Breastfeeding rate among low income women in Chicago are much low than those in the high income population. Most of these women in the low income areas in Chicago stop breastfeeding after a very short duration that is below six month period (WHO, 2003). Breastfeeding peer counseling encourages and support pregnant mothers and breastfeeding mothers. It is done by currently breastfeeding mothers and those who have done so in the past. These mothers must be well informed about the importance of breast milk to the infant. It includes individual counseling and mother to mother support groups. These groups undergo specific training to acquire knowledge and skills about breastfeeding and may work in informal group, visit other women in their homes, clinic and hospitals. Pear support includes education about breastfeeding, psycho-emotional support, help solving problems pertaining breastfeeding and encouragement
Breastfeeding is very crucial and beneficial to infants because it make them grow healthy because b mreast milk contains a lot of nutrients that increase body immunity that protects infants against some common childhood illnesses and infections. It protects an infant against inflammatory, autoimmune and malignant diseases thus impacting a longer term immune function. It also protects mother health because it minimizes chances of getting breast cancer. Therefore, women who don’t have health problems should try to breastfeed their children for at least the first six month of life but women with infectious diseases such as HIV/AIDS, active tuberculosis should not breastfeed because they will transmit infectious agents to the infants (Howard, et al., 1999).
Human breast milk has various immunological active compounds e.g. antimicrobial enzymes, leukocytes, and immunoglobulin. On top of that it contains tolerance promoting substances such as fatty acids, platelet activating factors interleukin-10. Once a child is born, it does not have a very strong immune system and the breast milk is the one that strengthens the immune system of the baby which makes it very essential to new born babies (Howard, et al., 1999).
To implement effective breastfeeding peer counseling, one should have clear understanding of the targeted group of which in this case is low income mothers in Chicago IL place. One should know their attitude in terms of how they perceive breastfeeding process and how they do it. Also challenges faced by this women and how to minimize them should be well highlighted. Again, in planning process, one should identify the key stakeholders and facilities available that will help to make this project effective and efficient.
Breastfeeding peer counseling do have great impact because it educate other women about the breastfeeding benefits and encourage one another to use appropriate measures such as prolonged breastfeeding and necessary items such as nutritious food to make it effective and beneficial to both mothers and children. It includes people who promote breastfeeding, facilitators, breastfeeding researchers and analysts.
Chicago IL community should be analyzed to identify their core values and norms pertaining breastfeeding. It will also help to understand their attitudes, occupation and interaction and relationship. This is to enable implementers to know appropriate strategy to follow to achieve the desired objective.
Attitude about breastfeeding has changed due to women’s role transformation in recent decades. Ninety one married women recruited during childbirth education classes in the Chicago metropolitan area survey, shows that most of the women developed positive attitude towards breastfeeding and bottle feeding.
Due to low income earned, Chicago women fail to access enough nutritious food rich of ions and calcium that help them produce quality and quantity breast milk. Therefore, they stop breastfeeding at an early weaning. On top of that, they are not capable of acquiring hospital based breastfeeding services because is too much expensive for them. Again they are not in the position to manage infectious diseases associated with poor breast feeding ways. These diseases include influenza, asthma and diarrhea.
Majority spend a lot of time in work place trying to gather enough for the family leaving their infants unattended. This is because they earn low wages and therefore they have to work overtime in order to raise enough to sustain their families. Alternatively they have to do more than one job per day to boost their surplus. Therefore, No much free time left for breastfeeding infants’ hence poor growth and development.
Peer pressure also interferes with breastfeeding whereby they advocate for early weaning. This has been like a code of conduct where every woman observes it. They believe that, if they prolong breastfeeding they end up getting old faster while young. Again they fear breastfeeding in the public areas because they consider it indecent. Sometimes, they are denied the right to breastfeed in working place by their employers
Low income women in Chicago are not well informed about the importance of prolonged breastfeeding and the possible problems that may arise if not well done. This is as a result of low level of education attainment because of low income that cannot cater for education expenses. Also they fail to understand about the health impacts to their children and to themselves such as low immune system and breast cancer respectively.
Aims and objectives
The main aims and objectives of this study on Breastfeeding peer Counseling Program is to be able to encourage breastfeeding among all the among low income women, Chicago, IL, and the promotion of the awareness of the benefits of breastfeeding by educating, advocating, facilitating and supporting the breastfeeding services. The among low income women, Chicago, IL, could choose to breastfeed their babies until they reach the age of 6 months and then after that, they would then continue giving the baby complimentary foods.
