Find State ESMs

Evidence Level: Moderate. Aligns with MCHbest strategy "Lactation Consultants". Find other NPM 4 mothers/family-level strategies in MCHbest.

Alignment with field-based evidence through Innovation Hub: Emerging Practice. Aligns with mothers/family-level strategy as documented by the BreastfeedingTraining.org program in AMCHP's Innovation Hub.

Measurement Quadrant: Quadrant 3: Measuring quantity of effect (# of "is anyone better off")

Service Type: Direct services level of pyramid

Essential Public Health Services: 7. Assure effective and equitable health systems

Service Recipient: Activities directed to families/children/youth

Goal: Increase the number of women served by Title V-funded breastfeeding support services

Numerator: Number of women receiving in-person, telehealth, or telephonic breastfeeding support

Denominator:

Significance: Breastfeeding, specifically exclusive breastfeeding, is known to provide immediate benefits to infants and mothers and long-term protection from chronic health problems that lead to morbidity and mortality. Achieving the Baby-Friendly designation is an evidence based practice that has been shown to increase breastfeeding initiation and duration. Guidelines and Evaluation Criteria for Facilities Seeking Baby-Friendly Designation. 2016 revision. Baby-Friendly USA, Inc.

Data Sources and Data Issues: Contractor reports

Year: 2023

Unit Type: Count, Unit Number: 10,000

Evidence Level: This ESM is population-based (measures access to/receipt of care), thus doesn’t align with a specific evidence-based strategy. Consider developing an ESM for one of the specific strategies in your state action plan to measure performance. Check MCHbest for examples to connect to the evidence.

Alignment with field-based evidence through Innovation Hub: No similar strategies found in Innovation Hub.

Measurement Quadrant: Quadrant 4: Measuring quality of effect (% of "is anyone better off")

Service Type: Systems level of pyramid

Essential Public Health Services: 1. Assess and monitor population health

Service Recipient: Activities directed to families/children/youth

Goal: Increase of the number of infants breastfed through 6 months

Numerator: Number of infants who were 3 months breastfed.

Denominator: Total number of infants

Significance: Although the goal is for mothers to exclusively breastfed their infants through 6 months, achieving this task is difficult specially if the population is showing a 6 months exclusively breastfed rate of 0% to 2% annually. Supporting mothers to breastfeed and targeting a period where we see drops in breastfeeding (around the timing for when most working mothers return to work) is critical for increasing the likelihood of longer breastfeeding duration. Studies have shown that mothers who are working full-time outside of the home is related to a shorter breastfeeding duration.

Data Sources and Data Issues: Women Infant and Children (WIC) program will provide data on infants ever breastfed

Year: 2023

Unit Type: Percentage, Unit Number: 100

Evidence Level: Mixed. Aligns with MCHbest strategy "Group Education" [https://www.mchevidence.org/tools/strategies/4-3.php]. Find other NPM 4 family-level strategies [https://www.mchevidence.org/tools/strategies/search/results.php?NPM=4&Target_Audience=Mother/family%20(through%20home%20visitors,%20community%20health%20workers,%20and%20health%20care%20providers)] in MCHbest.

Alignment with field-based evidence through Innovation Hub: Aligns with Innovation Hub's Starting Out Right Curriculum and Women's Health Education Navigation (WHEN) programs. https://amchp.org/wp-content/uploads/2021/05/Starting-Out-Right-Curriculum.pdf https://amchp.org/wp-content/uploads/2021/05/WHEN-Implementation-Handout_Final_Promising.pdf

Measurement Quadrant: Quadrant 4: Measuring quality of effect (% of "is anyone better off")

Service Type: Enabling services level of pyramid

Essential Public Health Services: 3. Inform and educate the public

Service Recipient: Activities directed to families/children/youth

Goal: Improve the rate of breastfeeding by encouraging mothers to breastfeed within the first six months after birth.

Numerator: Number of infants are breastfed within first six months of birth.

Denominator: Total number of live births.

