Find State ESMs

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

Alignment with field-based evidence through Innovation Hub: Promising. Aligns with Hospital breastfeeding quality improvement and staff training as documented by the Birth and Beyond program in AMCHP's Innovation Hub.

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 in the percentage of services that have CLCs. By the end of five years, 75% of staff will be 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 months of life. Public Health Nurses, WIC counselors, and home visitors engage with pregnant and postpartum women on an ongoing basis. By training staff from these programs as CLCs, we will increase the number of CLCs available statewide to support breastfeeding women.

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

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

Alignment with field-based evidence through Innovation Hub: Emerging. Aligns with Bresatfeeding web-based training course as documented by the BreastfeedingTraining.org (VA) program in AMCHP's Innovation Hub. Cutting Edge. Aligns with Workplace Policy as documented by the Reducing Breastfeeding Disparities in California Through Lactation Accommodation Workgroup (CA) program in AMCHP's Innovation Hub.

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

Service Type: Enabling services level of pyramid

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

Service Recipient: Activities related to systems-building

Goal: Improve healthy infant development through breastfeeding and caregiver/infant bonding

Numerator: Total views on the CBC and CWA websites per Title V reporting year

Denominator:

Significance: Breastfeeding improves maternal and infant wellbeing and reduces health care costs since it is associated with reductions in the prevalence of obesity, diabetes; it is also associated with better child development and post-pregnancy maternal health. Additionally, there are cost savings from better retention of experienced workers, higher employee morale, greater loyalty and productivity of employees, reduction in absenteeism and sick leave taken by parents of young children, and lower costs for health care and health insurance. While the percentage of employers having lactation support programs has increased over the past decade, many women still find it difficult to combine breastfeeding with work. The evidence demonstrates that supportive policies and programs at the workplace enable women to continue providing human milk for their infants for significant periods after they return to work, (Ref. The Surgeon General's Call to Action to Support Breastfeeding. 2011. Available from: https://www.ncbi.nlm.nih.gov/books/NBK52682/). High-quality lactation programs go beyond just providing time and space for breast milk expression, but also provide employees with breastfeeding education, access to lactation consultation, and equipment such as high-grade, electric breast pumps. In California, the proportion of women reporting receiving lactation accommodation has increased from 52% in 2011 to 66% in 2016, but significant disparities exist by race/ethnicity and income. (California Pediatric Obesity Collaborative Improvement and Innovation Network. Lactation Support for Low-Wage Workers. 2020. Published by the California WIC Association, California Breastfeeding Coalition, and California Department of Public Health. https://www.calwic.org/wp-content/uploads/2020/12/Lactation-Accommodation-Brief-201210.pdf)

Data Sources and Data Issues: California Breastfeeding Coalition (CBC) and California WIC Association Web analytics

Year: 2023

Unit Type: Count, Unit Number: 10,000

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: Moderate. Aligns with MCHbest strategy "Lactation Consultants". Find other NPM 4 family-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 professionals

Goal: To increase the number of credentialed lactation professionals within WIC (e.g., IBCLC, CLC, and CLS)

Numerator: Number of credentialed lactation professionals within WIC

Denominator:

Significance: One barrier to breastfeeding is the lack of access to lactation professionals. Breastfeeding promotion and support is an integral part of the WIC Program. Increasing the number of trained lactation personnel will assist WIC mothers to make the best decision regarding infant feeding.

Data Sources and Data Issues: WIC monitoring reports

Year: 2023

Unit Type: Count, Unit Number: 250

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

Alignment with field-based evidence through Innovation Hub: Emerging. Aligns with Community breastfeeding support designation model as documented by the Communities Supporting Breastfeeding (KS) 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: 4. Support and mobilize partners

Service Recipient: Activities related to systems-building

Goal: To support and encourage agencies/organizations who have identified increasing the rate of breastfeeding as a priority need in their communities.

Numerator: Total number of agencies/organizations choosing to use MCH support funding for breastfeeding support activities which have met their activity goals.

Denominator: Total number of agencies/organizations choosing to use MCH support funding for breastfeeding support activities.

