Find State ESMs

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

Alignment with field-based evidence through Innovation Hub: Emerging. Aligns with Hospital perinatal health quality improvement certification program as documented by the Baby Steps to Breastfeeding Success (AZ) 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: 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, Illinois had a low proportion of birthing occurring in Baby-Friendly facilities compared to other states. Increased encouragement for hospitals to pursue this designation since the early 2010’s resulted in a gradual increase in Baby-Friendly hospitals in the state. While there are fewer “new” hospitals seeking Baby-Friendly designation now, we want to ensure we are not losing ground in this area. This measure will track the percent of Illinois live births occurring in Baby-Friendly hospitals over time, which is a short-term outcome measure of the collaborative, systems-building work to support breastfeeding in Illinois.

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: 2023

Unit Type: Percentage, Unit Number: 100

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

Alignment with field-based evidence through Innovation Hub: 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: 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-Friendly™ 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: 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: Emerging Practice. Aligns with Hospital Policy Changes as documented by the Baby Steps to Breastfeeding Success 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 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: 2023

Unit Type: Percentage, Unit Number: 100

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

Alignment with field-based evidence through Innovation Hub: Promising. Aligns with Medicaid-funded program that provides care coordination, nutrition and mental health couseling as documented by the Prenatal Plus (CO) 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: 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 to 38.0% (2025).

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

Denominator: Number of live births insured by Medicaid

Significance: Families experiencing low socioeconomic status have greater breastfeeding disparities, are more likely to experience barriers to breastfeeding, and thus have lower breastfeeding rates (6). Baby-Friendly Hospital Initiative 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. 6. Odom EC, Li R, Scanlon KS, et al. Reasons for earlier than desired cessation of breastfeeding. Pediatrics 2013;131:e726–e732.

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

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: Mixed. Aligns with MCHbest strategy 4.6 "Hospital Policies" (https://www.mchevidence.org/tools/strategies/4-6.php). Find other NPM 4 Practice-level strategies in MCHbest.

Alignment with field-based evidence through Innovation Hub: Best. Aligns with Hospital breastfeeding quality improvement and staff training demonstration project as documented by Baby Steps to Breastfeeding Success (AZ) 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: 6. Utilize legal and regulatory actions

Service Recipient: Activities related to systems-building

Goal: By increasing the number of Michigan birthing hospitals with Baby-Friendly designation, the proportion of live births that occur in Michigan birthing hospitals that provide recommended care for lactating mothers and their babies will increase.

Numerator: Number of Michigan birthing hospitals with Baby-Friendly designation

Denominator: Number of Michigan birthing hospitals

Significance: Baby-Friendly designated birthing hospitals and centers 1) promote breastfeeding as the best method of infant feeding; 2) implement evidence-based practices to support breastfeeding and lactation; 3) facilitate informed health care decision-making for mothers and families; 4) ensure health care delivery that is sensitive to cultural and social diversity, 5) protect mothers and families from false or misleading product promotion and advertising, and 6) educate parents on safe and appropriate methods for formula mixing, handling, storage, and feeding when a mother has chosen not to breastfeed or has chosen to supplement. The Baby-Friendly Hospital Initiative is a global program launched by the World Health Organization and the United Nations Children’s Fund in 1991 to encourage and recognize hospitals and birthing centers that provide the best level of care for infant feeding and mother/baby bonding. Baby-Friendly designation is built on the implementation of Ten Steps to Successful Breastfeeding and the International Code of Marketing of Breast-Milk Substitutes, which empowers birthing facilities to examine maternity care policies and procedures, requires training and skill building for all levels of staff, and involves the development of quality assurance mechanisms within all aspects of maternity care operations. Baby-Friendly designated birthing hospitals and centers support healthy outcomes for both baby and mom, and can help to reduce breastfeeding disparities, especially within communities of color and low socioeconomic status communities.

