91漫画app

Breaking down barriers to breastfeeding has energized much of the research and community outreach of Nandi Marshall, DrPH, (’12) for more than half of her two-decade career.

As the associate dean of Academic Affairs and an associate professor of health policy and community health in 91漫画app鈥檚 Jiann-Ping Hsu College of Public Health, Marshall鈥檚 focal point didn鈥檛 stem from textbooks. Rather, it was her own dramatically different  鈥� and often heartbreaking 鈥� experiences that fueled her mission. 

鈥淢y mom breastfed me, her mom breastfed her, and her mom breastfed her,鈥� said Marshall. 鈥淪o for me, I’m supposed to breastfeed. I never questioned it, never thought anything about it. And I did not have a great experience the first time.鈥�

Marshall knows the many benefits of breastfeeding infants, which can provide optimal nutrition, cognitive support, strong immunity response and emotional bonding, among other positive long-term, child-health outcomes. 

She also considers breastfeeding to be an innate part of a mother鈥檚 biological nurturing, and one that flourished easily among generations of her maternal lineage. However, following the birth of her first child, she was confronted with something entirely different.

The disparity between breastfeeding her son, who was born in 2010, just one week after she completed a comprehensive exam toward earning a Doctor of Public Health at Georgia Southern, and her daughter, five years later, was stark.聽

Lactation nurses and public information on breastfeeding during the birth of her first child was limited to non-existent. As a stressed graduate student recovering from a c-section, Marshall’s attempts at breastfeeding her son were futile. The inability to do so broke her spirit.

鈥淚 literally felt like I was a horrible mom,鈥� recalled Marshall. 鈥淢y husband was so supportive. He said that I wasn鈥檛 a horrible mom and if it was that stressful we should go with formula. We ended up giving our son formula, but when it was time for my second child, I thought, 鈥楬ow can I make this a better experience?鈥欌��

A friend of Marshall’s who worked for Women, Infants and Children (WIC), which provides support to mothers and children on their journeys with pregnancy and beyond, suggested she read the book, 鈥淏reastfeeding Made Simple: Seven Natural Laws for Nursing Mothers,鈥� and other materials on breastfeeding. 

鈥淚 studied,鈥� recalled Marshall. 鈥淚 read that book from front to back and there were a lot of things I didn’t realize that could really help me.鈥�

When Marshall gave birth to her daughter, there were lactation consultants in the community who could offer guidance. By then, Marshall was an assistant professor on the Armstrong Campus with a flexible schedule and her own office where she could close her door and pump milk as needed. This encouraged her to breastfeed for 15 months. 

鈥淚 felt so accomplished,鈥� said Marshall. 鈥淥nce I was so successful with my daughter, I was like, 鈥榃hat were the differences here?鈥欌�� 

As someone who worked in community engagement and health equity before college, Marshall has developed an innate sense of caring for communities.

鈥淚 considered what I had access to before, what I had access to the second time, the education I didn’t have, the education I did have,鈥� she said. 鈥淭he second time, I had access to a lactation counselor. I didn’t have that before.

鈥淚 thought that there were probably people out there who are struggling just like me and need help. What can I do to make a difference? I decided to couple my experiences with my background in health equity and community engagement and try to make a difference in breastfeeding.鈥�

As such, she has collaborated with Heidi Altman, Ph.D., associate professor of sociology and anthropology at Georgia Southern, who conducted extensive interviews with mothers across Georgia for . Assisting with various aspects of maternal and child health research, Marshall contributed to help procure a deeper understanding of the mothers鈥� experiences with maternal care, from pregnancy to postpartum.

Marshall also serves as the lead consultant for the breastfeeding continuity of care work on a multi-year grant. This is the second time the grant has been funded, and it serves to identify the limiting experiences of local Black mothers, whom Marshall said often face social, physical and cultural barriers to breastfeeding in public, familial and work settings, and help destigmatize and remove some of those obstacles.

鈥淲hen we’re looking at breastfeeding barriers from the local piece, a lot of it mirrors what we’re seeing nationally,鈥� Marshall said. 鈥淪ome of the examples include access to care. When we look at Bulloch County, which has a lot of rural areas, but also Savannah, which is not rural and has a lot of access to health care, they don’t have a lot of access to lactation support.鈥� 

The results of Marshall鈥檚 research point to attainable solutions. Many mothers expressed anxiety over where and when to pump breast milk at work. Though the PUMP for Nursing Mothers Act became a mandate in December 2022 and requires employers with 50 or more employees to provide a private space and reasonable break time for nursing employees to pump breast milk, many businesses don鈥檛 know about or adhere to the policies.

