Find State ESMs

Measure Status: Active

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

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:

Goal: Increase the proportion of live births that occur in facilities that have met all requirements set by the Stepping up for Utah Babies program to become a “Breastfeeding Friendly Facility.”

Numerator: Number of infants born in a facility that has met the requirements set by the Stepping up for Utah Babies program

Denominator: Number of live births

Significance: Hospital policy and practice significantly affect whether a woman feels confident enough to reach her breastfeeding goals. The Stepping Up for Utah Babies program encourages and recognizes hospitals that offer an optimal level of care for lactation based on the World Health Organization (WHO)/United Nations Children’s Fund (UNICEF) Ten Steps to Successful Breastfeeding. To be designated as a “Breastfeeding Friendly Facility,” facilities must meet the requirements set by Stepping Up program staff for each of the Ten Steps. By fully implementing all Ten Steps, the participating hospitals can help new mothers successfully start and continue breastfeeding.

Data Sources and Data Issues: Numerator: Maternal and Infant Health Program Data/Vital Records Birth Certificate Data Denominator: Vital Records Birth Certificate Data

Year: 2021

Unit Type: Percentage, Unit Number: 100

Measure Status: Active

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

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: Count

Significance:

Data Sources and Data Issues: 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.

Year: 2021

Unit Type: 10000, Unit Number: Contractor reports

Measure Status: Active

Evidence Level: Mixed. Aligns with MCHbest strategy 4.6 "Hospital Policies". Find other NPM 4 practice-level strategies in MCHbest.

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

Service Type: Enabling services level of pyramid

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

Service Recipient: Activities related to systems-building

Goal: To increase the number of Florida hospitals achieving the Baby Steps to Baby Friendly hospital designation.

Numerator: The number of Florida hospitals achieving the Baby Steps to Baby Friendly hospital designation.

Denominator: Count

Significance:

Data Sources and Data Issues: Baby Friendly birthing hospitals offer an optimal level of care for infant feeding and mother/baby bonding. They provide mothers with the information, confidence, and skills necessary to successfully initiate and continue breastfeeding their babies or feed formula safely. Breastfeeding provides the most complete nutrition possible, the optimal mix of nutrients and antibodies necessary for each baby to thrive. Studies have shown that breastfed children have far fewer and less serious illnesses than those who never receive breast milk, including a reduced risk of SIDS, childhood cancers, and diabetes. Recent studies show that women who breastfeed enjoy decreased risks of breast and ovarian cancer, anemia, and osteoporosis. Both mother and baby enjoy the emotional benefits of the very special and close relationship formed through breastfeeding.

Year: 2021

Unit Type: 100, Unit Number: Baby Steps to Baby Friendly USA multi-year tracker

Measure Status: Active

Evidence Level: Emerging. Aligns with MCHbest strategy "Family Leave, Workplace Policies, State Laws". Find other NPM 4 workplace-level strategies in MCHbest.

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 number of workplace presentations and workplace policies implemented to support breastfeeding mothers.

Numerator: Number of workplace presentation participants surveyed who report increase in knowledge and skills regarding workplace breastfeeding policies.

Denominator: Number of workplace presentation participants surveyed.

Significance: Support for breastfeeding mothers in the workplace through workplace policies on breastfeeding is critical for women to sustain breastfeeding their infants at least till 6 months of age. There is evidence to suggest that working full-time outside of the home is related to a shorter breastfeeding duration. As mothers are one of the fastest growing segments of the labor workforce, we need to ensure that interventions are in place to support them.

Data Sources and Data Issues: The MCH program will develop a survey to gather data for this measure.

Year: 2021

Unit Type: Percentage, Unit Number: 100

Measure Status: Active

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

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

Service Type: Enabling services level of pyramid

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

Service Recipient: Activities directed to professionals

Goal: Increase the number of home visitors trained in breastfeeding best practices

Numerator: Home visitors trained in breastfeeding best practices in the past year

Denominator: MIECHV home visitors

Significance: Advantages of breastfeeding are indisputable. The American Academy of Pediatrics recommends all infants exclusively breastfeed for about six months as human milk supports optimal growth and development by providing all required nutrients during that time. Breastfeeding strengthens the immune systems, improves normal immune response to certain vaccines, offers protection from allergies, and reduces the possibility of SIDs.