Significance: This will raise community-level understanding on the importance of breastfeeding and increase support for breastfeeding mothers.

Data Sources and Data Issues: Bureau of Family Health and Nursing Services - The number of agencies/organizations choosing to use MCH support funding in this way may change from year to year.

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. Aligns with distribution of multi-media information as documented by the First Five California Kit for New Parents (CA) 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: 7. Assure effective and equitable health systems

Service Recipient: Activities directed to families/children/youth

Goal: Increase knowledge of importance of breastfeeding to ensure that the feeding decision is fully-informed.

Numerator: Number of maternal health and WIC clients who receive education on breastfeeding.

Denominator: Total number of women who receive direct or enabling services from a Guam Title V and the Guam WIC Program

Significance: Education of the importance of breastfeeding has been shown to increase the initiation and continuation of breastfeeding in mothers.

Data Sources and Data Issues: Tally sheet will need to be developed to capture if maternal health and WIC clients received breastfeeding education

Year: 2023

Unit Type: Percentage, Unit Number: 100

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

Alignment with field-based evidence through Innovation Hub: Promising. Aligns with Web-based referral tool for implmenting and sustaining a coordinated referral network as documented by the Cultivating Connections Through Coordinated Referral Netowrks (KS) 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: Increase the number of MIECHV and Healthy Start women who are referred to WIC services

Numerator: Number of MIECHV and Healthy Start women who are referred to WIC services

Denominator:

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: Georgia Home Visiting Program (GHVP) Data

Year: 2023

Unit Type: Count, Unit Number: 1,000

Evidence Level: Moderate. Aligns with MCHbest strategy "Lactation Consultants". Find other NPM 4 Mother/family 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: 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 access to skilled lactation support through provision of 24/7 access to breastfeeding counselors and skilled clinical lactation specialists who provide information, counseling and referrals related to infant feeding for Texas families and

Numerator: Total annual number of calls received by the Texas Lactation Support Hotline after-hours service

Denominator:

Significance: The U.S. Surgeon General’s Call to Action to Support Breastfeeding calls for assurance of access to “to trained individuals with established relationships in the health care community who are flexible enough to meet mothers’ needs outside of traditional work hours and locations, and provide consistent information”, including access to services provided by International Board Certified Lactation Consultants.

Data Sources and Data Issues: Data Source: Monthly after hour hotline call logs The Texas Lactation Support Hotline provides callers with information, tele-consult services for lactation support, and referrals to local WIC services. The line provides access to international Board-Certified Lactation Consultants for any calls requiring lactation support or clinical lactation expertise. Calls received during daytime hours (typically 8 a.m.-4:30 p.m. on non-holiday weekdays) are fielded by WIC staff and funded by the Texas WIC Program. MCH funds coverage of the hotline during the remaining hours through a subcontract with a national lactation tele-consult service to ensure 24-hour per day, 7-day per week coverage. Data Issues: None anticipated

Year: 2023

Unit Type: Count, Unit Number: 100,000

Evidence Level: Moderate. Aligns with MCHbest strategy "Peer Counselors"[https://www.mchevidence.org/tools/strategies/4-2.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 Innovation Hub's Communities Supporting Breastfeeding program https://amchp.org/wp-content/uploads/2021/05/Communities-Supporting-Breastfeeding.pdf

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: Increase rates of breastfeeding initiation and continuation to 6 months among African American women from 63% to 75% by 2026

Numerator: Number of women referred for breastfeeding peer counseling support

Denominator: Number of women enrolled in WIC

Significance: The 2014 Breastfeeding Report Card reports 77.6% of infants in the District of Columbia initially breastfed. Breastfeeding rates drop dramatically by six months (53%) and twelve months (30%). Only 17% of women in the District are exclusively breastfeeding at six months. In DC, the breastfeeding initiation rates can be as low as 36% at WIC clinics in predominantly African American areas of the city. WIC breastfeeding initiation rates DC wide are lower than the District average at 59% for fiscal year 2015.

