Six for Success: A Policy Strategy to Increase Exclusive Breastfeeding to Six Months in North Carolina

Exclusive breastfeeding through six months is recommended to reduce the risk of adverse health outcomes for infants and mothers. Black mothers in North Carolina disproportionately experience breastfeeding disparities that result in early breastfeeding cessation. Systemic barriers, including inadequate access to lactation services, drive these inequities. This thesis will examine policy recommendations aimed at increasing exclusive breastfeeding rates in North Carolina, focusing on Black mothers. Policies were assessed across affordability, impact, equity, and political feasibility. Our recommended policy is a Medicaid State Plan Amendment (SPA) to expand reimbursement eligibility to Certified Lactation Counselors (CLCs) and Certified Lactation Educators (CLEs). With an estimated three-year state cost of approximately 1. 25 million, this approach offers a cost-effective, equity-centered strategy to expand access to culturally responsive lactation support across North Carolina.