Mothers who were given access to virtual breastfeeding support (or telelactation) through a free app tended to report more breastfeeding than peers who did not receive such help, with a more-pronounced effect observed among Black mothers, according to a new RAND study.
Reporting results from the first large trial of telelactation services, researchers found that mothers who were given access to video telelactation services reported slightly higher rates of breastfeeding six months after giving birth, as compared to mothers who did not receive the service.
The study found that 70.6% of mothers who were given access to a telelactation app reported any breastfeeding at 24 weeks, as compared to 66.8% of those who did not receive access to the app. However, the findings were not statistically significant.
The difference was sharply higher among Black women. Among Black mothers who received access to free, on-demand video visits, 65.1% reported breastfeeding as compared to 57.4% among Black mothers who did not receive access to these services.
The findings are published in the journal JAMA Network Open.
"Our results suggest that offering telelactation could be a component of a comprehensive strategy to reduce racial disparities in breastfeeding rates," said Lori Uscher-Pines, the study's lead author and a senior policy researcher at RAND, a nonprofit research organization. "Telelactation is positioned to have a meaningful impact on breastfeeding rates when paired with strategies to enhance use of the technology."
Although sustained breastfeeding offers health benefits for mothers and their infants, most people stop breastfeeding earlier than recommended, with members of minority groups having lower rates of breastfeeding initiation and duration. For example, national surveys show that 49% of Black infants receive any breastmilk at 6 months compared to 61% of non-Hispanic White infants.
Telelactation, which provides parents with remote counseling and video instruction by trained lactation support professionals, may increase access and convenience because new parents can avoid traveling with their infants.
Use of telelactation became widespread during the COVID-19 pandemic, with 34% of mothers in the U.S. reporting participating in video or phone visits with lactation consultants in 2020-2021. Many insurance providers and public health programs now offer telelactation to augment or replace on-site breastfeeding support.
Despite this proliferation, little is known about the effect of telelactation on breastfeeding rates, how effectiveness may differ across populations, and its potential as a tool to mitigate breastfeeding disparities.
To better understand the issues, RAND researchers led a randomized controlled clinical trial using a widely available telelactation service (Pacify Health) to examine whether such services could improve breastfeeding duration and exclusivity.
Paticipants were recruited into the clinical trial via popular pregnancy apps that offer pregnancy tracking tools and educational content to millions of users in the U.S. Recruitment targeted women in 39 states and territories that have a lower density of certified lactation consultants. All participants expressed an intention to breastfeed their babies.
More than 2,000 women were enrolled in the trial during 2021 and 2022. Participants randomly were assigned either a telelactation mobile phone app free of charge (treatment group) or provided an e-book about infant care (control group). All participants were followed for 24 weeks after giving birth.
The proportion of all participants who reported exclusive breastfeeding was 46.9% in the treatment group and 44.1% in the control. The proportion of Black participants who reported breastfeeding exclusively was 42.7% in the treatment group and 33.9% in the control group.
Participants in the treatment group could decide if and how often they wanted to use telelactation services. Among all participants who received access to telelactation through the study, about half reported participating in video visits with a lactation consultant. The total number of visits that mothers participated in did not vary significantly by race and ethnicity.
"We suspect that telelactation may have larger benefits among Black women because, overall, they have lower baseline breastfeeding rates and may have reduced access to in-person support for breastfeeding within their usual medical care," Uscher-Pines said. "Offering telelactation may address a gap in access to professional support that perhaps is wider among Black women."
Researchers say that future research should test standalone as well as multi-component interventions to address the barriers to breastfeeding faced by parents. In addition, research should explore the cost-effectiveness of different models of telelactation to inform decisions about implementation and payment.
Support for the study was provided by the National Institute of Nursing Research.
Other authors of the study are Kandice Kapinos, Molly Waymouth, Khadesia Howell, Gaby Alvarado, Rhianna Rogers, Kortney Floyd James and Maria DeYoreo, all of RAND; Kristin Ray of the University of Pittsburgh; Jill Demirci of the University of Pittsburgh School of Nursing; and Ateev Mehrotra of Brown University.
The RAND Social and Economic Well-Being division seeks to actively improve the health, and social and economic well-being, of populations and communities throughout the world.