The overview of Breastfeeding Peer Counselor Program (BPC)
The Breastfeeding Peer counselor Program (BPC) is a program which is intended to target a population which is composed of low income women in Chicago hospital (Baby friendly support). This program is all about mothers helping mothers because the peer counselors of the program are mothers who have the experience of breastfeeding experience and knowledge and are out to help other mothers into the importance of breastfeeding their babies up to the age of about 6 months when the baby is old enough to be given complementary foods. These peer counselors are highly skilled since one has to have the minimum requirements to qualify to be a Breastfeeding Peer counselor.
The peer counselors of the program are mothers who have completed their high school certificate and have been trained in breastfeeding management where the peer counselor has to attend 30 hours classroom training from the program coordinator on breast anatomy, physiology, social factors, counseling techniques, and breastfeeding management. The peer counselor should have scored a score of about 85% and above on all the written exams that they are presented to during the training and also have a working experience of about 3-6 months of working with a qualified peer counselor. And to ensure that the peer counselor is well informed on the breastfeeding management, she should have at least 1 hour of continuing education and also work for at least 20 hours per week.
With the help of the BPC program, all the pregnant women can be able to get ready to breastfeed their babies once they are born. The pregnant women would be given counseling sessions on the importance of breastfeeding their babies and with this knowledge, they can know how breast milk is very essential to a baby. Through the program, the pregnant mothers will be able express all their thoughts and views on breastfeeding where the fearful mothers will be helped in overcoming their fears on breastfeeding so that they can be able to start it off with no fears.
The BPC program is very essential to a pregnant woman because it can help in the solving and the prevention of common problems. Some mothers worry too much and it makes their problems to become very complicated. With the help of these peer counselors, they can help the situation by referring the mother to a lactating specialist or Health Care Providers. The breastfeeding peer counselors play a very important role in the BPC program because they offer breastfeeding support and share all the information that they have on breastfeeding. The BPC program has support group meetings where very many breastfeeding mothers can meet and the peer counselors are always available to every breastfeeding mother and the pregnant women.
The Breastfeeding Peer Counselor can help a breastfeeding mother to be able to make a good choice concerning the breastfeeding of her baby and they are there to assist the mother with all the support regarding the decision that she has undertaken. The Breastfeeding Peer Counselor can help on how to hold the baby when breastfeeding, can help the working mothers on how to make a breastfeeding plan so that the mother can also continue to work when still breastfeeding the baby, and they provide a 24 hour support when needed since they are there to listen to all the concerns of the worried mothers.
Key stakeholders should be identified in Chicago in order to facilitate collaborative environment that will enhance effective and efficient implementation of breastfeeding peer counseling program. These include non-hospital breastfeeding group in Chicago, like for example the La Leche League which is the best known breastfeeding support group in the world. It was initiated by groups of moms in Chicago with an aim of supporting volunteers’ leader to run local groups for pregnant mother and lactating women .They held several meetings to discuss about different parenting ways e.g. sleeping duration, nutritious food, relationship and mother’s discipline pertaining breastfeeding.
The Abiyamo Omo Society at UIC Medical Center (Chicago, IL) is focused on supporting all breastfeeding mothers and to enhance natural parenting. They also offer knitting skills to mothers to enable them earn some income that is later used for purchasing nutritious food. Other non- hospital breastfeeding supporting groups include: Kick sprout at Family Grounds Cafe (Chicago, IL – near Lincoln and Addison), New Mother New Baby (Northbrook, IL), Breastfeeding USA Chapter, Lake County - Baby & Me, Be By Baby (Chicago, IL – Lincoln and Roscoe).
Also implementers should link with hospital based breast feeding support group such as: Adventists Hinsdale Hospital, Centegra’s Family Birth centers which also offer free breastfeeding support, Little company of Mary Hospital that offers new mothers an opportunity to exchange ideas and experiences, Sherman Hospital and St. Alexius Medical Center. These groups will take part in breastfeeding research and come up with possible solutions that can be used to enhance effective breastfeeding peer counseling in Chicago. Again they will help to mobilize Chicago mothers and other supportive group to work together in disseminating information about the importance of breast milk to the infants and how long infants should be breastfed.
