An Examination of Breastfeeding Support Services in Perinatal Substance Use Disorder Treatment Programs in the United States

Background: Many perinatal substance use disorder (PSUD) programs are providing services to women with substance use disorders (SUDs) in the United States. Breastfeeding is associated with improved maternal and infant outcomes, yet breastfeeding rates are low in this population, and our understanding of breastfeeding support in PSUD programs is limited. Research Aim: To describe breastfeeding support services, and barriers and facilitators to improving breastfeeding support and breastfeeding outcomes within PSUD programs in the United States. Methods: From January to April 2024, a 61-item survey was sent electronically to a convenience sample of PSUD programs. Quantitative survey responses were analyzed using descriptive statistics to report frequencies. Open-ended survey responses were analyzed using content analysis. Results: Representatives from 35 programs across 16 states reported limited within-program lactation support with 10 (29%) having a lactation consultant on staff. Barriers to breastfeeding support include: complex medical and social challenges individuals with SUDs face, lack of provider/staff education, referral-based lactation consultants not attuned to the specific challenges of SUDs, disagreement among providers regarding breastfeeding support, and no or outdated policies which restrict breastfeeding. Suggestions for enhancing breastfeeding support included increasing postpartum support, inclusion of peer support, increasing provider/staff education on breastfeeding and SUDs, increasing understanding of lactation support during the birth hospitalization, and updating policies to allow more individuals with SUDs to breastfeed. Conclusion: Programs reported limited support for breastfeeding individuals with SUDs. More research is needed to explore how breastfeeding interventions tailored for programs may improve outcomes for individuals with SUDs.