Significance: One of the most highly effective preventive measures a mother can take to protect the health of her infant and herself is to breastfeed. However, in the U.S., while 75 percent of mothers start out breastfeeding, only 13 percent of babies are exclusively breastfed at the end of six months. Additionally, rates are significantly lower for African-American infants. Breast milk provides all of the nutrients an infant needs for the first six months. Additionally, it has immunological properties that protect infants against common diseases, such as diarrhea and pneumonia, which are important causes of infant morbidity and mortality. Breastfeeding also presents advantages to the mother’s health, increasing the postpartum infertility period, helping them return to their pregestational weight, and reducing their risk of developing breast 6 and ovarian cancer. Despite the benefits of breastfeeding, the decision to breastfeed is a personal one, and a mother should not be made to feel guilty if she cannot or chooses not to breastfeed. The success rate among mothers who want to breastfeed can be greatly improved through active support from their families, friends, communities, clinicians, health care leaders, employers and policymakers. Given the importance of breastfeeding for the health and well-being of mothers and children, it is critical that we take action across the country to support breastfeeding.

Data Sources and Data Issues: SILAS and Postpartum Data

Year: 2023

Unit Type: Percentage, Unit Number: 100

Evidence Level: Moderate. Aligns with MCHbest strategy "Lactation Consultants" (https://www.mchevidence.org/tools/strategies/4-1.php). Find other NPM 4 family-level strategies in MCHbest. https://www.mchevidence.org/tools/strategies/search/results.php?NPM=4&Target_Audience=Mother/family%20(through%20home%20visitors,%20community%20health%20workers,%20and%20health%20care%20providers)

Alignment with field-based evidence through Innovation Hub: Aligns with Early Intervention Parenting Partnerships (EIPP) https://amchp.org/wp-content/uploads/2021/05/EIPP_Final-Handout.pdf

Measurement Quadrant: Quadrant 2: Measuring quality of effort (% of reach; satisfaction)

Service Type: Systems level of pyramid

Essential Public Health Services: 3. Inform and educate the public

Service Recipient: Activities directed to families/children/youth

Goal: Increase the number of infants breastfed up to six months and increased the percent of infants exclusively breastfed.

Numerator: Number of women provided with in-person or telephonic breastfeeding consults/support services

Denominator:

Significance: Breastfeeding is the normative standard for infant feeding and nutrition and can result in improved infant and maternal health outcomes. Moreover, promoting and/or facilitating community activities that reinforce breastfeeding may allow for more women across the state to have access to the support they need to initiate breastfeeding and continue doing so exclusively for at least 6 months.

Data Sources and Data Issues: MCH Program/Clinics. We will develop the collection tool for this ESM.

Year: 2023

Unit Type: Text, Unit Number: Yes/No

Evidence Level: Moderate. Aligns with MCHbest strategy "Peer Counselors" (https://www.mchevidence.org/tools/strategies/4-2.php). Find other NPM 4 mother/family-level strategies in MCHbest.

Alignment with field-based evidence through Innovation Hub: Emerging. Aligns with Community-based breastfeeding support designation model as documented by the Communities Supporting Breastfeeding (KS) program in AMCHP's Innovation Hub.

Measurement Quadrant: Quadrant 4: Measuring quality of effect (% of "is anyone better off")

Service Type: Direct services level of pyramid

Essential Public Health Services: 7. Assure effective and equitable health systems

Service Recipient: Activities directed to families/children/youth

Goal: Increase the percent of WIC participants who breastfeed exclusively through six months

Numerator: Number of WIC participants receiving breastfeeding peer counselor services who were exclusively breastfeeding at 3 months

Denominator: Number of WIC participants who receive breastfeeding peer counselor services

Significance: According to the Surgeon General’s Call to Action to Support Breastfeeding “one of the most highly effective preventive measures a mother can take to protect the health of her infant and herself is to breastfeed. However, in the U.S., while 75% of mothers start out breastfeeding, only 13 percent of babies are exclusively breastfed at the end of six months…A mother’s ability to begin and to continue breastfeeding can be influenced by a host of community factors… programs such as the U.S. Department of Agriculture’s WIC program can expand the support that women ideally have received in the hospital and help extend the duration of breastfeeding.” It focuses on increasing exclusive breastfeeding at 3 months, which is a milestone towards reaching exclusive breastfeeding at 6 months and one that is more within the control of the WIC peer counselor program.

