Caitlin Cross-Barnet

The Differential Impact of WIC Peer Counseling Programs on Breastfeeding Initiation across the State of Maryland

This cross-sectional study examines Maryland’s women, infants, and children (WIC) breastfeeding initiation rates by program participation. The authors report on data regarding demographic and health characteristics and infant feeding practices for infants (n = 18 789) newly WIC-certified from January 1, 2007 to June 30, 2007. The authors compared self-reported, breastfeeding initiation rates for 3 groups: peer counselor (PC-treatment group) and two comparison groups, lactation consultant (LC), and standard care group (SCG). Reported breastfeeding initiation at certification was 55.4%. Multiple logistic regression analysis, controlling for relevant maternal and infant characteristics, showed that the odds of breastfeeding initiation were significantly greater among PC-exposed infants (OR [95% CI] 1.27 [1.18, 1.37]) compared to the reference group of SCG infants, but not significantly different between LC infants (1.04 [0.96, 1.14]) and the SCG. LC and SCG infants had similar odds of breastfeeding initiation. In the Maryland WIC program, breastfeeding initiation rates were positively associated with peer counseling. J Hum Lact. 25(4):435-443.

Early Postpartum: A Critical Period in Setting the Path for Breastfeeding Success

BACKGROUND In the United States, most mothers who initiate breastfeeding will either stop or begin supplementing with formula before their infants are 3 months old. Routine breastfeeding education and support following hospital discharge are critical to breastfeeding success. The purpose of this article is to identify this critical period for supporting and reinforcing breastfeeding. METHODS We will use data from participants enrolled in the Maryland State Program of the U.S. Department of Agricultures Supplemental Nutrition Program for Women, Infants, and Children (WIC). This cross-sectional study will explore whether breastfeeding patterns during the period between birth and postnatal WIC certification differ by participation in a local WIC agency that provides breastfeeding peer counselor support (PC) versus two comparison groups, the lactation consultant (LC) and standard care (SC) groups. RESULTS During 2007, 33,582 infants were enrolled in the Maryland State WIC program. Infant breastfeeding status was categorized as exclusively breastfeeding, partially breastfeeding, or not breastfeeding. At certification, 30.4% of infants were breastfeeding, 25.3% had been breastfed but had stopped before certification in WIC, and 44.3% never breastfed. The breastfeeding initiation rate was higher for the PC group compared with the LC and SC groups (61.6% vs. 54.4% and 47.6%, respectively; p < 0.001). Participants in the PC group were more likely to certify as exclusively and partially breastfeeding compared with the LC and SC groups (36.0% vs. 24.8% and 25.3%, respectively; p < 0.001). CONCLUSION Our analysis identifies a window of opportunity during which targeted contact with breastfeeding mothers could enhance longer-term breastfeeding rates.

Inequality and Innovation: Barriers and Facilitators to 17P Administration to Prevent Preterm Birth among Medicaid Participants

Objectives Strategies to prevent preterm birth are limited. 17 Alpha-Hydroxyprogesterone Caproate (17P) injections have been shown to be effective, but the intervention is under-used. This mixed methods study investigates barriers and facilitators to 17P administration among Medicaid and CHIP participants enrolled in Strong Start for Mothers and Newborns, a federal preterm birth prevention program. Methods Twenty-seven awardees with more than 200 sites in 30 states, the District of Columbia, and Puerto Rico enrolled approximately 46,000 women in Strong Start from 2013 to 2016. Participant data, including data on preterm birth and 17P, was collected for each woman. Intensive interviews (n = 211) conducted with Strong Start program staff and providers (n = 314) included questions about 17P provision. Results Of women whose data included a valid response regarding 17P initiation, 3919 had a prior preterm birth and current singleton pregnancy; 14.95% received 17P. Barriers to 17P administration include late entry to prenatal care, administrative burden of preauthorization, cost risks to providers, limits in scope of practice for non-physician providers, and social barriers among participants. Facilitators for provision include streamlined work flows and the option of home administration. Conclusions for Practice A universal insurance authorization process could mitigate many barriers to 17P use. Providers need continuing education regarding the effectiveness of 17P, and expanding scope of practice for non-physician prenatal care providers would increase access. Targeted program interventions can help to overcome social barriers Medicaid participants face in accessing care. Streamlined work processes and the option of home health services are two effective program-based facilitators for providing 17P to a Medicaid population.

A Qualitative Study of Black Married Couples’ Relationships With Their Extended Family Networks:

Historically extended family networks have been identified as contributing to the resiliency of Black families. However, little is known about how extended family networks impact the lives of Black married couples. What we do know largely stems from quantitative research. Using a thematic analysis of qualitative interviews, we examine extended family network relationships among 47 Black couples from the Contemporary Black Marriage Study who had been married for more than 5 years. Black married couples’ relationship with extended family networks affects the marriage through the following acts: (a) extended family living, (b) childcare, (c) advice and emotional support, and (d) interfamilial conflict. The four themes influenced Black marriages in various ways. This study has implications for social workers working with married couples.

Living Together Apart : Vivre ensemble séparés Une comparaison France-États-Unis

A partir de deux enquetes exploratoires menees parallelement aux Etats-Unis et en France, l’article propose de saisir les raisons qui conduisent certains couples de differents milieux sociaux a vivre toujours ensemble, sous le meme toit, tout en ne formant plus un couple. Les auteurs reperent les specificites de ces arrangements dans la periode contemporaine par rapport au passe, et en tirent un certain nombre d’hypotheses quant a la signification que prennent actuellement la cohabitation et le lien familial (comme combinaison de lien conjugal et de lien parental). Malgre des conceptions differentes du mariage et de la cohabitation dans les deux pays, les situations considerees comme « vivre ensemble separes » (living together apart, LTA) et le sens qu’elles revetent pour les interesses sont finalement assez proches de part et d’autre de l’Atlantique. Les recits des personnes concernees temoignent de l’importance des conditions economiques et materielles dans lesquelles se deploient les trajectoires conjugales, que ce soit pour acceder au mariage ou au divorce. Les repondants considerent qu’ils se sont installes dans ces arrangements familiaux de facon a preserver la fonction parentale et surtout le lien paternel, et par crainte des consequences economiques du divorce, crainte qui pourrait augmenter avec la crise.