鈥淲e鈥檙e trying to educate folks on it because a lot don’t know about these things,鈥� said Marshall. 鈥淥ne of the things that we’re doing with Healthy Savannah is we’re working with companies to say, 鈥楬ere’s how you can support your lactating parents with a space or a policy.鈥� But even for those folks who have less than 50 employees, you have to prove that it’s going to be a burden for you to provide that for. So technically, everyone should be doing it.鈥�

Many of the women interviewed also noted that they would like to see more lactation consultants who look like them, and some feel undermined by the lack of cultural acceptance as long-held stigmas within their own community have eroded breastfeeding practices among Black women.

A 2019 study by the CDC supported Marshall鈥檚 findings, as Black women statistically breastfeed their babies less than white women, and health centers that serve Black women are less likely to initiate breastfeeding, offering formula instead. Yet, Black babies are born prematurely in greater numbers than white babies, and could especially benefit from their mother鈥檚 milk.

In 2020, Marshall launched the Photovoice Project to capture the experiences of local Black mothers. The women were given cameras to take pictures of social, cultural and physical barriers that impede their ability to breastfeed in Chatham County.

鈥淧hotovoice is one of my favorite community engagement strategies,鈥� Marshall said. 鈥淚t’s essentially putting a camera in the hands of a community, and you’re asking for their eyes. What do you see? We ask questions, and then they answer them through pictures. Once they take their pictures, I sit down with them one one-on-one and say, 鈥楾ell me why you took this picture. What were you experiencing?鈥� We had a whole conversation. And then I got all the moms together who participated and we talked through, 鈥極K, what do we see in these pictures? What did y’all experience similarly? What was different?鈥� And then, 鈥榳hat can Healthy Savannah do about this? What can Chatham County do? What can Savannah do? How can we make a difference?鈥� And so they gave recommendations.鈥�

With assistance from Georgia Southern doctoral students, a book of the participants鈥� photos and accompanying stories, 鈥�,鈥� was published in both print and online formats and shared with community partners. The response from local businesses was positive, and policy changes to support working mothers are forthcoming.

Early in phase two of this project, Marshall will expand this research, lending cameras to Hispanic and Latina mothers who will be able to document their barriers within the community.

Marshall鈥檚 community efforts garnered the attention of larger audiences who also aim to create a culture of breastfeeding support.

鈥淚’ve been fortunate that, because of my work with this, I’ve been pulled onto some national stages,鈥� said Marshall. 鈥淩ecently, the National Association of County and City Health Officials and the U.S. Breastfeeding Committee created a blueprint toolkit, and they brought me on to talk to over 500 people about the work that we’ve done in Savannah with breastfeeding. It’s been a really great experience. I’ve made a lot of connections with colleagues, and it’s been exciting to see how our work has been received while also having the opportunity to see what other folks are doing and how we can partner to really enhance what we’re doing as well.鈥�

A member of the U.S. Breastfeeding Committee鈥檚 CRASH Committee since 2018, Marshall will further amplify this work as she begins her role as president of the American Public Health Association in November. Recently serving as chair of the executive board for the organization, Marshall will soon lead the charge to advance the organization鈥檚 mission, which in large part is educating citizens on what public health is.

鈥淚t’s about the public’s health, and keeping folks healthy, right?鈥� Marshall posed. 鈥淪o when you consider some of the clinical jobs like medicine and nursing, they focus more on the individual. With public health, we’re focusing on communities and making sure we have that larger impact. So it’s about prevention. It’s about education. But it鈥檚 also about health policies and how what we’re writing and what we’re passing into law is going to affect someone’s health.鈥� 

Another important part of Marshall鈥檚 mission is inspiring a new generation of public health practitioners and leaders. While serving as a professor in Georgia Southern鈥檚 bachelor鈥檚, master鈥檚 and doctoral public health programs and mentoring students who participate in her research endeavors, she also teaches in the Bulloch County School system. She loves working with high school students and introducing them to public health while emphasizing the potential of this sector.

鈥淭he biggest piece that I’ve loved about it is you can tell that they’re learning about what public health is, which really is the point,鈥� Marshall said. 鈥淥ne of the things that we’re really passionate about in Georgia Southern鈥檚 College of Public Health is making sure that students know sooner than later that public health is a viable career option, but even if they don’t choose it as a career, regardless of what your job is, where you’re employed or what your career is, it’s going to have an effect on health outcomes. So even if people are just introduced to public health so that they have a different lens and really consider what they’re doing and how it affects someone’s health outcomes in anything from communications to engineering, it all can affect people’s health in some positive way.鈥�

Days are long and full, but she wouldn鈥檛 have it any other way.

鈥淢y work is everything,鈥� said Marshall. 鈥淚t’s about making a difference. It’s about fueling my passion, but also being a good example to my children and showing them that no matter how hard things get in the world, we have that opportunity to make a difference.鈥