Data Sources and Data Issues: Massachusetts WIC data system

Year: 2023

Unit Type: Percentage, Unit Number: 100

Evidence Level: No similar strategy found in the established evidence for this NPM. See similar ESMs for this NPM or search for other strategies or promising practices.

Alignment with field-based evidence through Innovation Hub: Emerging Practice. Aligns with patient-level strategy as documented by the Communities Supporting Breastfeeding program in AMCHP's Innovation Hub.

Measurement Quadrant: Quadrant 4: Measuring quality of effect (% of "is anyone better off")

Service Type: Enabling services level of pyramid

Essential Public Health Services: 7. Assure effective and equitable health systems

Service Recipient: Activities directed to families/children/youth

Goal: Reduce the number of women who stop breastfeeding due to lack of support from family or friends.

Numerator: Number of PRAMS respondents who stop breastfeeding due to lack of support from family or friends

Denominator: Number of PRAMS respondents

Significance: Breast milk provides the ideal nutrition for infants. It provides the proper mix of vitamins, protein, and fat to help babies grow. Breastmilk is more easily digested than infant formula, and contains antibodies to help babies fight off viruses and bacteria. Babies who are breastfed exclusively for the first 6 months, without any formula, have fewer health issues. They also have fewer hospitalizations and trips to the doctor. Understanding barriers to breastfeeding continuation as measured by this ESM is important when determining if breastfeeding support programs are having an impact on breastfeeding rates.

Data Sources and Data Issues: Nevada Pregnancy Risk Assessment Monitoring System; Data represents 2018 calendar year births. Nevada PRAMS receives data in fall of the preceding birth year, resulting in a year lag (2019 data is not received until fall 2020). That is why 2018 calendar year was used. 2018 Nevada PRAMS data had a response rate of 39.4% which is under the Centers for Disease Control and Prevention (CDC) required response rate threshold of 55% to publish data. Interpret data with caution due to the response rate.

Year: 2023

Unit Type: Percentage, Unit Number: 100

Evidence Level: Mixed. Aligns with MCHbest strategy "Hospital Policies" . Find other NPM 4 hospital-level strategies in MCHbest.

Alignment with field-based evidence through Innovation Hub: Emerging Practice. Aligns with hospital-level strategy as documented by the Baby Steps to Breastfeeding Success program in AMCHP's Innovation Hub. Practice Level (e.g., Emerging Practice). Aligns with hospital-level strategy as documented by the Birth and Beyond California program in AMCHP's Innovation Hub.

Measurement Quadrant: Quadrant 2: Measuring quality of effort (% of reach; satisfaction)

Service Type: Enabling services level of pyramid

Essential Public Health Services: 5. Create/champion/implement policy

Service Recipient: Activities directed to families/children/youth

Goal: Annually increase the percent of PA birthing facilities designated as a Keystone 10 facility each fiscal year

Numerator: Number of Keystone 10 facilities completing one or more steps during state fiscal year.

Denominator: Number of facilities enrolled in initiative at the beginning of the state fiscal year, excluding Keystone 10 designated facilities.

Significance: Improving breastfeeding initiation and duration rates is necessary to reduce infant mortality, as breastfeeding has been found to decrease the risk of hospitalization in the first year of life, the development of chronic health conditions, and the occurrence of Sudden Unexpected Infant Death (SUID) by at least 50%. Mothers in the United States are 13 times more likely to stop breastfeeding before six weeks after birth if they deliver in a hospital not participating in a 10-step breastfeeding initiative in comparison to mothers who delivered at a facility where at least six of the ten steps were followed. The program will continue to implement and promote the Keystone 10 initiative and encourage participants to complete Keystone 10 steps. Education will be given to participants on the positive outcomes breastfeeding has on mothers and their babies, and how completing Keystone 10 steps leads to better breastfeeding rates.

Data Sources and Data Issues: The number of steps completed by PA birthing facilities participating in Keystone 10 will be collected by the breastfeeding program staff.

Year: 2023

Unit Type: Percentage, Unit Number: 100

Evidence Level: This ESM is population-based (measures access to/receipt of care), thus doesn’t align with a specific evidence-based strategy. Consider developing an ESM for one of the specific strategies in your state action plan to measure performance. Check MCHbest for examples to connect to the evidence.

