Breastfeeding delivers essential health benefits to babies, though parents often discontinue breastfeeding earlier than recommended, while racial and ethnic groups experience lower breastfeeding success rates. Black infants receive breastmilk at a rate of 49% during their sixth month, while non-Hispanic White infants reach 61%, limiting the availability of breast milk’s health and economic benefits.
Social and cultural factors, language barriers, racism, and limited access to lactation consultants create the barriers that lead to disparities. The availability of International Board-Certified Lactation Consultants (IBCLCs) must expand because they stand as a critical element for breastfeeding support.
Telelactation provides an easy solution through video connections that break down obstructions to travel while offering better care access to underserved communities. The COVID-19 pandemic boosted telehealth adoption rates, so 34% of U.S. parents received lactation support through this method from 2020 through 2021. Despite expanded access to telehealth resources, sufficient research evidence remains lacking.
The Tele-Mothers to Improve Lactation Confidence (MILC) clinical trial evaluated breastfed outcomes with its video-based telelactation application among Black, Latinx, and White adults to investigate diminishing breastfeeding inequality.
The Tele-MILC trial utilized digital technology to execute a parallel-design randomized clinical trial devoted to studying treatment differences between racial groups and cultural backgrounds. The study followed an equity-based model aligned with the consolidated Standards of Reporting Trials (CONSORT) guidelines. The study received approval from the RAND institutional review board before it obtained ClinicalTrials.gov (NCT04856163) registration. Each participant was granted their approval through electronic document signatures.
The study recruited participants between July 2021 and December 2022 via pregnancy applications that focused on 39 U.S. states and territories with limited IBCLC availability. The research design targeted an equal distribution of participants across the Black, Latinx, and all other racial/ethnic backgrounds. The study included pregnant women who were breastfeeding first-timers in their third trimester and spoke English or Spanish. Participants with multiple pregnancies who plan for newborn separation or breastfeeding restrictions due to medical conditions or imprisonment status were excluded from the study.
The study aimed to recruit 1,800 participants to achieve 80% power for detecting treatment effects, with 600 participants from each racial/ethnic subgroup. Research projections indicated a 15% boost in breastfeeding among Black and Latinx groups, whereas the study had no influence on other population subgroups. The estimated sample count enabled researcher-made assessments using Cohen’s h = 0.23 as the minimum effect size threshold.
The data analysis occurred through Stata version 17.0 and R version 4.2.2 from December 2023 to June 2024. The study used P < .05 as its two-sided significance value.
Of the 2,108 participants enrolled in the study, 1,911 finished the final assessment, resulting in a 9.3% participant dropout rate. The participants had a mean age of 29.6 years old, while 37% came from households earning under $55,000 annually. Among the study respondents, Black participants made up 32%, Latinx participants composed 35.5%, and other races/ethnicities contributed 32.5%.
Nearly 50% (48.8%) of the intervention group accessed the telelactation application, and the use of IBCLCs reached higher rates in the intervention group among all racial backgrounds.
The breastfeeding rates at week 24 were higher among participants in the treatment group (70.6% versus 66.8%), whereas Black participants demonstrated a significant increase (65.1% versus 57.4%, P = 0.045). Exclusive breastfeeding success rates improved slightly in the treatment group against the control group (46.9% vs. 44.1%) among Black participants (42.7% vs. 33.9%, P = 0.02) demonstrated the most significant improvement. Statistically significant data reveals that breastfeeding rates increased by 10.2 percentage points (P = 0.008), and exclusive breastfeeding improved by 8.4 percentage points (P = 0.03) after accounting for app nonusers. These results became more substantial when analyzing all telelactation usage.
In this randomized clinical trial, no meaningful differences emerged regarding breastfeeding duration or exclusivity based on intent-to-treat analysis of the overall participant group despite insufficient power to detect minor variations. The participants who used telelactation services achieved better breastfeeding rates according to instrumental variable analysis, demonstrating a substantial increase of (8.4-10.2 percentage points) within the treatment group.
The telelactation intervention generated the most significant improvements among Black participants, who showed significant growth in breastmilk feeding practices at week 24. This strategy addressed lactation support shortages that affect Black communities. Outcomes from the Intent-To-Treat analysis were possibly diluted because a significant number of participants in the treatment group did not use the telelactation services. Better engagement rates would likely result from telelactation service integration within standard health care and public health initiatives.
This evaluation faced three main constraints due to digital recruitment combined with self-reported data and excluding women who were unsure about breastfeeding. The higher breastfeeding rates in the control group made general population statistics less effective for comparison purposes.
The telelactation intervention demonstrated positive outcomes for Black parents but did not significantly affect overall breastfeeding rates. Researchers need to analyze the cost-effectiveness of telelactation strategies while developing ways to minimize racial and ethnic inequality in breastfeeding practices.
References: Uscher-Pines L, Kapinos K, Waymouth M, et al. Telelactation services and breastfeeding by race and ethnicity: a randomized clinical trial. JAMA Netw Open. 2025;8(2):e2461958. doi:10.1001/jamanetworkopen.2024.61958
