Community Health Workers: Collaborating to Support Breastfeeding Among High-Risk Inner-City Mothers

Background: Low breastfeeding rates persist as a health disparity among high-risk inner-city mothers. We
sought to obtain input of community health workers (CHWs) in preparation for a breastfeeding intervention.
Subjects and Methods: We conducted audiotaped focus groups with CHWs of the Cleveland (OH) Department of
Public Health’s MomsFirst, a federally funded Healthy Start program, which addressed interest in breastfeeding,
positives and negatives of breastfeeding, perceived barriers, and an intervention concept. We used notes-based and
tape-based analysis with a previously developed theme code modified for breastfeeding relevance.
Results: Seventeen (50%) of 34 actively employed CHWs participated in two focus groups. Issues that emerged
were as follows: (1) breastfeeding is ‘‘hard’’ for young mothers, with multiple obstacles identified, including lack
of support at home, pain with nursing, extra time required, incompatibility with medications and lifestyle, body
image concerns, and ‘‘no equipment’’ (breast pumps); (2) expected supports such as postpartum hospital care
have not been helpful, and in-home help is needed; (3) many CHWs’ personal breastfeeding experiences were
difficult; (4) CHWs requested additional breastfeeding education for themselves; and (5) while strongly endorsing
‘‘making a difference’’ in their clients’ lives, CHWs worried that additional curricular mandates would
create burden that could become a disincentive.
Conclusions: CHWs who make home visits are in a unique position to impact their clients’ breastfeeding
decisions. A targeted intervention for high-risk inner-city mothers must meet the educational needs of the
teachers (CHWs) while minimizing administrative burden, address issues identified by the clients (mothers),
and provide hands-on help within the home.

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