Breastfeeding imparts numerous health benefits for both infants and their mothers, as shown in science and in research (Lawrence & Lawrence, 2010). Despite the known benefit of breastfeeding, rates for African American mothers and families have remained lower than all ethnic groups for initiation, duration, and exclusivity. In addition, rates are exceptionally low among African American women living in the South. The Surgeon General’s Call to Action to Support Breastfeeding recommends implementation strategies that address socioeconomic, racial, and ethnic inequities focusing on communities with low breastfeeding rates (U.S. Department of Health and Human Services, 2011).

On April 15, 2013, the U.S. Department of Health and Human Services, Office on Women’s Health launched the campaign titled It’s Only Natural: Mother’s Love, Mother’s Milk (ION). This national campaign seeks to address disparities in breastfeeding and increase breastfeeding rates among African American mothers and families. The goal of the campaign is to increase awareness of the benefits of breastfeeding to mom and baby, while also providing practical “how to” information about breastfeeding (Office on Women’s Health, 2013). In 2014, the Office on Women’s Health contracted with ICF International for intense implementation of the ION campaign in three states with low breastfeeding rates: Alabama, Louisiana, and Mississippi.

Objectives of ION ImplementationThe year 1 project goal was to implement the ION campaign in the three target states and contribute to a positive shift in breastfeeding initiation, duration, and attitudes. Implementation goals included working toward making breastfeeding a societal and cultural norm in the African American community. The eight target audiences for 2014–2015 ION implementation follow: 1. Physician groups and/or hospitals 2. Health professionals in nursing, dietetic, midwifery, and other health professional organizations 3. Historically Black Colleges and Universities (HBCUs) 4. African American fathers’ groups 5. Community groups, including peer counselors, mother-to-mother support groups, Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) clinics 6. Faith-based organizations 7. Nontraditional partners 8. Mothers’ groups

Background ● This approach targeted health care professionals because of their known influence in patients’ health-related decision making. The purpose of these events was to identify, mobilize, and empower health professionals to advocate for and support breastfeeding through lactation management best practices.

In addition, to reach a broader, national audience, the ICF team bolstered the ION online and social media implementation through Twitter using the #itsonlynatural hashtag.

The exhibit below depicts which strategies were implemented with each audience in each of the three implementation sites.

ION Strategies Per Target Audience

Audience

Strategy 1Dissemination of ION

Materials by Community Transformers

Strategy 2Breastfeeding Management Summits with Health Care

Providers

AL LA MS AL LA MS Physician groups and/or hospitals Health professionals in nursing, dietetic, midwifery, and other fields Historically black colleges and universities*

African American father’s groups Community groups, including peer counselors, mother-to-mother support groups, WIC clinics Faith-based organizations

Nontraditional partners

Mothers’ groups

ION Implementation Methods (Cont.) ION Implementation Results (Cont.)

ION Implementation Results

Conclusions The two-pronged ION implementation strategy using (1) CTs to disseminate ION messages and print materials, and (2) large-scale breastfeeding summits conducted in partnership with existing breastfeeding conferences or meetings proved a valuable approach for grassroots implementation of the ION campaign to reach African American mothers, and other primary target audiences. This strategy requires partnership with a community-based organization(s) trusted in the community and with proven success to reach desired target audiences, particularly vulnerable or hard-to-reach populations.

References

● Lawrence, R. A., & Lawrence, R. M. (2010). Breastfeeding: A guide for the medical profession (7th ed.). Philadelphia, PA: Saunders.● Office on Women’s Health. (2013). It’s Only Natural: Leader’s guide. Retrieved March 19, 2016, from http://womenshealth.gov/itsonlynatural/pdfs/leaders%20guide_designed_final_508%20copy.pdf● U.S. Department of Health and Human Services. (2011). The Surgeon General’s call to action to support breastfeeding. Washington, DC: U.S. Department of Health and Human Services, Office of the Surgeon General. Retrieved March 18, 2016, from http://www.ncbi.nlm.nih.gov/books/NBK52682/pdf/Bookshelf_ NBK52682.pdf

