Volunteers Assisting South Carolina Breastfeeding Coalition with GIS Needs

Background

The South Carolina Breastfeeding Coalition (SCBC) is a non-profit (501c3) organization whose purpose is to promote, protect, and support the art and science of human milk feeding as the superior form of nutrition and nurture for infants and young children. They carry out this mission through education, advocacy, networking, and financial support of projects consistent with their purpose. Their activities include education and resources for parents, health and lactation providers, and employers including their Web site SCBreastfeeds.org and YouTube channel. For the last several years, their organization has been collecting information about lactation resources in the state to assist families and referring providers to locate the assistance they need. 

Needs/Goals

The goal of this project was to create a new resource locator map for SCBC to replace the rudimentary map on the SCBC website. This map is used to help families find lactation resources, including breastfeeding individual help from certified counselors, support groups and classes and locations of milk banks. SCBC was also hoping to crowd-source more information from the public about lactation resources in the state. Finally, SCBC wanted to analyze access to lactation resources in the state, breaking down this analysis into both access (spatial proximity) and accessibility (economic and other barriers to care). 

Following the recruitment, two GISCorps volunteer were selected for this project; Kathy Cappelli from Maryland and Trish Young from Connecticut.

The Work

Work on this project can be broken down based on the deliverables:

1. Resource locator map and public survey;
2. Demographics dashboard showing accessibility barriers at the county and census tract level;
3. Analysis of statewide access to lactation care facilities/providers.

SCBC’s first priority was to replace the resource locator map displayed on their homepage to make it easier for their community to find the resources they needed close to their home. SCBC provided data gathered for several types of services, including hospitals in the state certified as Baby-Friendly (a designation given for promoting breastfeeding infants), certified lactation consultants, and more. Additional data was created to show the location of Women, Infant, and Children (WIC) services in the state, government-sponsored clinics that provide (with limitations) nutrition services and lactation consultation to families, and peer support groups, such as Breastfeeding USA and La Leche League. 

A map and Nearby Instant App were created in ArcGIS to display this information. The Nearby app is configured to show resources within a specified distance of the user’s location by category or service type. Link to App

Understanding that the maintenance of this data is time-intensive and manual, a Survey123 form was also built for this portion of the project, which allows families to submit additional resources that they’ve used or learned about which aren’t yet represented on the map. 

SCBC’s second priority was to use the mapped locations of various types of breastfeeding support resources to understand areas of the state and populations that were underserved in order to understand how to bring services, education, and support to these areas. The benchmark metric selected to understand the benefits of access to resources is Breastfeeding Initiation Rate. Breastfeeding initiation was defined as receiving any breast milk or colostrum between delivery and discharge from the birth facility or birth certificate completion for home births. The most recent data for this metric, published by the Centers for Disease Control, is for the years 2018-2019. This data exists at the state and county levels. 

To kick off this portion of the project, a literature review summarized the approaches taken in different peer reviewed publications (n = 7). Researchers have conducted similar analyses in Ohio, Pennsylvania, and North Carolina. The literature review summarized the analytic approaches, demographic, and spatial variables used by other researchers to guide the analysis and deliverables of this portion of the project. 

Following the literature review, the question of access was split into two components: access (spatial proximity) and accessibility (economic and other barriers to care). To analyze access, network analysis in ArcGIS Pro mapped a 30-minute driving distance to medical support in the state (hospitals, certified consultants, and other medical services) and a 20-minute driving distance to peer support groups. These distance bands were selected based on the literature review. The portion of each county in South Carolina that fell within driving distance to at least one of these resources was then calculated to summarize the percentage of each county within driving distance of lactation resources. This analysis provides a way to understand access, but is imperfect- first, it considers percentage of land area accessible to resources, not the population; second, it does not account for other barriers to access, such as transportation, insurance, and other financial means.

To better understand these accessibility concerns, a dashboard was created to show various demographic indicators at both the county and tract level. Breastfeeding initiation rate for each county is shown in order of lowest to highest rates. Demographic data for both the county and tract level includes:

• CDC Vulnerability Index
• Urban/rural population
• Percent of women who gave birth in the last 12 months
• Percent of population 5+ who speak Spanish at home
• Percent of households with no vehicle available
• Percent of population 19-34 with no health insurance
• Percent of children whose income is below poverty level

Together, these resources can be used by both SCBC staff and volunteers to better plan and provide education and other vital support to families who need it most. 

“South Carolina Breastfeeding Coalition is extremely grateful for GISCorps for helping map lactation resources in South Carolina so that families in our state can find help breastfeeding. We had an extremely rudimentary map previously that was difficult to update. We now have a map that is searchable by location and are able to add new resources easily. In addition, GISCorps’ dashboard has helped us identify the areas in South Carolina that are in the most in need of more lactation resources. This is a project that our small non-profit organization could have never funded by itself. We have been so impressed by the whole process from start to finish.“– Sarah Brunson, Chair, South Carolina Breastfeeding Coalition

Project completed.