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Strengthening the evidence base for maternal and child health programs

New: MCH Best strategies database for sample ESMs

Evidence Tools
MCH Best. NPM 4: Breastfeeding

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baby feeding at it's mother's breastPeer Counselors

MCH Strategy. Utilize breastfeeding peer counselors through WIC programs.

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Overview. Peer counselors can significantly improve breastfeeding initiation rates and have an impact on breastfeeding rates at 1 and 3 months post-partum.1,2

Evidence. Moderate Evidence. 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. Access the peer-reviewed evidence through the MCH Digital Library. (Read more about understanding evidence ratings).

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

Outcome. Initiation, Duration, and Exclusivity; however peer counselor interventions appear to be more likely to influence initiation than exclusivity at 6 months. 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. There are currently 5 ESMs across all states/jurisdictions that use this strategy directly or intervention components that align with this strategy. Access descriptions of these ESMs through the MCH Digital Library. You can use these ESMs to see how other Title V agencies are addressing the NPM.

Sample ESMs. Using the strategy “Utilize breastfeeding peer counselors through WIC programs,” 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 pregnant and postpartum WIC clients served by breastfeeding peer counselors.

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

  • Percent of pregnant and postpartum WIC clients served by breastfeeding peer counselors.

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

  • Number of pregnant and postpartum WIC clients who report positive impact on breastfeeding practices based on breastfeeding peer counselors’ activities.

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

  • Percent of pregnant and postpartum WIC clients who report positive impact on breastfeeding practices based on breastfeeding peer counselors’ activities.

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.


Reference:

1 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 journal22(1), 71-81.

2 Chapman, D. J., Damio, G., Young, S., & Pérez-Escamilla, R. (2004). Effectiveness of breastfeeding peer counseling in a low-income, predominantly Latina population: a randomized controlled trial. Archives of pediatrics & adolescent medicine, 158(9), 897-902.

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.