Who Served Act of 2021, discrepancies exist in the consistency of services between medical centers. This research can better inform MCC interventions that aim to support these veterans even when their obstetric care is obtained elsewhere.