The Impact of Telelactation Services on Breastfeeding Outcomes among Minority Mothers: Siteless Tele-MILC Trial

Project Summary Breast milk is the best source of nutrition for infants, and breastfeeding offers numerous medical advantages for parents and infants. However, the COVID-19 pandemic has erected new barriers to breastfeeding, undermining important gains in breastfeeding initiation and duration that the U.S. has achieved in recent years. Key barriers include reduced breastfeeding support services and social support, and increased stress and postpartum depression, which can lead to early breastfeeding cessation. Further, pregnant and breastfeeding parents, who are at heightened risk of COVID-19 morbidity and mortality, now face complex decisions regarding COVID-19 vaccination given vague clinical recommendations for these populations. This study leverages an existing siteless randomized controlled trial on the effectiveness of telehealth for breastfeeding support (telelactation) among minority parents and will field a new cross-sectional survey to 1500 additional parents to collect data about the impact of COVID-19 on breastfeeding support, including use of telelactation, and vaccination. As part of the already funded clinical trial, 1200-1500 parents, including approximately 900 minority parents, will be recruited using the Ovia pregnancy app to participate in a trial evaluating telelactation services. This longitudinal study, which recruits participants starting in May 2021, coupled with a cross- sectional survey that will collect comparable data on the experiences of 1500 postpartum parents prior to and in the early months of the COVID-19 pandemic, offers an unparalleled opportunity to assess how the pandemic has impacted breastfeeding support, including use of telelactation, and how attitudes about the COVID-19 vaccine change over time as the vaccine supply grows and clinical recommendations become more directive. The project aims to 1) assess how the pandemic has impacted the provision of professional breastfeeding services and lay support and how changes have influenced breastfeeding experiences; and 2) track changes in attitudes about COVID-19 vaccine, willingness to be vaccinated, and timing and receipt of vaccination as the pandemic progresses. This study will provide important information on the impacts of the COVID-19 pandemic on breastfeeding experiences and track vaccine attitudes in a high-risk population that is typically excluded from clinical vaccine trials. With a cross-sectional survey to establish baseline trends and ongoing data collection through a longitudinal study, we can explore how key breastfeeding facilitators change over time and how diverse populations of parents are making decisions about vaccination. This information will help inform public health strategies and clinical practice to support new parents and to reduce disparities in breastfeeding duration and vaccination rates.