Alignment with field-based evidence through Innovation Hub: No similar strategies found in Innovation Hub.

Measurement Quadrant: Quadrant 4: Measuring quality of effect (% of "is anyone better off")

Service Type: Enabling services level of pyramid

Essential Public Health Services: 7. Assure effective and equitable health systems

Service Recipient: Activities directed to families/children/youth

Goal: To increase through education on the benefits of breastfeeding, the percentage of infants who are ever breastfed.

Numerator: 5785

Denominator: 7991

Significance: Breastfeeding strengthens the immune system, reduces respiratory infections, gastrointestinal illness, and SIDS, and promotes neurodevelopment. Breastfed children may also be less likely to develop diabetes, childhood obesity, and asthma. American Academy of Pediatrics Section on Breastfeeding. Breastfeeding and the use of human milk. Pediatrics. 2012 Mar;129(3):e827-41. http://pediatrics.aappublications.org/content/early/2012/02/22/peds.2011-3552

Data Sources and Data Issues: WIC Program

Year: 2023

Unit Type: Percentage, Unit Number: 100

Evidence Level: This ESM is based on state data and measures access to/receipt of care, thus doesn't align with a specific evidence-based strategy. Consider developing an ESM for one of the specific strategies in your state action plan to measure performance. Check MCHbest for examples to connect to the evidence.

Alignment with field-based evidence through Innovation Hub: No similar strategies found in Innovation Hub.

Measurement Quadrant: Quadrant 4: Measuring quality of effect (% of "is anyone better off")

Service Type: Direct services level of pyramid

Essential Public Health Services: 7. Assure effective and equitable health systems

Service Recipient: Activities directed to families/children/youth

Goal: Promote breastfeeding to ensure better health for infants and mothers

Numerator: Number of infants certified for the WIC program whose mothers reported initiation of breastfeeding (at the time of WIC certification)

Denominator: Number of infants certified for the WIC program

Significance: Breastfeeding is the best source of nutrition for most infants. It can also reduce the risk for certain health conditions for both infants and mothers. Infants who are breastfed have reduced risks of asthma, obesity, Type 1 diabetes, severe lower respiratory disease, acute otitis media (ear infections), sudden infant death syndrome (SIDS). gastrointestinal infections (diarrhea/vomiting), and necrotizing enterocolitis (NEC) for preterm infants. Mothers who breastfeed also experience several benefits, including lowering a mother's risk of high blood pressure, Type 2 diabetes, ovarian cancer, and breast cancer.

Data Sources and Data Issues: Arkansas WIC Program SPIRIT System. Breastfeeding initiation data are collected on the telephone call to set up the initial WIC certification appointment.

Year: 2023

Unit Type: Percentage, Unit Number: 100

Evidence Level: Mixed. Aligns with MCHbest strategy "Hospital Policies" (https://www.mchevidence.org/tools/strategies/4-6.php). Find other NPM 4 hospital-level strategies in MCHbest.

Alignment with field-based evidence through Innovation Hub: Emerging. Aligns with Hospital perinatal health quality improvement and staff training demonstration project as documented by the Baby Steps to Breastfeeding Success (AZ) program in AMCHP's Innovation Hub.

Measurement Quadrant: Quadrant 4: Measuring quality of effect (% of "is anyone better off")

Service Type: Systems level of pyramid

Essential Public Health Services: 6. Utilize legal and regulatory actions

Service Recipient: Activities directed to families/children/youth

Goal: Increase the proportion of births that occur at Breastfeeding-Friendly Maternity Centers

Numerator: Number of live births that occurred at currently accredited MDH Breastfeeding-Friendly Maternity Centers

Denominator: Number of live births in calendar year

Significance: Most births in Minnesota occur in hospital settings. Maternity hospital practices and policies can undermine maternal and infant health by creating barriers to supporting a mother's decision to breastfeed. When hospitals implement the Baby-Friendly Ten Steps, they have the tools to give mothers the information, confidence, and skills necessary to successfully initiate and continue to breastfeed their babies. Women who get the support they need in the hospital are much more likely to continue once they return home. MDH’s Breastfeeding-Friendly Maternity Center Five-Star program tracks progress by hospitals in implementing evidence-based processes, provides technical assistance to hospitals applying for Stars, and provides intermediate recognition of work on the Ten Steps, without the costs associated with Baby-Friendly designation, which are a barrier to hospitals achieving BFHI designation. MDH’s program is intended to encourage hospitals to move toward BFHI designation. Hospitals can achieve designation are accredited for 3 years, or, in conjunction with Baby-Friendly USA designation, for 5 years. Each two Steps implemented earns one Star, for a possible total of Five Stars/Ten Steps achieved.

