Find State ESMs

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 "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: 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: 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