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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. Hospital Policies

Approach. 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 as well as on breastfeeding duration and exclusivity.[1,2,3,4,5,6,7,8,9,10]

Evidence. Emerging Evidence. Strategies with this rating typically trend positive and have good potential to work...

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source.

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

  • Policy. This strategy helps to promote decisions, laws, and regulations that promote public health practices and interventions.
  • 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).
  • Patient Experience of Care. This study improves individuals' perceptions, feelings, and satisfaction with the healthcare services they receive.

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. Policy Development and Enforcement (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 or aligned components.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the RBA framework (see The Role of Title V in Adapting Strategies).

Quadrant 1:
Measuring Quantity of Effort (“What/how much did we do?”)

  • Number of hospitals engaged in Baby-Friendly policy promotion efforts. (Measures the reach and scale of the initiative across hospital systems) Number of training sessions provided to hospital staff on Baby-Friendly practices. (Quantifies the efforts to build workforce capacity for policy implementation)

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

  • Percent of Baby-Friendly policy promotion materials that are evidence-based and aligned with current guidelines. (Assesses the quality and validity of policy promotion content) Percent of hospitals receiving intensive technical assistance for Baby-Friendly policy implementation. (Measures the level of support provided to facilitate successful adoption)

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

  • Number of state/local health coalitions collaborating to promote Baby-Friendly hospital policies. (Assesses the level of collective action and partnership around the initiative) Number of hospitals that integrate Baby-Friendly policies into standard operating procedures and EHRs. (Measures systemization and hardwiring of practice changes) Number of mothers and infants who have early skin-to-skin contact at Baby-Friendly policy hospitals. (Measures a key practice outcome associated with Baby-Friendly care) Number of hospitals reporting cost savings for improved patient outcomes after Baby-Friendly implementation. (Assesses broader health care quality and value impacts of the policies)

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

  • Percent of Baby-Friendly policy promotion efforts tailored to hospitals serving populations experiencing health challenges. (Assesses strategic focus on greatest need) Percent of Baby-Friendly policy hospitals that provide linguistically appropriate care. (Measures implementation of patient-centered practices) Percent increase in breastfeeding initiation among populations experiencing socioeconomic challenges at Baby-Friendly policy hospitals. (Measures the policies' impact on reach in breastfeeding outcomes) Percent of all births in the state/jurisdiction occurring at Baby-Friendly designated hospitals. (Measures the reach and saturation of Baby-Friendly practices at the population level)

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 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.

2 Marinelli, A., Del Prete, V., Finale, E., Guala, A., Pelullo, C. P., & Attena, F. (2019). Breastfeeding with and without the WHO/UNICEF baby-friendly hospital initiative: A cross-sectional survey. Medicine, 98(44).

3 Jung, S., Nobari, T. Z., & Whaley, S. E. (2019). Breastfeeding outcomes among WIC-participating infants and their relationships to baby-friendly hospital practices. Breastfeeding Medicine, 14(6), 424-431.

4 Nobari, T. Z., Jiang, L., Wang, M. C., & Whaley, S. E. (2017). Baby-friendly hospital initiative and breastfeeding among WIC-participating infants in Los Angeles County. Journal of Human Lactation, 33(4), 677-683.

5 Spaeth, A., Zemp, E., Merten, S., & Dratva, J. (2018). Baby‐Friendly Hospital designation has a sustained impact on continued breastfeeding. Maternal & child nutrition, 14(1), e12497.

6 Kahin, S. A., McGurk, M., Hansen-Smith, H., West, M., Li, R., & Melcher, C. L. (2017). Key program findings and insights from the baby-friendly Hawaii project. Journal of Human Lactation, 33(2), 409-414.

7 Ducharme-Smith, K., Gross, S. M., Resnik, A., Rosenblum, N., Dillaway, C., Orta Aleman, D., ... & Caulfield, L. E. (2021). Exposure to Baby-Friendly Hospital Practices and breastfeeding outcomes of WIC participants in Maryland. Journal of Human Lactation, 0890334421993771.

8 Liberty, A. L., Wouk, K., Chetwynd, E., & Ringel-Kulka, T. (2019). A geospatial analysis of the impact of the baby-friendly hospital initiative on breastfeeding initiation in North Carolina. Journal of Human Lactation, 35(1), 114-126.

9 Crenshaw, J. T., & Budin, W. D. (2020). Hospital Care Practices Associated With Exclusive Breastfeeding 3 and 6 Months After Discharge: A Multisite Study. The Journal of Perinatal Education.

10 Kivlighan, K. T., Murray‐Krezan, C., Schwartz, T., Shuster, G., & Cox, K. (2020). Improved breastfeeding duration with Baby Friendly Hospital Initiative implementation in a diverse and underserved population. Birth, 47(1), 135-143.

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.