Data Sources and Data Issues: Data Source: MN Vital Records and MDH’s Accreditation Database, tracked in Redcap. Accreditation process monitored by WIC breastfeeding unit staff and OSHII staff. Achievement of individual Steps is applied for and progress documented by hospital staff, with completed Steps reviewed and verified by MDH staff and partners from the Minnesota Breastfeeding Coalition. Limitations of Data: The expiration of accreditation is tied to completion of the 10th Step and other Steps may have been completed longer than 3/5 years prior. MN Vital Records are limited to births that occur to Minnesota Residents in Minnesota.

Year: 2023

Unit Type: Percentage, Unit Number: 100

Evidence Level: Emerging. Aligns with MCHbest strategy "Provider Training". Find other NPM 4 provider-level strategies in MCHbest.

Alignment with field-based evidence through Innovation Hub: No similar strategies found in Innovation Hub.

Measurement Quadrant: Quadrant 1: Measuring quantity of effort (counts and "yes/no" activities)

Service Type: Systems level of pyramid

Essential Public Health Services: 8. Build and support a workforce

Service Recipient: Activities directed to families/children/youth

Goal: Increase the number of Idahoans who receive information about best practices related to breastfeeding through attendance at the annual Idaho Breastfeeeding Summit.

Numerator: Number of professionals and parents who attend annual Idaho Breastfeeding Summit.

Denominator:

Significance: The MCH leadership team will support an annual statewide breastfeeding summit to provide healthcare providers training on best practices for breastfeeding initiation and duration. The Kansas Breastfeeding Coalition (KBC), established the Community Supporting Breastfeeding (CBS) program, which incorporates varied approaches that assist breastfeeding mothers, promote initiation and duration of breastfeeding by including the formation of a local breastfeeding coalition, offering a course for healthcare providers to learn about supporting breastfeeding, and provide resources and information to reduce barriers and increase the perception of breastfeeding (Association of Maternal & Child Health Programs [AMCHP], 2016). Program participants indicated that the coalition cultivated engagement, leadership development, and community support, as well as increased involvement from organizations and government officials that support and advocate towards breastfeeding by enhancing the sustainability and engagement of existing programs, and allocating breastfeeding coalitions in areas where they are not provided (AMCHP, 2016). Additionally, Colorado has had success in increasing breastfeeding rates through statewide training of hospital personnel and informing parents about beneficial breastfeeding practices through Local Public Health agencies such as Women, Infants and Children (WIC) (AMCHP, 2012). Colorado experienced notable increases in breastfeeding initiation and duration rates following the five-key breastfeeding strategy, Colorado Can Do 5, which offers five beneficial breastfeeding practices to hospitals and medical centers (Colorado Department of Public Health and Environment, 2011).

Data Sources and Data Issues: Idaho Breastfeeding Coalition

Year: 2023

Unit Type: Count, Unit Number: 1,000

Evidence Level: Moderate. Aligns with MCHbest strategy "Peer Counselors". Find other NPM 4 mother/family-level strategies in MCHbest.

Alignment with field-based evidence through Innovation Hub: Emerging. Aligns with Nutrition educational materials based on "emotional pulse points" as documented by the Touching Hearts and Minds (MA) program in AMCHP's Innovation Hub.

Measurement Quadrant: Quadrant 1: Measuring quantity of effort (counts and "yes/no" activities)

Service Type: Direct services level of pyramid

Essential Public Health Services: 7. Assure effective and equitable health systems

Service Recipient: Activities directed to families/children/youth

Goal: To improve breastfeeding initiation rates and have an impact on breastfeeding rates at 1 and 3 months post-partum.

