Applying a systems approach to identify strengths and opportunities to support Black breastfeeding families in Southeastern North Carolina

Background: Breastfeeding rates continue to rise in the United States, yet, inequities persists among racial groups. Multi-level factors spanning clinical and community settings influence breastfeeding outcomes, especially for Black families that have some of the lowest rates of breastfeeding continuation. To understand how the confluence of structural, societal, and interpersonal forces produce the inequities in breastfeeding seen in North Carolina and to identify opportunities for improved support, I will apply a systems thinking approach to critically assess breastfeeding services and map the experiences of Black families living in coastal, southeastern North Carolina.Methods: Circle of care modeling, causal loop diagraming, and group model building were used understand and map strengths and opportunities for improving breastfeeding support for Black families in Southeastern North Carolina. Analyses were conducted using thirty-three key informant interviews were conducted along with shadowing sessions in the inpatient settings. Discussion: There are significant strengths in the system that support Black families including familial support and the lactation workforce. Some opportunities for improvement include expanding, supporting, and diversifying the workforce and improving delivery of care for breastfeeding support during the inpatient setting. Additionally, group model building participants identified and prioritized actions for change. Conclusion: The findings of this dissertation can be used by health system leaders, community-based organizations, and WIC staff that are interested in supporting breastfeeding within their settings. Next steps for this research include disseminating findings by contributing to the literature and engaging with individuals and organizations who are interested in supporting breastfeeding. The actions for change identified can be further developed into feasible solutions and adapted for the local context in southeastern North Carolina. Future research should investigate how to meaningfully support, expand, and diversify the lactation workforce particularly in healthcare systems serving patients across counties such as in this project.