The Affordability of Latation Support: A Multi-State Survey

ABSTRACTMara K. Early: The Affordability of Lactation Support: A Multi-State Survey(Under the direction of Eric A. Hodges, PhD, FNP-BC, FAAN) Despite well-established health benefits of lactation for both parents and infants, rates of exclusive lactation in the United States remain far below recommendations from the World Health Organization and the American Academy of Pediatrics. Financial barriers to outpatient lactation support—specifically International Board Certified Lactation Consultant (IBCLC) counseling and double electric breast pumps—may contribute to early lactation cessation, yet few studies have examined these barriers across multiple states or insurance types.This dissertation examined how differences in insurers’ implementation of the Affordable Care Act are associated with the affordability of outpatient IBCLC counseling and lactation supplies, and how affordability and insurance type relate to individuals meeting personal lactation goals and achieving exclusive lactation for the first six months. Guided by Dynamic Systems Theory, this cross-sectional study used a newly developed survey to collect data from 471 first-time lactating individuals residing in Wisconsin, New Jersey, and Georgia. Descriptive analyses, bivariate analyses, and logistic regression were used to examine associations among affordability, insurance type, socioeconomic factors, and lactation outcomes.Results indicated that more than one-third of participants delayed or did not receive IBCLC counseling due to cost, coverage limitations, or access barriers. Nearly half of respondents spent money on a double electric breast pump, and over one-third reported spending more on lactation supplies than expected, with many experiencing financial strain as a result. Participants with commercial insurance were significantly more likely than those with government insurance to meet their personal lactation goals, achieve six months of exclusive lactation, and breastfeed for a longer duration. Difficulty affording lactation supplies was independently associated with lower odds of meeting personal lactation goals, even after controlling for socioeconomic factors.Findings highlight persistent financial and insurance-related barriers to lactation support despite federal coverage mandates. Addressing affordability through improved insurance standardization, enforcement of existing policies, and expanded access to outpatient lactation services may reduce inequities and improve lactation outcomes.