Numerator: Number of pregnant and postpartum WIC clients served by breastfeeding peer counselors

Denominator:

Significance: Peer counselor interventions appear to be effective and are more likely to influence initiation than exclusivity at 6 months. Programs based on this strategy are likely to work. This strategy has been tested more than once and results trend positive overall.

Data Sources and Data Issues: Beauregard JL, Hamner HC, Chen J, Avila-Rodriguez W, Elam-Evans LD, Perrine CG. Racial Disparities in Breastfeeding Initiation and Duration Among U.S. Infants Born in 2015. MMWR Morb Mortal Wkly Rep 2019;68:745–748. DOI: http://dx.doi.org/10.15585/mmwr.mm6834a3 McCoy, M. B., Geppert, J., Dech, L., & Richardson, M. (2018). Associations between peer counseling and breastfeeding initiation and duration: an analysis of Minnesota participants in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Maternal and child health journal, 22(1), 71-81.

Year: 2023

Unit Type: Count, Unit Number: 100,000

Evidence Level: Moderate. Aligns with MCHbest strategy "Peer Counselors". Find other NPM 4 patient-level strategies in MCHbest.

Alignment with field-based evidence through Innovation Hub: No similar strategies found in Innovation Hub.

Measurement Quadrant: Quadrant 1: Measuring quantity of effort (counts and "yes/no" activities)

Service Type: Direct services level of pyramid

Essential Public Health Services: 7. Assure effective and equitable health systems

Service Recipient: Activities directed to families/children/youth

Goal: By 2025, the number of eligible WIC participants who receive breastfeeding peer counselor services will be 31,425 (15% increase from FY19 baseline of 27, 587).

Numerator: Number of eligible WIC participants who receive breastfeeding peer counselor services (determined by having a signed Breastfeeding Peer Counselor Program Letter of Agreement in the Crossroads WIC System)

Denominator:

Significance: Systematic literature reviews have returned similar findings: “Dedicated lactation specialists may play a role in providing education and support to pregnant women and new mothers wishing to breastfeed and to continue breastfeeding (duration) to improve breastfeeding outcomes.”1 1 Patel, S., & Patel, S. (2016). The Effectiveness of Lactation Consultants and Lactation Counselors on Breastfeeding Outcomes. Journal of Human Lactation, 32(3), 530–541.

Data Sources and Data Issues: NC Crossroads WIC System

Year: 2023

Unit Type: Count, Unit Number: 100,000

Evidence Level: No similar strategy found in the established evidence for this NPM. See similar ESMs for this NPM or search for other strategies or promising practices.

Alignment with field-based evidence through Innovation Hub: Emerging Practice. Aligns with Breastfeeding Initiation strategy as documented by the Community Breastfeeding Support Designation Mode program in AMCHP's Innovation Hub.

Measurement Quadrant: Quadrant 4: Measuring quality of effect (% of "is anyone better off")

Service Type: Enabling services level of pyramid

Essential Public Health Services: 2. Investigate and address health problems

Service Recipient: Activities directed to families/children/youth

Goal: To increase breastfeeding among marginalized communities.

Numerator: Number of Non-Hispanic Black mothers that initiate breastfeeding

Denominator: Number of Non-Hispanic Black mothers

Significance: While Oregon has a consistently high rate of breastfeeding initiation, racial/ethnic disparities in this rate persist. Examining the breastfeeding rate among marginalized communities will facilitate the evaluation of the effectiveness of laws and policies that support breastfeeding individuals.

Data Sources and Data Issues: Vital statistics

Year: 2023

Unit Type: Percentage, Unit Number: 100

Evidence Level: Mixed. Aligns with MCHbest strategy 4.6 "Hospital Policies". (https://www.mchevidence.org/tools/strategies/4-6.php) Find other NPM 4 strategies in MCHbest. (https://www.mchevidence.org/tools/strategies/search/refine.php?NPM=4)

Alignment with field-based evidence through Innovation Hub: Aligns with Innovation Hub's The Tampa Bay Doula Program https://amchp.org/wp-content/uploads/2021/05/Tampa-Bay-Doula_2015.pdf

Measurement Quadrant: Quadrant 2: Measuring quality of effort (% of reach; satisfaction)

Service Type: Enabling services level of pyramid

Essential Public Health Services: 3. Inform and educate the public

Service Recipient: Activities directed to families/children/youth

Goal: To increase the percentage of infants ever breastfed and those breastfed exclusively through 6 months.