Data Sources and Data Issues: MIECHV Program

Year: 2021

Unit Type: Percentage, Unit Number: 100

Measure Status: Active

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

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

Service Type: Systems level of pyramid

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

Service Recipient: Activities related to systems-building

Goal: Track the certification of eligible facilities by DOH as Breastfeeding Friendly Washington

Numerator: Number of eligible facilities which have adopted Breastfeeding Friendly Washington

Denominator: Total number of eligible facilities

Significance: Breastfeeding has been shown to be extremely beneficial for both the mother and infant. The initiation of breastfeeding and its maintenance for as long as possible has been one of DOH’s core recommended practices. An increase in this measure will help to assure that new mothers are introduced to the practice with the greatest amount of support to achieve the longest maintenance of the behavior. In the long run, this will lead to healthier mothers and healthier infants.

Data Sources and Data Issues: Data come from eligible facilities reporting that they are compliant with the program and have obtained their certification. These data are reported to DOH. One potential issue is inconsistencies in co-sleeping practice recommendations between the certification for Breastfeeding Friendly and the “Cribs for Kids” program.

Year: 2021

Unit Type: Percentage, Unit Number: 100

Measure Status: Active

Evidence Level: Moderate. Aligns with MCHbest strategy "Lactation Consultants" (https://www.mchevidence.org/tools/strategies/4-1.php). Find other NPM 4 mother-level strategies in MCHbest.

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

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 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: Text

Significance:

Data Sources and Data Issues: 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.

Year: 2021

Unit Type: Yes/No, Unit Number: MCH Program/Clinics. We will develop the collection tool for this ESM.

Measure Status: Active

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.

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.” This ESM will track the outcomes of breastfeeding support services offered to WIC participants. 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. This ESM is supported by the findings of Chapman and Perez-Escamilla (2012) which found that peer counseling interventions greatly improved breastfeeding initiation, duration or exclusivity. (http://dx.doi.org/10.3945/an.111.001016) Chapman et al (2010) also found that breastfeeding incidence increased significantly more among mothers attending WIC clinics offering breastfeeding peer counselors. (http://dx.doi.org/10.1177/0890334410369481)

Data Sources and Data Issues: Massachusetts WIC data system

Year: 2021

Unit Type: Percentage, Unit Number: 100

Measure Status: Active

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

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

Service Type: Enabling services level of pyramid

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

Service Recipient: Activities directed to professionals

Goal: By 2025, have at least 85% of the 330 available 10-Steps to Successful Breastfeeding training slots utilized annually by staff and providers from the state's birthing hospitals.

Numerator: Number of training slots utilized by staff and providers from the state's birthing hopsitals

Denominator: Total number of available training slots (330)

Significance: The American Academy of Pediatrics (AAP) recommends all infants (including premature and sick newborns) exclusively breastfeed for about six months as human milk supports optimal growth and development by providing all required nutrients during that time. 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. Maternal benefits include reduced postpartum blood loss due to oxytocin release and possible protective effects against breast and ovarian cancer.

Data Sources and Data Issues: Data Source: Women's Health 5-STAR Initiative Program Data

Year: 2021

Unit Type: Percentage, Unit Number: 100

Measure Status: Active

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

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

Service Type: Systems level of pyramid

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

Service Recipient: Activities directed to professionals

Goal: Baseline for this measure is 48%. Each year there will be an increase of the percentage of services that have CLCs. By the end of five years, there will be 75% of the staff who are certified.

Numerator: Number of PHN, WIC and Maine Families Home Visitors trained as Certified Lactation Counselors.

Denominator: Number of PHN, WIC and Maine Families Home Visitors

Significance: Certified Lactation Counselors have the necessary skills, knowledge, and attitudes to provide clinical breastfeeding counseling and management support to families who are thinking about breastfeeding or who have questions or problems during the course of breastfeeding/lactation. The idea is to provide families with support after they are discharged to enable them to breastfeed through the baby's first 6 month of life. This will provide the number of CLCs available statewide.

