How My Life Course Led Me to Focus on Breastfeeding

A NICHQ Leadership Message from Elaine Fitzgerald (Associate Project Director and Perinatal Operational Lead)

March 2013

Elaine FitzgeraldI learned about Life Course Theory in my doctoral program, which I completed less than a year ago. Until then, the idea never had a name for me. But the concept of Life Course has been with me as long as I can remember. In retrospect, it makes complete sense that my own life course led me to a focus on breastfeeding, but things are always crystal clear in hindsight.

Life Course Theory promotes the idea that an individual’s health trajectory is influenced by a lifetime of exposure to persistent social, economic and environmental factors, and that these factors are underlying causes of ongoing inequalities in health across population groups. The framework, along with extensive early childhood research, suggests that experiences during the first five years of a life are highly influential in an individual’s future health and development.

I feel my life course was set very early in my childhood. As a first-generation Filipina American, I had an appreciation early on that my life would be very different had I been born and raised in the Philippines. Somehow, from an early age, my internal compass pointed to issues that affect children, especially the most vulnerable.

While I was raised in the US, my family spent time in the Philippines, and the contrast between my life here and the one there was quite evident. I simultaneously developed a deep appreciation for all we have here and a strong empathy for how these disparities acutely impact children. This perspective fueled my desire to work on children’s issues. But it wasn’t until I enrolled in the United States Coast Guard Academy as a young adult that my beliefs began to take shape as action.

I spent time volunteering at a domestic abuse shelter near the Academy in New London, Connecticut. There, I worked with trauma-inflicted children coping with horrendous living conditions that were beyond their control. I saw firsthand how the environment and factors external to children could have lasting effects on their health and development. Each day my heart would come alive to witness the resiliency and joy these children would express despite all the odds that lay before them. At the same time, I felt an all-too-familiar sadness as my heart would break knowing that their opportunities and experiences would be limited compared to others.

After my time at the Academy, I went on active duty with the Coast Guard for seven years, and had the extraordinary opportunity to lead teams on capacity-building missions in developing nations. In those settings, I learned even more about the factors that directly and indirectly impact a child’s life. From a remote pueblo in Cartagena, Colombia, to an orphanage in Ecuador, I witnessed firsthand the disparities and depravities that exist globally and the disproportionate impact those have on children.

These experiences left a lasting impression on me, turning my passion to help children into an obligation to improve children's health on a population level. I began to understand the importance of early intervention and prevention, which put me on a path that would lead me to public health and interventions that were more “upstream” or preventative in nature.

I transitioned from the Coast Guard to UNICEF in pursuit of my deep desire to work on global children’s issues. In time, I realized my own need to feel more connected to the community and population I served, so I redirected my focus to domestic children’s issues as the project director of a federally funded early childhood system of care. This collaborative effort was aimed at developing and implementing comprehensive services and support to aid families with young children in New London County who were facing social emotional challenges. After six months of the intervention, our target population saw a significant reduction in maternal stress, alcohol use, child behavioral issues and other gains.

That work brought into clear focus for me that the earliest days of a child’s life are often the most influential in his or her life course. And so I enrolled in a doctoral program at Boston University School of Public Health, where I learned about the bountiful evidence associating breastfeeding with improved health outcomes for the infant and mother. I also saw confirmation that quality improvement techniques could help build provider and organizational capacity to support mothers intending to breastfeed.

All of these experiences came together to lead me to NICHQ, an organization that is applying quality improvement techniques to improve how healthcare systems deliver services and support to mothers and newborns at the beginning of a newborn’s life. As the Associate Project Director for NICHQ’s Texas Breastfeeding Learning Collaborative, I have the pleasure of again being part of the solution to holistically make sustainable improvements to better children’s health and well being. During this first year of the program, NICHQ has been helping hospitals from the northern region of Texas create environments in which families’ choices concerning breastfeeding are best supported. The 20 participating birthing facilities represent 43% of the births in the region – more than 45,000 births annually. So we expect our work together with the state will have an impact on both local and national breastfeeding rates – especially for those in greatest need of support.

And ultimately, I believe this work will, in turn, improve health for generations to come.

My life course has been circuitous and iterative, not unlike the process of quality improvement. My journey started with a passion to help children and now returns to the beginning of life itself – to infancy, where we have an enormous opportunity to optimize children’s health through the early initiation and continuation of exclusive breastfeeding.