Numerator: The number of maternity service hospitals that teach breastfeeding mothers how to recognize feeding cues, breastfeed on-demand, and understand the risks of artificial nipples/pacifiers.

Denominator: The total number maternity service hospitals in Florida.

Significance: This ESM helps capture individuals who breastfeed at the hospital before discharge (i.e., ever breastfed). Although this measure cannot help quantify exclusive breastfeeding through six months, this measure can instead provide insight to the prevalence of breastfeeding patients who were taught, in the hospital, strategies to support continued exclusive breastfeeding through six months. Measuring it is important to show progress because observed increases in the prevalence would indicate the success of statewide partnerships in improving breastfeeding initiation and exclusive breastfeeding, which in turn would help reduce associated adverse health outcomes (e.g. infant mortality) in Florida.

Data Sources and Data Issues: Maternity Practices in Infant Nutrition and Care (mPINC). The survey measures care practices and policies that impact newborn feeding, feeding education, staff skills, and discharge support. CDC invites all hospitals with maternity services in the U.S. and territories to participate. In 2020, 71 of 110 eligible hospitals in Florida participated (65%).

Year: 2023

Unit Type: Percentage, Unit Number: 100

Evidence Level: No similar strategy found in the established evidence for this NPM. See similar ESMs for this NPM or search for other strategies or promising practices.

Alignment with field-based evidence through Innovation Hub: Promising. Aligns with health education curriculum as documented by the Starting Out Right program in MCHP's Innovation Hub. Cutting Edge. Aligns with Workplace policy as documented by the Reducing Breastfeeding Disparities in California Through Lactation Accomodation Workgroup (CA) program in MCHP's Innovation Hub.

Measurement Quadrant: Quadrant 2: Measuring quality of effort (% of reach; satisfaction)

Service Type: Direct services level of pyramid

Essential Public Health Services: 3. Inform and educate the public

Service Recipient: Activities directed to families/children/youth

Goal: Increase the number of Maternal Health clients who receive education about breastfeeding through 6 months and information on pumping at work

Numerator: Number of Maternal Health clients who receive education

Denominator: Total number of Maternal Health clients served

Significance: Educating women on the benefits of breastfeeding through 6 months and their rights and best methods on pumping at work will help increase the rate on initiation and breastfeeding through 6 months.

Data Sources and Data Issues: Title V data system report. Ensuring agencies are aware of how to document the this activity in the data system

Year: 2023

Unit Type: Percentage, Unit Number: 100

Evidence Level: This ESM is population-based (measures access to/receipt of care), thus doesn’t align with a specific evidence-based strategy. Consider developing an ESM for one of the specific strategies in your state action plan to measure performance. Check MCHbest for examples to connect to the evidence.

Alignment with field-based evidence through Innovation Hub: No similar strategies found in Innovation Hub.

Measurement Quadrant: Quadrant 4: Measuring quality of effect (% of "is anyone better off")

Service Type: Enabling services level of pyramid

Essential Public Health Services: 7. Assure effective and equitable health systems

Service Recipient: Activities directed to families/children/youth

Goal: Increase the percent of non-Hispanic Black infants ever breastfed according to Vital Records from 51% to 56.1% (+10%) by 2025.

Numerator: Number of non-Hispanic Black infants ever breastfed in Wisconsin

Denominator: Number of non-Hispanic Black infants born alive in Wisconsin

Significance: Breastfeeding offers both short and long term benefits for the mother and child. Breastfeeding is also a protective factor for Sudden Unexpected Infant Death. Disparities persist in Wisconsin related to breastfeeding initiation and duration rates for the African American community.

Data Sources and Data Issues: Vital Records will be the main data source for this ESM. One issue is that Vital Records is often missing information. Additionally, “ever breastfed” is filled out by health care workers at time of hospital discharge, so there are gaps in this information. The strength of this data source over others such as PRAMS or Home Visiting data is that Vital Records is more reflective of the entire population. It is also reported in a timely manner, and collects information on a larger number of individuals than other sources.

