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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. Multicomponent Education and Support Programs

Approach. Implement breastfeeding education and professional support to promote breastfeeding

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Overview. Research indicates that breastfeeding education and professional support practices can effectively increase breastfeeding rates. Studies have examined the benefits of a team-based approach with lactation consultants and primary care providers,[1] peer counselors,[2] and/or home visitors,[3] providing professional counseling support,[4] and/or gifting infant care supplies and breast pumps[5] to improve breastfeeding duration and exclusivity.[6,7] Breastfeeding education and support are core services provided by WIC and in other outpatient settings with many programs working to ensure that breastfeeding support is provided throughout the prenatal period and first year postpartum.

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):

  • