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Strengthen the Evidence for Maternal and Child Health Programs

New: MCHbest strategies database for sample ESMs

Evidence Tools
MCHbest. NPM 4: Breastfeeding

MCHbest Logo baby feeding at it's mother's breast

Strategy. Group Education

Approach. Promote the use of group education for pregnant women around breastfeeding practices.

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Overview. Group education may impact breastfeeding attitudes and perceptions, as well as on exclusive breastfeeding initiation and duration.1,2

Evidence. Mixed Evidence. There is a mixture of both positive and inconclusive evidence on group education and its influence on increasing both breastfeeding initiation and exclusivity at 6 months. However, this strategy still appears to be effective in many settings. 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, Duration, 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. There are currently 14 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 approach “Promote the use of group education for pregnant women around breastfeeding practices,” 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 women who attended group education breastfeeding programs.

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

  • Percent of pregnant women who attended group education breastfeeding programs.
  • Number of pregnant women enrolled in group education breastfeeding programs who indicate that the program conains useful information to help them make the decision to breastfeed.

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

  • Number of pregnant women enrolled in group breastreeding education programs who are confident in their ability to engage in breastfeeding best practices.

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

  • Percent of women enrolled in group education programs who have either initated breastfeeding or exclusively breastfed at 6 months.

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 Martin-Iglesias, S., Santamaría-Martín, M. J., Alonso-Álvarez, A., Rico-Blazquez, M., del Cura-Gonzalez, I., Rodríguez-Barrientosn, R. & Durand-Rincón, I. (2018). Effectiveness of an educational group intervention in primary healthcare for continued exclusive breast-feeding: PROLACT study. BMC pregnancy and childbirth18(1), 59.

2 Finch, C., & Daniel, E. L. (2002). Breastfeeding education program with incentives increases exclusive breastfeeding among urban WIC participants. Journal of the Academy of Nutrition and Dietetics, 102(7), 981.

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.