ION Campaign Implementation Strategy 1: Implementation Using Community TransformersThe ICF team trained CTs to disseminate ION campaign materials to six of the eight key target audiences, with the primary goal of promoting breastfeeding in these target audiences (especially African American mothers):

● 28 CTs were trained to disseminate ION campaign materials across the three implementation sites. − 8 CTs were trained to implement the ION campaign in Birmingham, AL. − 5 CTs were trained to implement the ION campaign in New Orleans, LA. − 5 CTs were trained to implement the ION campaign in Greenwood, MS. − 10 CTs were trained to implement the ION campaign in Jackson, MS. ● All CTs were trained on how to engage six of the ION campaign’s target audiences and disseminate ION campaign materials in their respective cities.

In addition to disseminating ION campaign materials in their respective communities: ● CTs facilitated 27 in-person, mother-to-mother support meetings across 8 breastfeeding clubs in AL and MS. − Meeting attendance ranged from 3 to 10 participants per breastfeeding club meeting. − To date, two breastfeeding clubs have been established in AL, while six have been established in MS.

ION Campaign Implementation Strategy 2: Implementation Using Statewide Breastfeeding Management SummitsThrough coordination and conduct of statewide breastfeeding management summits, the ICF team implemented Strategy 2 to reach two ION campaign target audiences: (1) physician/hospital groups and/or hospitals; and (2) health professionals in the three campaign implementation cities. ● The breastfeeding management summits were designed to introduce the ION campaign as a resource to health professionals and encourage them to use and disseminate the ION campaign materials with their patients and others, and ultimately develop a plan of action that encourages, promotes, supports, and protects breastfeeding among African American women, especially in the targeted states with low breastfeeding rates.● The ICF team conducted 3 breastfeeding management summits and provided training to 211 attendees under this contract.

ION Campaign Social Media Activities● The ICF team monitored the ION Twitter handle via TweetReach which counted a total of 1,800 tweets from 1,400 contributors. ● In addition, the #itsonlynatural message reached 2.5 million accounts, with an exposure of 22.3 million. ● Further, #itsonlynatural reach nearly doubled from 1.4 million users at the end of the first quarter (March 2015) to 2.5 million users at the end of year 1 (September 2015), with the largest surge in exposure during August (World Breastfeeding Month).

ION Implementation MethodsThe two-pronged ION implementation strategy involved the following: 1. ION implementation via community transformers (CTs) disseminating ION materials to the eight target audiences in African American communities in Birmingham, AL; New Orleans, LA; and Greenwood and Jackson, MS. ● This grassroots approach involved training of individuals who applied and were selected for a 2-day workshop using an evidence-based curriculum on providing peer breastfeeding support. During the CT training, individuals learn (1) essential skills for providing peer counseling in basic lactation management, and (2) methods for making referrals to resources for interventions that may be beyond their scope of practice. Trained CTs were then tasked with disseminating ION campaign messages and materials to the eight target audiences in the three States.

2. ION implementation via breastfeeding management summits with health care providers in Birmingham, AL; Baton Rouge, LA; and Greenwood and Jackson, MS.

Ursuline Singleton, MPH, RD, Office on Women’s Health; Ashani Johnson-Turbes, PhD, ICF International; Danielle Nielsen, MPH, ICF International; Brieon Arthur, MPH, ICF International;Kimarie Bugg, MSN, FNP, MPH, CLC, Reaching Our Sisters Everywhere, Inc. (ROSE); Andrea Serano, CLC, Reaching Our Sisters Everywhere, Inc.

Implementation and Assessment of the “It’s Only Natural: Mother’s Love, Mother’s Milk” Campaign

*Direct outreach to historically black colleges and universities proved more challenging than anticipated, due to the misalignment of the project timeline and school year calendar. Ideally, planning and initial outreach would occur prior to the beginning of the semester in which campaign message dissemination is scheduled to take place. Moving forward, the ICF team will engage historically black colleges and universities in the first 4 months of year 2 of the project.