Data Sources and Data Issues: Baby-Friendly USA, Inc. (BFUSA)

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

Alignment with field-based evidence through Innovation Hub: Promising Practice. Aligns with hospital-level strategy as documented by the Birth and Beyond California program in AMCHP's Innovation Hub. Emerging Practice. Aligns with hospital-level strategy as documented by the Baby Steps to Breastfeeding Success 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 related to systems-building

Goal: Increase the delivery of babies in Baby Friendly hospitals which will increase breastfeeding rates statewide.

Numerator: Births in Baby Friendly hospitals

Denominator: Total New Jersey Births

Significance: Breastfeeding is universally accepted as the optimal way to nourish and nurture infants, and it is recommended that infants be exclusively breastfed for the first six months. Breastfeeding is a cost-effective preventive intervention with far-reaching benefits for mothers and babies and significant cost savings for health providers and employers. Breastfeeding provides superior nutrition, prevents disease and enhances infant development. Increasing Baby Friendly hospitals is an evidence-based strategy to increase breastfeeding. Breastfeeding data at the individual infant level could be combined with hospital level including mPINC data and Baby Friendly status to provide more information on the policies and practices that promote breastfeeding.

Data Sources and Data Issues: New Jersey VIP Birth Certificate System

Year: 2023

Unit Type: Percentage, Unit Number: 100

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

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

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

Service Type: Enabling services level of pyramid

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

Service Recipient: Activities directed to families/children/youth

Goal: To increase breastfeeding among marginalized communities.

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

Denominator: Number of Non-Hispanic Black mothers

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

Data Sources and Data Issues: Vital statistics

Year: 2023

Unit Type: Percentage, Unit Number: 100

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

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

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

Service Type: Enabling services level of pyramid

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

Service Recipient: Activities directed to families/children/youth

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

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

Denominator: The total number maternity service hospitals in Florida.

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

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

Year: 2023

Unit Type: Percentage, Unit Number: 100

Evidence Level: Emerging. Aligns with MCHbest strategy "Family Leave, Workplace Policies, State Laws". https://www.mchevidence.org/tools/strategies/4-7.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 Reducing Breastfeeding Disparities in California through Lactation Accommodation Workgroup Program https://amchp.org/wp-content/uploads/2021/05/Lactation-Accommodation-Workgroup_Practice-Handout-CuttingEdge.pdf

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: To increase the percent of BFWH-designated businesses with ideal workplace lactation policies

Numerator: Number of Breastfeeding Welcomed Here (BFWH)-designated businesses with ideal workplace lactation policies

Denominator: Number of Breastfeeding Welcomed Here (BFWH)-designated businesses

Significance: Lack of lactation support in the workplace continues to be a significant barrier for mothers returning to work. Breastfeeding initiation and duration rates tend be higher in in workplaces that have developed lactation policies, offer breastfeeding support programs, and designated spaces for mothers to breastfeed or express milk.

Data Sources and Data Issues: BFWH Tracking Spreadsheet

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 Provider/Practice-level strategies in MCHbest. https://www.mchevidence.org/tools/strategies/search/results.php?NPM=4&Target_Audience=Provider/Practice

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: To increase the percent of birthing hospitals providing optimal lactation support

Numerator: # Baby-Friendly Hospitals in Illinois

Denominator: # Birthing Hospitals in Illinois

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, Illinois had a low proportion of birthing occurring in Baby-Friendly facilities compared to other states. Increased encouragement for hospitals to pursue this designation since the early 2010’s resulted in a gradual increase in Baby-Friendly hospitals in the state. While there are fewer “new” hospitals seeking Baby-Friendly designation now, we want to ensure we are not losing ground in this area. This measure will track the percent of Illinois hospitals that are Baby-Friendly hospitals over time. While this is closely related to ESM 4.1, this measure serves as more of a measure of state activities/process rather than outcomes of the work.