In order to enhance effective implementation of breastfeeding peer counseling program, community members must be involved. They must participate right from the grassroots level where it pertains planning, strategizing, implementing evaluating, organizing and managing the program to enhance sustainability. As a result, even new generation will benefit from this project’s accomplishment such as increased awareness, positive attitude towards breastfeeding and breastfeeding services support. Men from different families should also participate in order to encourage their wives to breastfeed their children for at least 6 months duration. Again they will be informed about the most needed items that will help mother produce nutritive and plenty breast milk for their infants
Local health agents should be included to improve enthusiasm among breastfeeding peer counseling and coordination. This is done through disseminating important information pertaining breastfeeding such as breastfeeding referral places, nutritious information, breastfeeding problem and how it can be eradicated. Again they will help in creating awareness to all low income earners in Chicago using the most affordable and accessible communication channels such as telephone method
Furthermore, national leaders such as senates, local leaders such as chief, religious leaders such as bishops, experts such as data analysts, professionals such as facilitators and accountants, doctors and business managers should be involved too in implementing this project. They will help to mobilize people and resources leading to high achievement and collaboration. Also, they provide financial support to acquire necessary facilities and resources needed in implementing the project.
Government should also be involved to promote good environmental condition for business operation through taxation and enforcement of desirable policies that favor breastfeeding peer counseling process. It gives incentives that empower women economically making them able to access nutritive food and breastfeeding services that improves breast milk quality suitable for infant growth and development
Implementers should fully understand enacted breastfeeding laws in order to comply with the legal system requirement. For example Illinois has enacted several breastfeeding laws such as: breastfeeding is not a public indecency, authorizing public information campaign, providing for program in WIC for lactation support and accommodation for employed mothers who are breastfeeding.
Cook county Hospital 1980s’ report shows that, women involved in peer group discussion and education session breastfeed longer than those who did not participate in it. It is very clear that peer counseling has been found effective and beneficial to all women including low income earners in Chicago. Peer support has been used successfully by low income earners and is perceived vital for breaking down existing barriers within women social network among women of low income earners and middle income women because it promotes collaboration and participation.
Breastfeeding peer counseling has been of great help to women because large number of low income women have responded positively. The outcome shows that 84% of peer counseled women have initiated proper breastfeeding method leading to low infant mortality rate.85% of mothers who started peer counselors received great help and support to alleviate breastfeeding problem. About 66% of low income women in Chicago who received breastfeeding services from the peer counselor plan to breastfeed beyond six months and 33% decided to go beyond twelve months, which is a whole year breastfeeding. This is because peer counseling have persuaded them to do so through educating them about breastfeeding techniques, importance and nutritious knowledge.
Surveys shows that, low income women in Chicago received individual peer counseling which made them to breastfeed at one to three months postpartum than those who received only routine breastfeeding support especially middle income earner because it was much accessible and affordable to them. It is the role of the implementer to know the causes of breastfeeding problem and suggest alternative ways of alleviating it. Some women are denied right to breastfeed in work place by the managers because they argue that they are wasting too much working hours (James & Lessen, 2009). Therefore, women are forced to stop breastfeeding their infants before the completion of at least six month. Also place of worship has denied mothers right to breastfeed because they consider it holy and it should be used to worship God only.
Culture has been another factor that interferes with breastfeeding in Chicago area. Majority have inclined too much to cultural norms and behaviors which limit the breastfeeding period. This is because of static attitudes they uphold instead of adapting the modern ways of doing things and illiteracy level whereby they are not educated about breast milk content and how it is important to the infants because it boost body immunity, intelligence, growth and development. Breastfeeding research is very low among low income earners in Chicago because is beyond their ability. First they lack enough resources in terms of funds, research tools and equipment and skilled personnel. Secondly they lack motivation and support from the government. Therefore much of the important information about breast milk remains hidden leading to poor growth and development of infants.
In order to lessen this problem a lot needs to be done which include; Low income women should be encouraged to help one another through fundraising to enable young women access breastfeeding hospital service, prenatal education and breastfeeding teaching. More so it will enable mothers to access nutritious food that contributes to production of nutritive breast milk leading to healthy growth and development of infants. Awareness should be created to inform women breastfeeding benefits and negative impacts that might arise if appropriate breastfeeding precautions are not put into consideration. For instance, breast milk contains tolerance and anti-immune compounds that reduce the rate of asthma to the infants. Failure to do that, infants become susceptible to asthma and allergic diseases.
Competent Facilitators are also needed to gather the most pressing needs of the young mothers. He must be able to hold healthy discussion with the groups of women to here every one’s opinion and views. Also he should have ability to promote efficient and effective strategy to be followed to come to consensus. As a result women learn a lot from one another pertaining breastfeeding and they develop strong and healthy relationship hence promoting peer counseling.
Licensed dietitians and registered nurses should be used to disseminate nutritious information to all people in Chicago IL. This can be achieved through guidance and counseling, campaigns, public assembly, media, posters, interviews and discussion forums. Also they can be used to distribute food supplements that contain nutrients, vitamins, proteins, ions, calcium, magnesium that enhance wholesome production of breast milk.
