Find State ESMs

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

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

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

Service Type: Systems level of pyramid

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

Service Recipient: Activities related to systems-building

Goal: Promote optimal infant health and development, by increasing breastfeeding education and supports at birthing hospitals

Numerator: # of 10 Step compliant or designated Baby-friendly hospitals

Denominator: # of Vermont birth hospitals

Significance: Birth hospital policies and practices significantly impact whether a woman chooses to start breastfeeding and how long she continues to breastfeed.

Data Sources and Data Issues: Data source: program-level data; no known data issues

Year: 2023

Unit Type: Percentage, Unit Number: 100

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

Alignment with field-based evidence through Innovation Hub: Emerging Practice. Aligns with workplace-level strategy as documented by the Communities Supporting Breastfeeding 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: 5. Create/champion/implement policy

Service Recipient: Activities directed to professionals

Goal: To increase the percent of infants who are breastfed and who are breastfed exclusively through six months.

Numerator: Number of businesses who receive information and technical assistance on workplace breastfeeding policies.

Denominator:

Significance: Number of businesses who receive information and technical assistance on workplace breastfeeding policies. This ESM will provide an indicator of the number of workplaces across the state who have been contacted regarding the Infant Friendly Workplace designation. This can help us track how efforts to provide education translate into workplaces implementing a policy and becoming designated as Infant Friendly. The Infant Friendly Workplace designation recognizes employers who implement breastfeeding support policies addressing adequate break time; a clean, private location for milk expression; and available resources for clean water and breast milk storage for employees. By providing technical assistance and education to employers about how to implement a breastfeeding support policy, more women will be supported at work and breastfeed longer, thereby increasing the percentage of infants who are breastfed exclusively for 6 months, NPM 4b.

Data Sources and Data Issues: North Dakota Department of Health. Family Health and Nutrition Program.

Year: 2023

Unit Type: Count, Unit Number: 200

Evidence Level: Emerging. Aligns with MCHbest strategy 4.7 "Family Leave, Workplace Policies, State Laws". Find other NPM 4 workplace-level strategies in MCHbest.

Alignment with field-based evidence through 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 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: Increase the education of businesses and organizations on the importance of strong policies to support employees to continue to breastfeed through or beyond 6 months of age.

Numerator: Number of businesses or organizations who were provided education by Title V agencies

Denominator:

Significance: Educating businesses and/or organizations on best practices and policies to implement within their practices will help ensure employees are able to continue to breastfeed when returning to work.

Data Sources and Data Issues: RFA/RFP documentation from Local Title V Agencies

Year: 2023

Unit Type: Count, Unit Number: 150

Evidence Level: Emerging. Aligns with MCHbest strategy "Provider Training" [https://www.mchevidence.org/tools/strategies/4-5.php]. Find other NPM 4 provider-level strategies [https://www.mchevidence.org/tools/strategies/search/results.php?NPM=4&Target_Audience=Provider/Practice)] in MCHbest.

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

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 trainers to promote exclusive breastfeeding.

Numerator: Percent of infants who are breastfed.

Denominator: Percent of infants who exclusively breastfed.

Significance: The goal of peer support is to encourage and support pregnant women and those who currently breastfeed. Peer support, which is provided by mothers who are currently breastfeeding or who have done so in the past, includes individual counseling and mother-to-mother support groups. Women who provide peer support undergo specific training and may work in an informal group or one-to-one through telephone calls or visits in the home, clinic, or hospital. Peer support includes psychoemotional support, encouragement, education about breast- feeding, and help with solving problems.

Data Sources and Data Issues: SILAS

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

Alignment with field-based evidence through Innovation Hub: Emerging Practice. Aligns with workplace-level strategy as documented by the Communities Supporting Breastfeeding program in AMCHP's 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: 5. Create/champion/implement policy

Service Recipient: Activities related to systems-building

Goal: To increase the percent of infants who are breastfed and who are breastfed exclusively through six months.

Numerator: Number of businesses designated Infant Friendly Workplaces.

Denominator:

Significance: Number of businesses designated Infant Friendly Workplaces. This ESM will provide the number of workplaces across the state who have implemented a policy and became designated as an Infant Friendly Workplace. The Infant Friendly Workplace designation recognizes employers who implement breastfeeding support policies addressing adequate break time; a clean, private location for milk expression; and available resources for clean water and breast milk storage for employees. By providing technical assistance and education to employers about how to implement a breastfeeding support policy, more women will be supported at work and breastfeed longer, thereby increasing the percentage of infants who are breastfed exclusively for 6 months, NPM 4b.