Data Sources and Data Issues: CARES/HANDS (WIC)

Year: 2023

Unit Type: Percentage, Unit Number: 100

Evidence Level: Moderate. Aligns with MCHbest strategy "Lactation Consultants". Find other NPM 4 Mother/Family 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: 7. Assure effective and equitable health systems

Service Recipient: Activities related to systems-building

Goal: By 2025, the breastfeeding helpline would support a total of 24,000 calls to offer critical breastfeeding consultation and support to caregivers.

Numerator: The aggregate number of calls to the breastfeeding hotline.

Denominator:

Significance: A range of interventions has been developed to improve the duration of breastfeeding by increasing resilience in overcoming breastfeeding difficulties (Meedya, Fernandez, & Fahy, 2017). One major strategy is the use of telephone support services, both proactive and reactive (McFadden et al., 2017).

Data Sources and Data Issues: Bureau of Nutrition and Physical Activity/WIC Program

Year: 2023

Unit Type: Count, Unit Number: 100,000

Evidence Level: Moderate. Aligns with MCHbest strategy "Peer Counselors". https://www.mchevidence.org/tools/strategies/4-2.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 Communities Supporting Breastfeeding Program. https://amchp.org/wp-content/uploads/2021/05/Communities-Supporting-Breastfeeding.pdf

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: Increase the percentage of eligible pregnant and postpartum WIC participants who received at least three contacts from a WIC Breastfeeding Peer Counselor.

Numerator: This is a new ESM for FY23

Denominator: This is a new ESM for FY23

Significance: Breastfeeding is the normative standard for infant feeding and nutrition and can result in improved infant and maternal health outcomes. Mothers who receive help and support when they need it are more likely to reach their breastfeeding goals and meet their infant’s complete nutritional needs. . A mother’s ability to begin and continue breastfeeding can be influenced by a host of community factors, and programs like WICs breastfeeding peer counselors can provide important coaching to enable and sustain breastfeeding efforts in WIC clients. Peer counseling interventions greatly improve breastfeeding initiation, duration, and exclusivity.

Data Sources and Data Issues: WIC program data

Year: 2023

Unit Type: Percentage, Unit Number: 100

Evidence Level: Emerging. Aligns with MCHbest strategy "Provider Training" (https://www.mchevidence.org/tools/strategies/4-5.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 On-Demand Telesimulation in Maternal-Newborn Care and Clinical Lactation and BreastfeedingTraining.org programs https://amchp.org/wp-content/uploads/2021/05/On-Demand-Telesimulation_Practice-Handout-Promising.pdf https://amchp.org/wp-content/uploads/2021/05/Breastfeeding-Training_2015.pdf

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 rates of breastfeeding initiation and continuation to 6 months among African American women from 63% to 75% by 2026

Numerator: Number of personnel eligible to complete the breastfeeding education training

Denominator: Number of completed breastfeeding education training

Significance: The 2014 Breastfeeding Report Card reports 77.6% of infants in the District of Columbia initially breastfed. Breastfeeding rates drop dramatically by six months (53%) and twelve months (30%). Only 17% of women in the District are exclusively breastfeeding at six months. In DC, the breastfeeding initiation rates can be as low as 36% at WIC clinics in predominantly African American areas of the city. WIC breastfeeding initiation rates DC wide are lower than the District average at 59% for fiscal year 2015.

Data Sources and Data Issues: CARES/HANDS (WIC)

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 mother-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 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 rates of breastfeeding initiation and continuation to 6 months among African American women from 63% to 75% by 2026

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

Denominator: Number of women enrolled in WIC

Significance: The 2014 Breastfeeding Report Card reports 77.6% of infants in the District of Columbia initially breastfed. Breastfeeding rates drop dramatically by six months (53%) and twelve months (30%). Only 17% of women in the District are exclusively breastfeeding at six months. In DC, the breastfeeding initiation rates can be as low as 36% at WIC clinics in predominantly African American areas of the city. WIC breastfeeding initiation rates DC wide are lower than the District average at 59% for fiscal year 2015.

Data Sources and Data Issues: CARES/HANDS

Year: 2023

Unit Type: Percentage, Unit Number: 100