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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 breastHospital Policies

MCH Strategy. Promote Baby Friendly policies for hospital systems across the state/jurisdiction.

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Overview. Professional support that can be offered to new mothers appear to have a positive effect on their decision to breastfeed. Hospital policy change that increases reporting requirements such as Baby Friendly policies appear to have a positive effect on initiation of breastfeeding; evidence is mixed on their long-term impact on breastfeeding (duration and exclusivity).1

Evidence. Mixed Evidence. There is a mixture of both positive and inconclusive evidence on hospital policies and their influence on increasing breastfeeding initiation. However, this strategy still appears to trend positive across a range of studies. Access the peer-reviewed evidence through the MCH Digital Library. (Read more about understanding evidence ratings).

Target Audience. Provider/Practice.

Outcome. Initiation. 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 19 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 “Promote Baby Friendly policies for hospital systems across the state/jurisdiction,” 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 Baby Friendly hospitals across the state/jurisdiction.

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

  • Percent of Baby Friendly hospitals across the state/jurisdiction.

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

  • Number of hospitals designated as Baby Friendly who are in compliance of the 10-step process across the state.

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

  • Percent of hospitals designated as Baby Friendly who are in compliance of the 10-step process across the state.

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 Strauch, J., Rohrer, J. E., & Refaat, A. (2016). Increased hospital documentation requirements may not increase breastfeeding among first‐time mothers. Journal of evaluation in clinical practice, 22(2), 194-199.

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.