Formulation, implementation and reinforcement of laws pertaining breastfeeding should be enacted. For example Breastfeeding women should have a right to breastfeed everywhere and at any time which includes worship places, public place e.g. market place and work place. Managers should give women more time for breastfeeding because it is important to both mothers and infants. Failure to this, justice should be enhanced through the court of law. Workplace Act that provides break time for nursing mothers should be observed. Also an employer should provide room
More women income generating projects should be initiated to empower women and make them financial stable to afford nutritious food (Mitra, et al., 2004). For example, knitting projects that enable low income earner generate more income that would be enough to cater for the family requirement including healthful food. Once more, they would have ability to access breastfeeding services. Also they can be encouraged to initiate women cooperative groups which will help in disseminating information about breastfeeding and giving guidance and counseling to all women in Chicago.
Knowledge should be imparted to Chicago mothers about the benefits of breastfeeding. They should know that, breastfeeding protects children against Diarrhea. Survey shows that, children less than twelve months have low incident of acute diarrhea diseases during the time they were being breastfed than children bottle fed. In addition, breastfeeding protect infants from hemophilic influenza (Mitra, et al., 2004).
The breastfeeding mothers and the pregnant women should be aware that breastfeeding enhance vaccine response by increasing the high rate of humeral immune. Breastfed children contains high level of antibodies thus shows better serum and secretory responses to perioral and parenteral vaccines than the formula fed Women should be informed that breastfeeding enhance child development and intelligent. Well breastfed children have high IQ level and cognitive development than formula fed infants. They also develop socially in terms of psychomotor and social capability.
Human milk transfer immunities to the external mucosal of intestine and also to the respiratory tract of the infants. The acquired immunity compound is particularly important in the early neonatal period before immune matures. Mother’s milk protects newborns from Herpes simplex virus 11 contamination Infectious mothers should also be guided not to breastfeed especially when they are infected with HIV (James & Lessen, 2009).
Participants must be recruited prenatally at Hospitals and must have the required criteria which specify that women must be at least 18 years old, come from low income women class, is a resident of Chicago area, they are available for telephone follow up, they must be considering breastfeeding their infants and not yet enrolled in the peer counseling program. This is done to enhance detailed information concerning infant breastfeeding so as to know what needed to be done to eradicate negative attitude towards breastfeeding among low income women in Chicago.
Participants of approximately about 200 mothers need to be randomized to either control group or the intervention group using computer software programs such as (SPSS, Version 10, SPSS Inc., Chicago, ILL). Cases should be entered into data file weekly and SPSS randomly selected approximately 50%. The selected case should be assigned to the intervention group which include; prenatal home visit, perinatal visit, 3 postpartum home visit and telephone contact as needed which were to be conducted at 1, 3, 6 months. After delivery, medical record should be reviewed to ensure that postpartum inclusion criteria are met which include; healthy full term singleton, absence of congenital anomalies and no maternal history of human immunodeficiency virus.
Key Processing Measures
Participant should be interviewed in the language of their choice i.e. English or Spanish by the field researchers or coordinators. Recruitment, demographic and infant feeding data should be collected too. Also participant should be interviewed regarding infant feeding methods, sources of prenatal and perinatal breastfeeding education and demographic details. In addition to this, medical record should be reviewed to know the number of infant mortality rate and breastfeeding recorded details. Participants can be interviewed monthly via telephone to obtain maximum information of 6 month postpartum on infant feeding practices
Implementation of breastfeeding peer counseling is not that smooth because is associated with barriers and challenges that face implementers. Some of these challenges include: Conflict among counselors and coordinators. Some sponsor’s agencies may demand more wages and salaries to help in peer counseling activities. Other disagree on appropriate method to use, some prefer home to home visit, clinic visit and other prefer telephone Services
Financial constraint is another challenge because peer counseling require funds so as to make if effective and efficient. This is because peer support group need to be trained first to enable them give quality and quantity information about breastfeeding. They need to be trained about breastfeeding management, infant growth and development, nutrition, counseling technique and criteria for making hospital referrals e.g. referral to International Board Certified Lactation Consultant (IBCL) in both individual and group settings. Peer counselors are supposed to be trained and be clinically monitored or overseen by professional in lactation management which include physician with specific training in skilled lactation care, nurses, IBCLC and nutritionist
Poor coordination and interaction is another challenge because in order to enhance effective and efficient implementation of breastfeeding project, there must be health link and collaboration with other groups. A lot of effort is required to sustain collaboration among; low income women, Hartford Hospitals, Hispanic Health Council and with the university of Connecticut’s Family Nutrition Program. It makes it so difficult to deliver Perinatal peer support to low income women in Chicago.
