Research & Discovery

The UVA Pediatrician Championing Breastfeeding Equity

When Dr. Ann Kellams became pregnant with her first child, she felt prepared. “How can you be more prepared than being a pediatrician, right?” she said.

She was shocked to find out, when having trouble breastfeeding her first baby, no one in her office or hospital knew how to help. That set her on a path to ensure no other new parents would endure similar experiences and, decades later, she remains committed to that mission.

Kellams has been a pediatrician at UVA Health and a pediatrics professor at the University of Virginia School of Medicine since 2006. She helped found the UVA Breastfeeding Medicine Program in 2011 and has served as the vice chair of clinical affairs of the pediatrics department since 2019.

She is also the lead author of a recent study published in Breastfeeding Medicine identifying the main barriers to breastfeeding, based on patient interviews. The research was a collaboration between the Academy of Breastfeeding Medicine, of which Kellams is the immediate past president, and Reaching Our Sisters Everywhere, a national nonprofit organization dedicated to increasing breastfeeding support for Black families.

“We wanted to capture the nuances of what people are really experiencing and feeling,” Kellams said. “As a marker of success, we didn’t just ask moms if they were breastfeeding exclusively and for how long. We wanted to know what was important to them; if they had everything they needed to breastfeed for as long as they wanted.”

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The goal was to move away from focusing on individual responsibility, shame and guilting, and evaluate what communities, health care providers, agencies and employers can do to support the process.

Barriers identified included inequities in parental education, community resources and whether care teams follow best practices. Researchers also identified the lack of a national paid maternity leave policy in the United States, as a significant barrier. “We are one of the only developed nations in the world to not have universal, paid maternity leave,” Kellams said.

She recalled that during her residency, sales representatives from baby formula companies routinely gave presentations to her class of pediatric residents.

“Everything I was taught about breastfeeding in the ’90s wasn’t right, which happens in medicine as discoveries are made and understanding advances,” Kellams said. “Both because breastfeeding rates were low and it wasn’t considered a priority, traditional medical and nursing curriculae did not include breastfeeding and lactation physiology, management and support.”

After World War II, the rise of breastmilk alternatives led commercial milk companies to launch marketing campaigns – which the World Health Organization has since labeled exploitative and predatory – that encouraged mothers to use baby formula, resulting in decreased breastfeeding rates. In 1981, the International Code of Marketing of Breast-milk Substitutes was established to prevent misleading marketing of formula; it barred companies from several practices, including giving free samples to mothers and hospitals.

“By the ’70s, only 22% of mothers were even attempting to breastfeed,” Kellams said. “And by the time studies showed differing health outcomes between breastfed and formula-fed babies in the late ’80s, you had doctors, nurses, parents, grandparents who were not prepared to support that.”

Kellams is an international board-certified lactation consultant and pediatrics professor at UVA. (Photo by Matt Riley, University Communications)

It takes a village to support new mothers, Kellams noted, emphasizing the further society has gotten from extended family units and close-knit communities interacting on a daily basis, the more challenging breastfeeding and parenthood has become.

Breastfeeding and lactation medicine, a relatively new medical field, is beginning to bridge that gap. Instead of separate doctors focusing on mothers and children, Kellams said she sees both mothers and babies every visit.

“We realize we’re filling a gap when we have something over 85% of people want to do and only 25% to 30% are successfully meeting their own personal breastfeeding goals,” she said. “You realize people need a lot more help than they have traditionally gotten.”

The good news, she said, is most of the reasons people end breastfeeding earlier than they want to are preventable if they have the right support and encouragement. Additionally, increased societal awareness and emphasis on maternal and infant health has resulted in more funding and resources for research and initiatives.

She recalled former Surgeon General Regina Benjamin’s first call to action in 2011 was to support breastfeeding.

“You can imagine this is a person with access to a lot of public health data, who chose to prioritize this,” she said. “It stresses the importance.”