For infants, breast milk is the first line of defense against infectious diseases, asthma, sudden infant death syndrome (SIDS), obesity, and type 2 diabetes mellitus (T2DM) (Centers for Disease Control and Prevention [CDC], 2023). The benefits also extend to mothers who breastfeed, including a reduced risk of breast and ovarian cancer and a decreased risk of obesity over a lifetime (CDC, 2023). While the medical and public health communities remain steadfast regarding the benefits of breastfeeding for both mother and baby, there are many barriers related to access, policy, and care. The literature indicates disparities in breastfeeding education and care, resulting in alarmingly low initiation and continuation rates (Kopp et al., 2023; Marks et al., 2023). This raises questions of why, despite the focus on child health and nutrition, breastfeeding access is not equitable for all and what can do to improve it.

Acknowledgment of low breastfeeding rates and high prevalence of infant morbidity and mortality in the U.S. led to 2011 being a pivotal year for breastfeeding health promotion. The U.S. Department of Health and Human Services published The Surgeon General’s Call to Action to Support Breastfeeding, and August was designated as National Breastfeeding Month by the U.S. Breastfeeding Committee. Breastfeeding and breastfeeding access remain hot topics in the U.S. due to improvements made through public health programs, but the increase in breastfeeding is still disproportionate for under-resourced communities.

The Healthy People 2030 Initiative set a target of 54.1% for infants who are exclusively breastfed at 1 year of age (Office of Disease Prevention and Health Promotion [ODPHP], n.d.). Current statistics for 2020 show this metric at 37.6% for all women who breastfed, with disaggregated data showing 26.8% for Black and African American women (ODPHP, n.d.). The disparity in breastfeeding rates is detrimental to vulnerable communities, which are disproportionately affected by reduced access to social determinants of health known to be mitigating factors for many health concerns. Vulnerable communities are often also medically underserved, with a high prevalence of poor health outcomes for infants and children.

There are many approaches to breastfeeding health care, but the most effective approach would be one that is multifaceted, targeting improvements in health care infrastructure and community empowerment. Through practice and research, gaps in continuity of care have been identified as being a leading factor in breastfeeding discontinuation (National Association of County and City Health Officials & United States Breastfeeding Committee, 2021). To be effective, continuity of care must maintain collaborative and continuous delivery of services for families during the first 1000 days from pregnancy to the child’s 2nd birthday. Being that maternal and pediatric care are decentralized, and often limited in under-resourced communities, it is pertinent for care providers to have a shared approach. In addition to the collaborative efforts of care teams, establishing supportive environments where families live, work, and play through implementation of organizational policies systems and environmental solutions should be a priority of local communities.

Each year the U.S. takes steps forward in improving breastfeeding equity through high-level public health programming such as the Special Supplemental Nutrition Program for Women, Infants and Children (WIC), Baby-Friendly Hospital Initiative and 10 Steps to Successful Breastfeeding. Although these have been great supports for breastfeeding initiation, the rate of continuation drops significantly in the months following birth for under-resourced communities. Identifying this gap paves the way for health practitioners and local communities to work together to assess and pinpoint high need targets for program implementation, improving the transition from clinical to the community environment.