Data Sources and Data Issues: PHN, WIC & Maine Families Home Visiting Data

Year: 2021

Unit Type: Percentage, Unit Number: 100

Measure Status: Active

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.

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

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.

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: 2021

Unit Type: Percentage, Unit Number: 100

Measure Status: Active

Evidence Level: There is limited research in the evidence base for this NPM to support this strategy.

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

Service Type: Direct services level of pyramid

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

Service Recipient: Activities directed to families/children/youth

Goal: By 2014, increase percentage of breastfeeding mothers by 5%.

Numerator: Number of pregnant women who initiated breastfeeding their infants at birth.

Denominator: Total number of pregnant women who live births in the reporting year.

Significance: Breastfeeding has many health benefits for both the mother and infant. Breast milk contains all the nutrients an infant needs in the first six months of life. Breastfeeding protects against diarrhoea and common childhood illnesses such as pneumonia, and may also have longer-term health benefits, such as reducing the risk of overweight and obesity in childhood and adolescence. Provision of mother’s breast milk to infants within one hour of birth is referred to as “early initiation of breastfeeding” and ensures that the infant receives the colostrum, or “first milk”, which is rich in protective factors. Current evidence indicates that skin-to-skin contact between mother and infant shortly after birth helps to initiate early breastfeeding and increases the likelihood of exclusive breastfeeding for one to four months of life as well as the overall duration of breastfeeding. Infants placed in early skin-to-skin contact with their mother also appear to interact more with their mothers and cry less.

Data Sources and Data Issues: SILAS

Year: 2021

Unit Type: Percentage, Unit Number: 100

Measure Status: Active

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

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

Service Type: Enabling services level of pyramid

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

Service Recipient: Activities related to systems-building

Goal: To increase the percent of births occurring in hospitals providing optimal lactation support

Numerator: # live births in Baby-Friendly Hospitals

Denominator: # live births in Illinois Hospitals (occurrent births)

Significance: Lactation support and breastfeeding-friendly policies are essentially components for helping new mothers initiate and maintain breastfeeding. The Baby-Friendly Initiative is a process that certifies hospital facilities as having the necessaries policies and supports in place to promote breastfeeding for all infants. For many years, very few of Illinois' birthing hospitals were Baby-Friendly, but increased encouragement for hospitals to pursue this designation over the last 5-10 years has slowly begun to expand the number of Baby-Friendly hospitals in the state. Prior to 2015, there were only 4 Baby-Friendly hospitals in Illinois. The number of additional hospitals that were designated as Baby-Friendly in the following years were: 3 in 2015, 8 in 2016, 4 in 2017, 6 in 2018, and 6 in 2019. The total number of Illinois Baby-Friendly Hospitals now stands at 28 (due to a couple closures or hospitals that did not pursue re-designation), and additional hospitals are in the middle of completing the designation process. This measure will track the percent of Illinois live births occurring in Baby-Friendly hospitals over time. It is related to Healthy People 2020 objective MICH-24: Increase the proportion of live births that occur in facilities that provide recommended care for lactating mothers and their babies.

Data Sources and Data Issues: Birth Certificates, Baby-Friendly USA The full list of Baby-Friendly hospitals in Illinois is available at: https://www.babyfriendlyusa.org/find-facilities/designated-facilities--by-state.

Year: 2021

Unit Type: Percentage, Unit Number: 100

Measure Status: Active

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

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: The Breastfeeding Awareness and Support Program is currently funding an initiative called the Keystone 10 Initiative within Pennsylvania birthing facilities. The goal of this initiative is to facilitate the adoption and implementation of ten evidence-based steps, commonly known as the Ten Steps to Baby Friendly Hospitals. Evidence demonstrates that breastfeeding rates at facilities increase as those facilities implement the evidence-based steps. Monitoring the increase in the number of facilities completing all steps and becoming Keystone 10 designated will ensure movement by these facilities towards increasing breastfeeding rates.

