By Linels Higuera Ancidey, IBCLC, MPH Candidate, UNC Gillings School of Global Public Health
Field Placement with Breastfeed Durham, Summer 2025
Breastfeeding is a cornerstone of maternal and child health, yet disparities persist across racial, ethnic, and linguistic groups. Spanish-speaking families in Durham face unique challenges, including limited culturally tailored lactation support and low Baby-Friendly Hospital designation among local birthing facilities. Un Día a la Vez offers a culturally responsive, peer-led model to address these gaps, providing a safe space for sharing experiences, exchanging knowledge, and receiving emotional support.
The practicum aimed to (1) develop a six-module facilitator training curriculum, and (2) create a Spanish-language social media and digital communication toolkit. In addition, the program was represented at community events to foster local partnerships. These activities sought to strengthen program sustainability and expand culturally congruent support for Spanish-speaking families.
Public Health Significance
Breastfeeding improves both short- and long-term outcomes for mothers and infants, but disparities remain. In Durham County, 89.9% of mothers initiate breastfeeding, yet continuation drops to 61.9% at six months and 40.5% at twelve months. Nationally, Hispanic infants have an initiation rate of 83.0% compared with 85.3% for White non-Hispanic and 74.1% for Black non-Hispanic infants (CDC, 2024). What is more, according to the CDC, 60% of families do not breastfeed for as long as they intend to. Spanish-speaking families face language, cultural, and structural barriers, making peer-led, culturally aligned interventions critical for promoting health equity. This initiative also aligns with the 2011 Surgeon General’s Call to action to support breastfeeding by integrating education and support for breastfeeding into public health programs that serves new families(Office of the Surgeon General (US) et al., 2011).
Development Process
The facilitator training curriculum equips current circle participants with core competencies in peer support, health education, and group facilitation. Participants are expected to complete Community Health Worker and lactation educator certification to fully prepare for leadership roles. The curriculum reflects community values and lived experiences, refined iteratively with feedback from participants, current facilitators and community organization representative. One of the motivations to develop this curriculum rests on the CDC’s Strategies for Continuity of Care in Breastfeeding by increasing the community’s ability to provide consistent, tailored, evidence-based lactation education and support by regularly training anyone who provides services to families (Strategies for Continuity of Care in Breastfeeding | Breastfeeding | CDC, n.d.).
The social media and digital communication toolkit was designed to be concise, visually engaging, and culturally relevant. Similarly to the WIC Breastfeeding Support Social Media Strategy & Best Practices Playbook the idea behind this toolkit is to make social media and digital communication a strategic, enjoyable and more efficient activity(USDA, n.d.). Insights from community engagement informed the toolkit, including a section with email and text messages templates to facilitate collaboration among local organizations.
All images in these materials are the property of Breastfeeding Family Friendly Communities (BFFC) and Linels Higuera Ancidey, who retains rights to their use for this project. Cultural elements, such as the use of tangerines (cuties) and the color orange, were intentionally incorporated. Tangerines, popular across Latin America, were regularly brought by a facilitator as a snack during support circle meetings, and participants quickly embraced them. Its segmented nature symbolizes the gradual, supportive steps of the breastfeeding, postpartum, and parenting journey, while the nickname “cuties” captures the warmth babies bring to each gathering.
Challenges and Lessons Learned
Several challenges emerged during the practicum, providing valuable learning opportunities. Time management, which I had previously identified as a challenge in my learning agreement, remained significant, particularly when organizing and condensing information while transitioning into the roles; approaching the project as a learner allowed for increased productivity and clarity. Balancing English and Spanish during materials development was a welcomed challenge, enhancing cognitive flexibility and linguistic precision. Engaging with community members proceeded smoothly and supported iterative product refinement. Lastly, a key insight was recognizing that the practicum products are living resources, meant to adapt to evolving community needs. For instance, just days prior, a session addressing infant safety (including baby proofing, bouncers, walkers, and the impact of new behaviors on breastfeeding) was developed due to pressing needs, demonstrating the curriculum’s ongoing evolution in practice.
Community Representation & Network Building
Though outside the formal practicum scope, volunteering at seven community events resulted in three guest speakers joining the circle. This collaboration not only enriched the program’s content but also informed the toolkit’s digital communication strategies, strengthening sustained partnerships and community engagement.
Intended Impact
In the short term, the practicum enhances facilitator preparedness, awareness, and participation. Long-term goals include increasing breastfeeding continuation rates and support for Spanish-speaking families in Durham County, North Carolina. Plus, it expands culturally competent, peer-led models for maternal and child health. The Office of Minority Health and Health Equity emphasizes the need for a culturally competent workforce to effectively raise awareness about disease prevention, treatment, and management. (Spinner et al., 2021). By empowering community members as trained facilitators, this program will cultivate such a workforce while also strengthening peer support, fostering trust, and promoting equitable access to vital resources.
Conclusion
For over 1.5 years, Un Día a la Vez has empowered Spanish-speaking families to support each other’s breastfeeding and perinatal health efforts. Participants have grown into a self-sustaining community, offering mutual support both during and outside meetings. Transitioning participants into leadership roles represents a critical milestone for community empowerment. The practicum’s curriculum, toolkit, and community engagement activities exemplify a replicable, peer-led model that advances maternal, child and family health equity. Continued investment and policy support are essential to sustaining and expanding culturally responsive, peer-led programs that reduce structural inequities.
References
Centers for Disease Control and Prevention. (2023). Disaggregation of breastfeeding initiation rates by race and ethnicity. Preventing Chronic Disease, 20. https://www.cdc.gov/pcd/issues/2023/23_0199.htm
Centers for Disease Control and Prevention. (2024). National Immunization Survey, Breastfeeding Data. https://www.cdc.gov/breastfeeding/data
Council on Education for Public Health. (2024). MPH Foundational Competencies. https://publichealth.gwu.edu/sites/g/files/zaxdzs4586/files/2024-03/d2.-mph-foundational-competencies-gwsph-ceph-report-for-extractions-for-web-21.pdf
Durham County Department of Public Health. (2023). Durham County community health assessment. https://healthydurham.org/wp-content/uploads/2024/03/2023-Durham-County-Community-Health-Assessment-PC.pdf
Higuera Ancidey, L. (2025). Currículo de capacitación para facilitadoras del círculo de apoyo comunitario “Un día a la vez” (Unpublished manuscript).
Higuera Ancidey, L. (2025). Kit de herramientas para círculo de apoyo comunitario “Un día a la vez” (Unpublished manuscript).
Un Día a la Vez – Círculo de Apoyo Comunitario. (2023). https://breastfeeddurham.org/events/un-dia-a-la-vez-circulo-de-apoyo-comunitario/
U.S. Office of Minority Health. (2023). Language and cultural competency in maternal and child health. https://minorityhealth.hhs.gov