Skip Navigation

Strengthen the Evidence for Maternal and Child Health Programs

Sign up for MCHalert eNewsletter

Evidence Tools
MCHbest. Breastfeeding.

MCHbest Logo

Strategy. Peer Counselors

Approach. Utilize breastfeeding peer counselors through WIC programs

Return to main MCHbest page >>

Overview. The USDA Food and Nutrition Service’s (FNS) Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) includes in its mission breastfeeding promotion and support. FNS’s stated goal is to have peer counselors be a core component in WIC agencies nationwide. In 2004, FNS launched the Loving Support© Makes Breastfeeding Work model.[1] Peer counselors can significantly improve breastfeeding initiation rates and have an impact on breastfeeding rates at 1,3, and 12 months postpartum.[2,3,4,5,6,7]

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):

  • Health and Health Behaviors/Behavior Change. This strategy improves individuals' physical and mental health and their adoption of healthy behaviors (e.g., healthy eating, physical activity).
  • Environmental Health. This strategy improves the impact of physical, chemical, and biological factors in the environment on health.
  • Utilization. This strategy improves the extent to which individuals and communities use available healthcare services.

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. Counseling (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 WIC agencies that have implemented the Loving Support© breastfeeding peer counselor program. (Measures program adoption)
  • Number of breastfeeding peer counselors recruited, trained, and actively supporting WIC participants. (Assesses workforce capacity)
  • Number of WIC participants assigned to and receiving support from a breastfeeding peer counselor. (Evaluates service delivery)

OUTCOME MEASURES:

  • Total number of WIC participants who initiated breastfeeding with the support of a peer counselor. (Captures breastfeeding initiation)
  • Number of contacts (e.g., phone calls, visits) made by peer counselors to provide breastfeeding support to WIC participants. (Measures support intensity)
  • Number of WIC agencies that reported increased breastfeeding initiation rates after implementing the peer counselor program. (Assesses agency-level impact)

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

PROCESS MEASURES:

  • Percent of breastfeeding peer counselors who completed the required Loving Support© training and ongoing education. (Measures training completion)
  • Percent of WIC participants who were offered and accepted peer counselor support during the prenatal and postpartum periods. (Evaluates program reach)
  • Percent of peer counselor contacts that addressed specific breastfeeding concerns or questions raised by WIC participants. (Assesses tailored support)

OUTCOME MEASURES:

  • Percent of WIC participants who reported high satisfaction with the breastfeeding support received from their peer counselor. (Measures participant satisfaction)
  • Percent of WIC participants who exclusively breastfed their infants at 1, 3, and 6 months postpartum with peer counselor support. (Assesses breastfeeding exclusivity)
  • Percent of breastfeeding challenges or barriers that were successfully addressed by peer counselors, as reported by WIC participants. (Captures problem resolution)

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

PROCESS MEASURES:

  • Number of community partnerships established by WIC agencies to enhance the reach and impact of the peer counselor program. (Measures community collaboration)
  • Number of peer counselors who received advanced training or certification to provide specialized breastfeeding support (e.g., for preterm infants, multiples). (Assesses workforce development)
  • Number of quality improvement initiatives implemented by WIC agencies to monitor and enhance the effectiveness of the peer counselor program. (Evaluates continuous improvement)

OUTCOME MEASURES:

  • Number of WIC participants who continued breastfeeding at 3, 6, and 12 months postpartum with ongoing peer counselor support. (Measures breastfeeding duration)
  • Number of healthcare providers who reported improved coordination and continuity of breastfeeding support for WIC participants due to the peer counselor program. (Assesses care coordination)
  • Number of WIC agencies that achieved or maintained Loving Support© awards for excellence in breastfeeding support and promotion. (Captures program recognition)

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

PROCESS MEASURES:

  • - Percent of WIC agencies serving predominantly racial/ethnic minority or low-income populations that have implemented the peer counselor program. (Measures equitable implementation)
  • - Percent of breastfeeding peer counselors who reflect the cultural, linguistic, and socioeconomic diversity of the WIC participants they serve. (Assesses culturally congruent support)
  • - Percent of WIC agencies that have integrated the peer counselor program into their overall breastfeeding promotion and support strategies. (Evaluates program integration)

OUTCOME MEASURES:

  • - Percent reduction in breastfeeding disparities among WIC participants from different racial, ethnic, and socioeconomic groups who received peer counselor support. (Measures disparity reduction)
  • - Percent of WIC participants from communities with historically low breastfeeding rates who achieved their breastfeeding goals with the help of a peer counselor. (Captures progress in underserved areas)
  • - Percent increase in breastfeeding initiation, duration, and exclusivity rates among the total WIC population served by agencies with peer counselor programs. (Assesses population-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 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 journal, 22(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.

3 Assibey-Mensah, V., Suter, B., Thevenet-Morrison, K., Widanka, H., Edmunds, L., Sekhobo, J., & Dozier, A. (2019). Effectiveness of peer counselor support on breastfeeding outcomes in WIC-enrolled women. Journal of nutrition education and behavior, 51(6), 650-657.

4 Ware, J. L., Love, D., Ladipo, J., Paddy, K., Starr, M., Gilliam, J., ... & Baker, T. (2021). African American Breastfeeding Peer Support: All Moms Empowered to Nurse. Breastfeeding Medicine, 16(2), 156-164.

5 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 journal, 22(1), 71-81.

6 Lee, C. H. M., O'Leary, J., Kirk, P., & Lower, T. A. (2018). Breastfeeding outcomes in Washington State: Determining the effect of Loving Support peer counseling program and characteristics of participants at WIC agencies. Journal of nutrition education and behavior, 50(4), 379-387.

7 Martinez, N. G., Strohbach, A., Hu, F., & Yee, L. M. (2020). “Real-world” effect of a peer counselor on breastfeeding outcomes in an urban prenatal clinic in the United States. BMC Pregnancy and Childbirth, 20(1), 1-8.

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.