Data Sources and Data Issues: Data for the numerator will be gleaned both from the vendor reports as well as from the Department of Health website on which the listing of hospitals achieving steps is provided. The denominator is the total number of facilities enrolled in the initiative at the beginning of the fiscal year, excluding facilities that are already Keystone 10 designated. The denominator will change as new facilities are added to the initiative (funding dependent).

Year: 2021

Unit Type: Percentage, Unit Number: 100

Measure Status: Active

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.

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: 544

Denominator: 640

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 Infants

Year: 2021

Unit Type: Percentage, Unit Number: 100

Measure Status: Active

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.

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: 2021

Unit Type: Percentage, Unit Number: 100

Measure Status: Active

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

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 related to systems-building

Goal: To increase the number of infants born in hospitals that are implementing evidence-based policies and practices aligned with the Baby-Friendly Hospital Initiative’s Ten Steps to Successful Breastfeeding.

Numerator: Number of infants born in Gift-designated hospitals during the calendar year

Denominator: Number of infants born in Louisiana during the calendar year

Significance: The Gift is an evidence-based hospital designation program for Louisiana birthing facilities designed to increase breastfeeding rates and hospital success. The Gift program helps hospitals improve the quality of their maternity services and enhance patient-centered care through incremental adoption of internationally recognized practices. Facilities that enroll to become Gift designated are guided through the implementation of ten steps that are aligned with the Baby-Friendly Hospital Initiative. The Gift program encourages progress toward pursuit of Baby-Friendlyâ„¢ designation.

Data Sources and Data Issues: Hospital designation data derived from the Gift program records. Birth data retrieved from Louisiana Vital Statistics birth record data.

Year: 2021

Unit Type: Percentage, Unit Number: 100

Measure Status: Active

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.

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

Service Type:

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

Service Recipient: Activities related to systems-building

Goal: To increase the proportion of births occurring in facilities taking steps to provide recommended support for lactating mothers and their babies

Numerator: Estimated number of births occurring in hospitals that are designated by the HHSC Texas Ten Step Program

Denominator: NA

Significance: CDC breastfeeding policy or environmental support indicators focus on increasing the state score on the Maternity Practices in Infant Nutrition and Care (mPINC) survey and increasing proportion of live births that occur in facilities that provide recommended care for lactating mothers and their babies. This is measured by the number of births occurring in facilities that have achieved the Baby Friendly Hospital designation by demonstrating full implementation of the Ten Steps. The Baby Friendly Hospital Initiative is an international WHO/UNICEF program that is administered in the United States by Baby-Friendly USA. Another key metric is reducing the proportion of breastfed newborns who receive formula supplementation within the first 2 days of life.

Data Sources and Data Issues: Data Source: Hospital’s self-reported number of annual births; Texas Ten Step designation listing (HHSC Texas Ten Step Program) Data Issues: None anticipated

Year: 2021

Unit Type: Percentage, Unit Number: 100

Measure Status: Active

Evidence Level: Mixed. Aligns with MCHbest strategy 4.6 "Hospital Policies". Find other NPM 4 Practice-level strategies in MCHbest.

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

Service Type: Systems level of pyramid

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

Service Recipient: Activities related to systems-building

Goal: Increase the percent of births insured by Medicaid at Baby-Friendly designated hospitals from 38.2% (2019) to 45.0% (2025).

Numerator: Number of live births inured by Medicaid in Baby-Friendly designated hospitals

Denominator: Number of live births insured by Medicaid

Significance: Low-income families have greater breastfeeding disparities and lower breastfeeding rates in Colorado. Baby-Friendly hospital policies and practices significantly impact breastfeeding rates for all births, thus increasing the number of designated hospitals that serve high proportions of Medicaid paid births will positively impact breastfeeding rates for low-income families in Colorado and decrease related health disparities in this population.

Data Sources and Data Issues: Birth Certificates, Vital Statistics Program, Colorado Department of Public Health and Environment

Year: 2021

Unit Type: Percentage, Unit Number: 100

Measure Status: Active

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.

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: 2021

Unit Type: Percentage, Unit Number: 100