Year: 2023

Unit Type: Percentage, Unit Number: 100

Evidence Level: This ESM is population-based (measures access to/receipt of care), thus doesn’t align with a specific evidence-based strategy. Consider developing an ESM for one of the specific strategies in your state action plan to measure performance. Check MCHbest for examples to connect to the evidence.

Alignment with field-based evidence through Innovation Hub: No similar strategies found in Innovation Hub.

Measurement Quadrant: Quadrant 4: Measuring quality of effect (% of "is anyone better off")

Service Type: Direct services level of pyramid

Essential Public Health Services: 7. Assure effective and equitable health systems

Service Recipient: Activities directed to families/children/youth

Goal: Increase the percentage of infants who are breastfeeding at time of discharge from a birthing facility to 74% by 2025.

Numerator: Number of infants who are breastfeeding at time of discharge from birthing facilities

Denominator: Number of live infant discharged from a birthing facility

Significance: Birthing facility utilization the Ten Steps to Successful Breastfeeding will encourage breastfeeding and increase the percent of infants who are ever breastfed and breastfed exclusively through 6 months.

Data Sources and Data Issues: Vital Statistics

Year: 2023

Unit Type: Percentage, Unit Number: 100

Evidence Level: Moderate. Aligns with MCHbest strategy "Home Visits". Find other NPM 4 family-level strategies in MCHbest.

Alignment with field-based evidence through Innovation Hub: Promising. Aligns with Nurse home visits and case management by CHIP nurses, in combination with a medical home and regular nurse consultations by Optima as documented by the Partners in Pregnancy (VA) program in AMCHP's Innovation Hub. Promising. Aligns with Nurse home visit as documented by the Welcome Family (MA) program in AMCHP's Innovation Hub. Best. Aligns with home visiting program as documented by the Every Child Succeeds (OH/VA) program in AMCHP's Innovation Hub.

Measurement Quadrant: Quadrant 4: Measuring quality of effect (% of "is anyone better off")

Service Type: Enabling services level of pyramid

Essential Public Health Services: 7. Assure effective and equitable health systems

Service Recipient: Activities directed to families/children/youth

Goal: Increase the percentage of infants enrolled in home visiting receiving breast milk

Numerator: Number of infants enrolled in home visiting receiving breast milk at 6 months of age

Denominator: Number of infants enrolled in home visiting at 6 months of age

Significance: Our home visiting programs enroll the most vulnerable families that are of lower socio-economic status. Mothers in this population have lower rates of initiating breastfeeding as well as difficulty continuing to breastfeed through 6 months of age.

Data Sources and Data Issues: MCH/MIECHV program data

Year: 2023

Unit Type: Percentage, Unit Number: 100

Evidence Level: This ESM is based on state data and measures access to/receipt of care, thus doesn’t align with a specific evidence-based strategy. Consider developing an ESM for one of the specific strategies in your state action plan to measure performance. Check MCHbest for examples to connect to the evidence.

Alignment with field-based evidence through Innovation Hub: Emerging Practice. Aligns with Breastfeeding Initiation strategy as documented by the Community Breastfeeding Support Designation Mode program in AMCHP's Innovation Hub.

Measurement Quadrant: Quadrant 4: Measuring quality of effect (% of "is anyone better off")

Service Type: Enabling services level of pyramid

Essential Public Health Services: 2. Investigate and address health problems

Service Recipient: Activities directed to families/children/youth

Goal: To increase breastfeeding among marginalized communities.

Numerator: Number of Non-Hispanic American Indian/Alaska Native mothers that initiate breastfeeding

Denominator: Number of Non-Hispanic American Indian/Alaska Native mothers

Significance: While Oregon has a consistently high rate of breastfeeding initiation, racial/ethnic disparities in this rate persist. Examining the breastfeeding rate among marginalized communities will facilitate the evaluation of the effectiveness of laws and policies that support breastfeeding individuals.

Data Sources and Data Issues: Vital statistics

Year: 2023

Unit Type: Percentage, Unit Number: 100