The father’s role was also to be considered in terms of their performance, involvement, support, and attitude. The fathers are assumed to be very supportive to the breastfeeding mother by encouraging the mother to breastfeed the baby until the baby is 6 months of age. This can make the mothers get the motivation to breastfeed their babies since they can also get support from home.
Impacts and Results
Peer counselors have helped low income mothers to understand the tips for how to breastfeed comfortably and discreetly even in public place such as public market. It has made low income women to gain courage of breastfeeding their children even when they are in the groups of people.
It has promoted good and close relationship between mother and the infants because breastfeeding mothers have learned important ways of staying close to their babies after work and after school. Again mother have known various ways of producing plenty and nutritious breast milk for their infant thus they cannot stay for long without breastfeeding hence close relationship with their children.
They have acquired a lot of ideas on how to obtain breastfeeding information and support from referral places, family and friends. As a result strong bond have been formed that link low income women with hospital based breastfeeding programs, university based nutritious programs and even community based breastfeeding institutions.
They have acquired ways to get good start with breastfeeding unlike before. Immediately after birth, nurses do provide written information pertaining proper breastfeeding ways (Howard, et al., 1999). Yet again they receive immediate breastfeeding support from the peer counselor who guide on the procedure to be followed on breastfeeding action.
They have known ways of making plenty of breast milk for their babies through taking in nutritious food. These nutritive food increase immunity system to the infant thus prevent chances of getting sick. Again wholesome breast milk facilitates healthy growth and development of infants (Howard, et al., 1999).
On the other hand, there is a very great negative impact to women who fail to breastfeed their children as required. They become prone of various cancers diseases such as breast cancer, ovarian cancer. This is because lack of breastfeeding leads to formation of cramps in the breast resulting to inflammation and death of body cells and tissues thus breast cancer.
According the World Health Organization (2003), children who were not breastfed have high tendency of contracting non communicable disease such as diabetes mellitus, leukemia and lymphoma. More so they have high rate of crohn’s disease, ulcerative colitis and celiac diseases. As a result this interferes with child growth and development (James & Lessen, 2009). Short period of breastfeeding involve another crucial risk of recurrent respiratory infections and otitis media.
Most of the hospital population does not reflect the general population of the low-income women of Chicago, IL. And the birth weight of the babies was also a factor which was supposed to be considered because some babies who were born underweight had to be placed in the specialized nurseries where breastfeeding was a problem (Mitra, et al., 2004).
Funding has been a major problem in the effective implementation of the BPC program since a lot of money is required so as to fund all the activities by the Peers counselors which include the funding for the phone call follow ups, the Peers training programs in many hospitals so as to recruit as many peer counselors as possible. There has been a problem when it comes to the funding.
Loss to follow-up appointments by the breastfeeding mothers has also been another problem which has hindered the implementation of the BPC program. This has been so because some of the breastfeeding mothers have not been positive towards the follow-up appointments since they end up not turning up for the counseling sessions that they are scheduled for which makes it very inconveniencing to the peers counselors. Other mothers are arrogant and ignorant which makes the work of the peer counselors to be very difficult because when they are contacted through the telephones, some of them ignore the phone calls, while others end up telling likes about their not making for a counseling session which has been a discouraging factor to many peer counselors.
Understaffing is a major problem in most of the government funded hospitals in Chicago where the staffs there were overworked quite a lot therefore ending up neglecting the breastfeeding mothers who had breastfeeding issues (Mitra, et al., 2004). Due to this understaffing of the personnel, the staff lacked the support and the training facilities and most of the staff in the hospital did not have set job responsibilities.
The government of Chicago should initiate many campaigns so as to be able to sensitize and create awareness about the importance of breastfeeding to both mother and the infants. For the mothers they should know that this is one way of preventing breast cancer thus they will minimize medical expenses incurred to treat it. In addition infants obtain enough nutrients that help them to grow healthy, strong and with high level of immunity (James & Lessen, 2009).
Project and programs should be initiated to provide nutritious food for the mothers in order to increase the level of nutrients and ions in the breast milk that helps the infants to grow healthy. These programs include lactation support services that provide nutrition programs to pregnant women and breastfeeding mothers. It also include payment for breast pumps, breast shields, supply of registered nurses, licensed dietitians and any person who has completed a lactation management training program. The BPC would work effectively because all the Breastfeeding Peer Counselors are role models and they provide the women with enough confidence because they also share their backgrounds since they were also mothers who have also breastfed their babies up to 6 months. The importance of the BPC program should be made known to all the hospital staff in Chicago, IL.