School of Public Health

SPOTLIGHT ON INNOVATION: Infant Health Program Diversifies Lactation Support

Author / Malka Main

Amber Jokinen, Leah Ford, Lea Johnson (BIH Program Coordinator), and Sharon Giberson have added diversity to the face of lactation support in Pierce County, Washington.

A small, dynamic program in Washington state has diversified lactation support and raised the visibility of African American women who breastfeed, two efforts that could help reverse low breastfeeding rates.1,2,3 In a county where African American babies are twice as likely to die as White babies before their first birthday,the Tacoma-Pierce County Health Department’s Black Infant Health (BIH) program connects African American mothers to Medicaid and other social services. Although BIH tracks birth outcomes not breastfeeding duration, many clients nurse their babies beyond 6 months, according to Program Coordinator and Public Health Nurse Lea Johnson. Some breastfeed for more than two years.

The program has a history of evolving in response to new data and opportunities. The original focus was safe sleep promotion but Johnson and her colleagues transformed BIH in 2009, after state data showed that home visits from Maternity Support Services improved African American birth outcomes. “Babies are dying,” said Johnson. “We needed to do something different.”

They restructured the program to support African American women from early pregnancy through the first year of her child’s life. This lets staff take on projects that address a multitude of factors that contribute to infant health, including breastfeeding support.

Lea Johnson, BIH Program Coordinator, holds baby Esther at a Celebration of Life event. "I had an amazing mother," Johnson said. "She taught me how to care for children - mine and the community's."

The program’s new format allowed Johnson to diversify peer and professional lactation support in 2015 through a NACCHO funded breastfeeding grant. She partnered with Delores Baccus, a King County nurse and IBCLC, to train 19 African American breastfeeding peer counselors. The grant included certification for Johnson who joined Baccus as one of the few African American IBCLCs in the state. Some of the newly-trained peer counselors went to work for WIC and others became part of the BIH support network. They meet with clients one-on-one and attend all BIH events to publicly nurse their babies, answer questions, and help solve on-the-spot breastfeeding problems.


The program offers clients lots of support, including monthly “health socials,” mother-to-mother support groups, and Celebration of Life events for every baby who reaches age one. The volunteer Health Ministers, recruited from local churches, assist with outreach. “Church is the backbone of the African American community,” explained Johnson. “It’s where people go when in need and it’s where folks gather and talk about serving the community outside the four walls.”

Johnson trains Health Ministers to teach safe sleep practices and link clients to Medicaid, prenatal and social services, and breastfeeding peer counselors. But they are more than a conduit to resources. The success of BIH, said Johnson, is the long-term and trusting relationship between the Public Health Nurse, the Health Ministers, and the clients. “Most of the Health Ministers are mature, age-wise and bring life experience to the table,” she said. “They serve as maternal role models. It’s surprising how many young women want that relationship and want to engage.”

Check out this Seattle program that has also improved breastfeeding through strong, personal connections

Health Ministers try to meet the physical, social, and spiritual needs of the clients and their families. They let the client’s situation inform the way they serve. If a woman works days, the Minister meets her in the evening. If she doesn’t have a car, the Minister comes to her home. If she doesn’t have a home, the Minister meets her at church or wherever she is, perhaps a shelter. The Health Ministers often recruit their own husbands and children to help support clients, adding to the family atmosphere of the program.

Clients stay in touch long after they’ve celebrated their babies first birthday. They send Johnson photos of their children as they grow. “They call when there’s a need. They send their friends. They offer to help support the effort,” said Johnson. She has even had former clients return to volunteer as Health Ministers.

Although there are only two paid staff members, BIH served 261 African American women and their families over the past seven years with the help of nearly 60 Health ministers and supporters. Their plan is to recruit more churches and Health Ministers to expand outreach. Johnson continues to identify new opportunities to improve birth outcomes, such as chronic disease prevention. She just started a project with the Washington State Department of Health and the American Heart Association to teach women of child-bearing age about hypertension and self-monitoring blood pressure.

All mothers in our society need more breastfeeding support. But the myriad breastfeeding barriers unique to African American families2,6,7 and the disturbing disparities in birth outcomes5 warrant more of the targeted, direct support that BIH provides and the Surgeon General promotes.8

For questions about the Black Infant Health Program or to find out how you can get involved please contact coordinator Lea Johnson, RN, IBCLC, Public Health Nurse II at


1. Jones KM, Power, ML, Queenan JT, et al. Racial and Ethnic Disparities in Breastfeeding . Breastfeeding Medicine. 2015;10(4):186-189. doi: 10.1089/bfm.2014.0152

2. Johnson A, Kirk R, Rosenbluem KL, et al. Enhancing Breastfeeding Rates Among African American Women: A Systematic Review of Current Psychosocial Interventions. Breastfeeding Medicine. 2015.

3.  Allers, KS. Saving Ourselves: Increasing Representation and Changing the Black Breastfeeding Narrative. MomsRising Blog. 2013.

4. Tacoma-Pierce County Health Department. Infant Mortality Rates. 2015.

5. Riddell CA, Harper S, Kaufman JS. Differences in US infant mortality rates among black, white babies. JAMA Pediatr. Published online July 3, 2017. doi:10.1001/jamapediatrics.2017.1365 

6. Centers for Disease Control. Racial Disparities in Access to Maternity Care Practices That Support Breastfeeding — United States, 2011. Morbidity and Mortality Weekly Report (MMWR)

7. Bentley ME, Dee DL, Jensen JL. Breastfeeding among Low Income, African-American Women: Power, Beliefs and Decision Making. Journal of Nutrition.

8. The U.S. Department of Health and Human Services. The Surgeon General’s Call to Action to Support Breastfeeding. 2011.