Supporting breastfeeding for mothers in homeless shelters may be particularly challenging. However, provision of human milk and breastfeeding for the mothers and their families should be viewed as an important priority. Children born during times of homelessness may be at increased risk of toxic stress. Toxic stress in infancy has short- and long-term negative consequences on health and developmental outcomes. Adult diseases such as obesity, diabetes, hypertension, and cardiovascular disease are developmental disorders that begin early in life which could be reduced with the alleviation of toxic stress in infancy and childhood (Hallowell et al., 2017). Helping families make a decision to initiate and continue breastfeeding from birth can reduce the economic stress of cost of purchasing infant formula and disparity in health outcomes due to all of the developmental and immunobiological components present in human milk but absent in infant formula (Hallowell et al.). It is critical that women living in homeless shelters have the opportunity to make an informed decision to provide milk and breastfeed their children as a measure to mitigate toxic stress.

Over the past 25 years, undergraduate nursing students at the University of Pennsylvania School of Nursing have had the opportunity to focus their course project on breastfeeding advocacy in the community (Spatz & Sternberg, 2005). One of the communities over the years my students have chosen to work with is the homeless community in Philadelphia where the school of nursing is located. There are many homeless shelters in our community and some provide services only to childbearing families. By partnering with these shelters, students have been able to educate staff and families in residence on importance of human milk and breastfeeding as a critical intervention for their children. Students have been able to provide education to staff and families on strategies to effectively initiate and maintain milk supply. As part of their projects, the students also develop resource lists and binders specific for that community.

At the Children's Hospital of Philadelphia (CHOP), since 1988, the Homeless Health Initiative (HHI) has volunteer medical residents and nurses providing care to families experiencing homelessness (CHOP, n.d.). Since approximately 2014, staff of HHI have focused on increasing breastfeeding support services for mothers with children in their shelters. The HHI team empowered the staff at shelters to create private breastfeeding spaces. A donation from a local insurance plan (Keystone First) was used to purchase three hospital-grade multiuser breast pumps. We now have three shelters that HHI partners with that have private space equipped with these pumps. Homeless Health Initiative provided funding to purchase double breast pumps kits for the pumps. Access to the pumps is quite important as it can be a difficult and confusing process for mothers to access pumps through their insurance. Many mothers who are in the shelters also return to work or school, which requires them to be away from their children for several hours of the day. By having hospital-grade pumps with computer chip technology and double pump kits onsite, mothers can express milk more efficiently. HHI staff worked with shelters to obtain refrigerators for storage of expressed human milk that can only be accessed by pumping mothers.

These projects in service of women in homeless shelters have allowed for more mothers to make the informed decision to breastfeed and express for their infants. This ultimately benefits the health of mothers, children, and society. All families, including those experiencing homelessness, should have the opportunity to make an informed feeding decision and receive evidence-based education, care, and support so that they too can meet their personal breastfeeding goals.

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