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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 breastHome Visits (Professionals Other than Lactation Consultants or Peer Counselors)

MCH Strategy. Provide training and coaching to MIECHV home visiting staff to promote breastfeeding best practices.

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Overview. Home visits in the first several weeks following birth may prolong the duration of exclusive breastfeeding. Postnatal support should focus on both psychosocial and practical aspects of breastfeeding. Mothers with no or little previous breastfeeding experience require special attention.1,2

Evidence. Moderate Evidence. Home visits provided by professionals (other than lactation consultants or peer counselors) 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. 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 strategy “Provide training and coaching to MIECHV home visiting staff to promote breastfeeding best 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 MIECHV home visiting staff who received education about best-practices for supporting breastfeeding among new mothers.

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

  • Percent of MIECHV home visiting staff who received education about best-practices for supporting breastfeeding among new mothers.

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

  • Number of MIECHV home visiting staff who received education about best-practices for supporting breastfeeding among new mothers who report an increase in knowledge and skill around breastfeeding best practices.
  • Number of mothers receiving home visiting services who report feeling supported or received the information they needed to be successful in breastfeeding.

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

  • Percent of MIECHV home visiting staff who received education about best-practices for supporting breastfeeding among new mothers who report an increase in knowledge and skill around breastfeeding best practices.
  • Percent of mothers receiving home visiting services who report feeling supported or received the information they needed to be successful in breastfeeding.

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 McGinnis, S., Lee, E., Kirkland, K., Miranda-Julian, C., & Greene, R. (2018). Let’s talk about breastfeeding: The importance of delivering a message in a home visiting program. American Journal of Health Promotion32(4), 989-996.

2 Kronborg, H., Væth, M., Olsen, J., Iversen, L., & Harder, I. (2007). Effect of early postnatal breastfeeding support: a cluster‐randomized community based trial. Acta Paediatrica, 96(7), 1064-1070.

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.