Data Sources and Data Issues: The Center for Disease Control and Prevention’s (CDC) Guide to Strategies to Support Breastfeeding Mothers and Babies lists intentions to work full-time are associated with lower rates of breastfeeding initiation and shorter duration. The CDC’s Implementation Guide for the Notice of Funding Opportunity: State Physical Activity and Nutrition Program lists evidence demonstrates supportive policies and programs at the workplace enable women to continue providing breast milk for their infants for significant periods after they return to work. The Infant Friendly Workplace designation recognizes employers who implement breastfeeding support policies addressing adequate break time; a clean, private location for milk expression; and available resources for clean water and breast milk storage for employees. By providing technical assistance and education to employers about how to implement a breastfeeding support policy, more women will be supported at work and breastfeed longer, thereby increasing the percentage of infants who are breastfed exclusively for 6 months, NPM 4b. By September 30, 2025, increase the number of businesses designated as Infant Friendly Workplaces from 133 to 200. North Dakota Department of Health. Family Health and Nutrition Program.

Year: 2023

Unit Type: Count, Unit Number: 200

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: 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: 4. Support and mobilize partners

Service Recipient: Activities related to systems-building

Goal: Annually collaborate with the Safe Sleep Program to identify and develop collaborative opportunities

Numerator: Number of collaborative meetings held between the Breastfeeding Program and the Safe Sleep Program

Denominator:

Significance: The Breastfeeding Awareness and Support Program is currently pursuing collaborative opportunities within the Department of Health with the Safe Seep Program with the intent of incorporating breastfeeding awareness, support, education, materials and messaging within the work of the Safe Sleep Program. The Program will also incorporate applicable education, materials and messaging from the Safe Sleep Program within their breastfeeding work. Building collaborative relationships helps ensure that women and families receive consistent, public health focused messaging on particular topics and better ensures that the professionals that interact with these populations are educated and also have a point of contact for questions and additional information. It has been anecdotally reported that it is the conflicting or incomplete messages that women/families receive that impact their decisions to breastfeed and they often do not know where to turn for assistance. It is therefore important for others serving those populations to have an effective understanding of breastfeeding.

Data Sources and Data Issues: The number of collaborative meetings held with the Safe Sleep Program will be collected by the breastfeeding program staff.

Year: 2023

Unit Type: Count, Unit Number: 10

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

Service Type: Enabling services level of pyramid

Essential Public Health Services: 9. Conduct evaluation, research and CQI

Service Recipient: Activities related to systems-building

Goal: Annually provide breastfeeding education, community outreach and improve breastfeeding initiation and duration rates.

Numerator: Number of regional breastfeeding collaborative meetings held by Grantee.

Denominator:

Significance: In 2020, the Breastfeeding Awareness and Support Program constructed an RFA allowing organizations to compete for grant funding to administer a program that would increase breastfeeding support and awareness statewide. PA AAP was awarded the grant funding in the summer of 2020 and the program officially started in October of 2020. PA AAP will collaborate with community-based organizations and partners by hosting regional collaborative meetings for birthing facilities and community partners and distributing mini-grants focused on improving initiation and duration breastfeeding rates in areas of need based on target population demographics.

Data Sources and Data Issues: The number of regional breastfeeding collaborative meetings held will be collected by the breastfeeding program staff.

Year: 2023

Unit Type: Count, Unit Number: 10

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

Service Type: Enabling services level of pyramid

Essential Public Health Services: 4. Support and mobilize partners

Service Recipient: Activities related to systems-building

Goal: Annually provide breastfeeding education, community outreach and improve breastfeeding initiation and duration rates.

Numerator: Number of mini-grants awarded to community partners by the Grantee

Denominator:

Significance: In 2020, the Breastfeeding Awareness and Support Program constructed an RFA allowing organizations to compete for grant funding to administer a program that would increase breastfeeding support and awareness statewide. PA AAP was awarded the grant funding in the summer of 2020 and the program officially started in October of 2020. PA AAP will collaborate with community-based organizations and partners by hosting regional collaborative meetings for birthing facilities and community partners and distributing mini-grants focused on improving initiation and duration breastfeeding rates in areas of need based on target population demographics.

Data Sources and Data Issues: The number of breastfeeding mini-grants awarded to community partners will be collected by the breastfeeding staff.

Year: 2023

Unit Type: Count, Unit Number: 15