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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Breastfeeding.

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Strategy. Lactation Consultants

Approach. Provide support through a certified lactation consultant

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Overview. 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;[3] 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.[4]

Evidence. Moderate Evidence. Strategies with this rating are likely to work. These strategies have been tested more than once and results trend positive overall; however, further research is needed to confirm effects, especially with multiple population groups. These strategies also trend positive in combination with other strategies. (Clarifying Note: The WWFH database calls this "some evidence").

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source. (Read more about understanding evidence ratings).

Source. Peer-Reviewed Literature

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

  • Patient Experience of Care. This study improves individuals' perceptions, feelings, and satisfaction with the healthcare services they receive.
  • Quality of Care. This strategy promotes the degree to which healthcare services meet established standards aimed at achieving optimal health outcomes.
  • Safety of Care. This study promotes avoidance of preventable harm to patients during healthcare delivery.

Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.

Intervention Type. Direct Care (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Community-Focused

Examples from the Field. Access descriptions of 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.

Sample ESMs. Here are sample ESMs to use as models 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?")

PROCESS MEASURES:

  • Number of certified lactation consultants hired or contracted to provide breastfeeding support. (Measures workforce capacity)
  • Number of prenatal and postpartum visits that included a lactation consultation. (Assesses service delivery)
  • Number of referrals made to connect mothers with additional breastfeeding resources and support groups. (Evaluates care coordination)

OUTCOME MEASURES:

  • Total number of mothers who received at least one lactation consultation. (Captures program reach)
  • Number of mothers who reported increased knowledge and confidence in breastfeeding after consulting with a lactation specialist. (Measures educational impact)
  • Number of mothers who initiated breastfeeding with the support of a lactation consultant. (Assesses breastfeeding initiation)

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

PROCESS MEASURES:

  • Percent of lactation consultants who completed continuing education and recertification requirements. (Measures provider competency)
  • Percent of breastfeeding mothers who received a personalized breastfeeding plan from their lactation consultant. (Evaluates individualized care)
  • Percent of lactation consultation services that were provided outside of traditional business hours or in flexible settings. (Assesses accessibility)

OUTCOME MEASURES:

  • Percent of mothers who reported high levels of satisfaction with the lactation support they received. (Measures patient experience)
  • Percent of breastfeeding mothers who achieved their personal breastfeeding goals with the support of a lactation consultant. (Captures goal attainment)
  • Percent of mothers who exclusively breastfed their infants at 3 and 6 months postpartum after receiving lactation consultation. (Assesses breastfeeding exclusivity)

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

PROCESS MEASURES:

  • Number of partnerships established between lactation consultants and community organizations to promote breastfeeding. (Measures community engagement)
  • Number of quality improvement projects implemented to monitor and enhance the effectiveness of lactation consultation services. (Evaluates continuous improvement)
  • Number of training sessions or workshops conducted to educate healthcare providers on breastfeeding best practices and referral processes. (Assesses provider education)

OUTCOME MEASURES:

  • Number of breastfeeding complications or challenges that were prevented or resolved with the timely support of a lactation consultant. (Captures clinical impact)
  • Number of mothers who continued breastfeeding beyond their initial goal with the ongoing support of a lactation consultant. (Measures breastfeeding duration)
  • Number of pediatric health outcomes (e.g., reduced infant hospitalizations, improved immunization rates) attributed to increased breastfeeding rates. (Assesses child health impact)

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

PROCESS MEASURES:

  • - Percent of low-income or underserved mothers who had access to lactation consultation services. (Measures health equity)
  • - Percent of lactation education materials and resources that were culturally and linguistically appropriate for the population served. (Evaluates cultural competence)
  • - Percent of breastfeeding mothers who received follow-up support from a lactation consultant through telehealth or remote consultation. (Assesses technology integration)

OUTCOME MEASURES:

  • - Percent reduction in breastfeeding disparities among racial, ethnic, or socioeconomic groups with access to lactation consultants. (Measures equity impact)
  • - Percent of mothers from disadvantaged communities who reported improved breastfeeding self-efficacy and social support after consulting with a lactation specialist. (Captures empowerment)
  • - Percent increase in breastfeeding initiation and duration rates at the population level attributable to the availability of lactation consultation services. (Assesses community-level impact)

Note. When looking at your ESMs, SPMs, or other strategies:

  1. Move from measuring quantity to quality.
  2. Move from measuring effort to effect.
  3. Quadrant 1 strategies should be used sparingly, when no other data exists.
  4. The most effective measurement combines strategies in all levels, with most in Quadrants 2 and 4.

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

References

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 Francis, J., & Dickton, D. (2019). Preventive Health Application to Increase Breastfeeding. Journal of Women's Health, 28(10), 1344-1349.

4 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.