Data Sources and Data Issues: Perinatal Program, 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: 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: 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: Systems level of pyramid

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

Service Recipient: Activities related to systems-building

Goal: To reduce work-related barriers to breastfeeding initiation, continuation, and exclusivity by providing employers with information and assistance on recommended practices for establishment of worksite lactation support policies and environments

Numerator: Estimated minimum total number of Texas workers employed at a worksite with a written and communicated worksite lactation support policy and recognized by the Texas Mother-Friendly designation

Denominator:

Significance: A previous statewide assessment showed many Texas employers did not perceive a need for formal support of breastfeeding and did not hear of the need from employees. Many working mothers reported fear (e.g. job insecurity) of asking employers for basic worksite lactation supports. Mothers report barriers to finding clean, private spaces and taking lactation breaks enough to maintain milk supply. Women reported that a written worksite policy providing flexible scheduling and access to clean, private space for lactation breaks, such as recommended by the Texas Mother-Friendly Worksite Program, would enable them to confidently approach their employer for these basic supports and would help with balance of work commitments and personal breastfeeding goals. Supportive worksite policies and practices increase a mother’s ability to establish and maintain lactation even when separated from her infant and can improve infant feeding outcomes while also benefiting the employers through cost savings of up to $3 for every $1 invested by employers. Savings are realized through increased employee retention, loyalty and productivity, reduced absenteeism, and reduced health care costs. Texas women have limited access to supportive workplace policies and programs that allow them to continue to breastfeed after returning to work. Many employers are now required by law to provide basic lactation support in the workplace.

Data Sources and Data Issues: Data Source: Texas Mother-Friendly Worksite applications. The current online application asks employers to report a range of number of employees employed at a business by choosing one of the following options from a dropdown list: 1-5 6-10 11-24 25-50 51-99 100-499 500-2499 2500-24,999 25000+ Data Issues: Range-based reporting restricts the ability to fully count the number of employees at a business to the lowest number in the range. This will result in under-estimating the number of employees reached by Mother-Friendly policies. Efforts will be made over the next three years to revise the online application system to include an actual count of fulltime equivalent positions at a worksite.

Year: 2023

Unit Type: Count, Unit Number: 1,000,000

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

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

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

Service Type: Enabling services level of pyramid

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

Service Recipient: Activities directed to families/children/youth

Goal: To increase breastfeeding among marginalized communities.

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

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

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

Data Sources and Data Issues: Vital statistics

Year: 2023

Unit Type: Percentage, Unit Number: 100

Evidence Level: Emerging. Aligns with MCHbest strategy "Family Leave, Workplace Policies, State Laws". https://www.mchevidence.org/tools/strategies/4-7.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 Reducing Breastfeeding Disparities in California through Lactation Accommodation Workgroup Program. https://amchp.org/wp-content/uploads/2021/05/Lactation-Accommodation-Workgroup_Practice-Handout-CuttingEdge.pdf

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: Support local health departments in efforts to help worksites meet the requirements of the federal lactation accommodations law. Measured by the number of worksites that meet the requirements.

Numerator: This ESM is new and FY2023 is a baseline year.

Denominator:

Significance: The U.S. Surgeon General calls for employers to have high-quality employee lactation support programs and policies that work towards reducing breastfeeding barriers for working mothers. Returning to work is a major reason for women to discontinue breastfeeding. Women who are employed in worksites with adequate lactation accommodations have a good chance of increasing their duration of breastfeeding.

Data Sources and Data Issues: EPICC Program Data

Year: 2023

Unit Type: Count, 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: Cutting-Edge. Aligns with workplace policy strategy as documented by the Reducing Breastfeeding Disparities in California through Lactation Accommodation Workgroup 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: 4. Support and mobilize partners

Service Recipient: Activities directed to professionals

Goal: To implement a recognition process for BFWH-designated businesses with lactation workplace policies for employees.

Numerator: Implement recognition process for Breastfeeding Welcomed Here (BFWH)-designated businesses with lactation workplace policies for employees

Denominator:

Significance: Lack of lactation support in the workplace continues to be a significant barrier for mothers returning to work. BFWH businesses that have ideal workplace lactation policies will be recognized to celebrate businesses with policies and practices that seek support working mothers.

Data Sources and Data Issues: FHW Program data

Year: 2023

Unit Type: Text, Unit Number: Yes/No