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Strengthen the Evidence for Maternal and Child Health Programs

New: MCHbest strategies database for sample ESMs

Evidence Tools
MCH Best. NPM 4: Breastfeeding

MCH Best Logo baby feeding at it's mother's breast

Strategy. Lactation Consultants

Approach. Maintain a 24-hour breastfeeding hotline staffed by a bilingual certified lactation consultant.

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Overview. The AAP recommends all infants (including premature and sick newborns) exculsively breastfeed for the first six months of life. Human milk supports optimal growth and development by providing all required nutrients. Breastfeeding has long-term benefits for mother and newborn.1 Systematic literature reviews over the past decade 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.”2 Numerous studies indicate that in-person lactation consultants are effective for initiation and exclusivity; several studies further show utility of telephone and Internet support. All studies indicate the need to have consistent access to consultation services, as needs may change over time. In addition, doulas can be used in a similar role as lactation consultants to promote breastfeeding.3

Evidence. Moderate. Lactation consultant interventions appear to be effective for increasing both breastfeeding initiation and 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. Access the peer-reviewed evidence through the MCH Digital Library. (Read more about understanding evidence ratings).

Target Audience. Mother/family (through home visitors, community health workers, and health care providers).

Outcome. Initiation and Exclusivity. For detailed outcomes related to each study supporting this strategy, click on the peer-reviewed evidence link above and read the "Intervention Results" for each study.

Examples from the Field. Access descriptions of current ESMs that use this strategy directly or intervention components that align with this strategy. You can use these ESMs to see how other Title V agencies are addressing the NPM.

The Role of Title V. Title V Agencies can support this approach by:

Sample ESMs. Using the approach “Maintain a 24-hour breastfeeding hotline staffed by a bilingual certified lactation consultant,” here are sample ESMs you can use as a model for your own measures using the Results-Based Accountability framework (for suggestions on how to develop programs to support this strategy, see The Role of Title V in Adapting Strategies):

Quadrant 1:
Measuring Quantity of Effort
("What/how much did we do?")

  • Number of calls annually to state-run hotline.

Quadrant 2:
Measuring Quality of Effort
("How well did we do it?")

  • Percent of pregnant and postpartum women who received telephone lactation support from the hotline.

Quadrant 3:
Measuring Quantity of Effect
("Is anyone better off?")

  • Number of hotline participants who, upon completion of call, indicate that they received appropriate advice from the hotline.

Quadrant 4:
Measuring Quality of Effect
("How are they better off?")

  • Percent of pregnant and postpartum women who indicated in a follow-up survey that they implemented advice gained from the hotline.

Note. ESMs become stronger as they move from measuring quantity to measuring quality (moving from Quadrants 1 and 3, respectively, to Quadrants 2 and 4) and from measuring effort to measuring effect (moving from Quadrants 1 and 2, respectively, to Quadrants 3 and 4).

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.


1 American Academy of Pediatrics Section on Breastfeeding. Breastfeeding and the use of human milk. Pediatrics. 2012 Mar;129(3):e827-41.

2 Patel, S., & Patel, S. (2016). The Effectiveness of Lactation Consultants and Lactation Counselors on Breastfeeding Outcomes. Journal of Human Lactation, 32(3), 530–541.

3 Hans SL, Thullen M, Henson LG, Lee H, Edwards RC, Bernstein VJ. Promoting positive mother–infant relationships: A randomized trial of community doula support for young mothers. Infant Mental Health Journal. 2013;34:446–457.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.