Before she even received her diploma, Cara Safon’s research was already having an impact. A study that she conducted while still an M.P.H. student at the Yale School of Public Health led to two published peer-reviewed articles on breastfeeding practices in León, Nicaragua.
Safon entered the program knowing she wanted to pursue research on maternal-child health, and began seeking out research opportunities in the field. She connected with YSPH Professor Rafael Pérez-Escamilla, Ph.D., who currently leads the Becoming Breastfeeding Friendly (BBF) scaling up initiative, a program that helps guide countries in assessing their readiness to improve breastfeeding protection, promotion and support environments. Together, they devised a research proposal that would examine the connection between delivery mode —natural or Cesarean section—and subsequent breastfeeding outcomes.
That project grew into a two-part study featuring both a survey component that examined the relationship between delivery type and breastfeeding practices, and an interview component, aimed at understanding women’s experiences with breastfeeding. With additional mentorship from Assistant Professor Danya Keene, Ph.D., Safon was able to serve as principal investigator of both studies. She graduated with her M.P.H in 2016.
The interdisciplinary nature of public health is as important and relevant as ever.
Cara Safon
The research revealed compelling results. The qualitative study found that many mothers experienced “perceived insufficient milk,” a phenomenon that occurs when mothers feel that their breastmilk cannot satiate their babies. This result was found to be associated with maternal anxiety about maintaining the health of their babies, mothers' concern about their own nutritional status when breastfeeding, family input about infant feeding, and perceptions of infant feeding norms. The quantitative study, which sought to examine the association between delivery type and early and exclusive breastfeeding, yielded no significant results; however, other factors, including pre-lacteal feeding and maternal perceived infant size at birth, were found to be associated with the outcomes. Both studies were published in the journal Maternal & Child Nutrition in 2016 and 2017, respectively.
“The articles Cara published, and the process that led to them tell a compelling story,” said Pérez-Escamilla. Even before graduation, “outstanding students like Cara are contributing to improving infant nutrition in low-income countries.”
Safon conducted her work in León through a collaboration with Student Partnerships for Global Health, a Yale organization that connects undergraduates and graduate students with international partners, including hospitals, health centers and other institutions, to conduct global health projects. Safon was connected with a researcher at the National Autonomous University of Nicaragua-León who became one of her Nicaraguan collaborators. She also was matched with two Yale College students, Darby Herkert and Sara Kiani, who helped collect and analyze the data, and who were both authors on the published manuscripts.
Safon said that the results from both studies indicate that structural-level support, like the Baby-Friendly Hospital Initiative and enforcement of the International Code of Marketing of Breastmilk Substitutes, is needed in order to improve poor breastfeeding outcomes.
Along with an improved understanding of infant nutrition, Safon also gained important insights into the importance of public health research. “The interdisciplinary nature of public health is as important and relevant as ever,” she said. “Everyone should become advocates for public health.”
Safon is now a researcher with the BBF initiative and a consultant for the Pan-American Health Organization. She hopes to continue maternal child health research in the future and plans to begin her doctorate within the next few years.