Clinically integrated breastfeeding peer counseling to promote breastfeeding equity: Research protocol for patient-centered costs of infant feeding and lactation care

Despite national and international recommendations for exclusive breastfeeding to 6 months of age, 44% of infants receive no breastmilk at this important milestone, imposing a significant cost on the US economy vis a vis elevated cardiovascular, infectious, and metabolic disease burden for the mother and infant. However, interventions to increase breastfeeding also come with individual costs that may disproportionately impact parent-infant dyads with lower incomes. These costs may partially explain why dyads who are publicly insured are less likely to meet these breastfeeding recommendations. This paper describes the research protocol to calculate out-of-pocket and opportunity costs related to infant feeding in the Furthering Equity through infant feeding EDucation and S upport (FEEDS) study, a randomized controlled trial of clinically-integrated breastfeeding peer counseling (ci-BPC). We will recruit 990 pregnant individuals delivering across three hospital sites. This protocol will leverage the pragmatic randomized controlled trial of FEEDS. Detailed patient out-of-pocket and opportunity costs will be compared by feeding type (exclusive breastmilk, exclusive formula, mixed feeding). The large, racially and economically diverse sample will permit stratified analyses of patient costs by race and ethnicity, insurance status, and birth delivery site. Clinical trials registration number NCT05441709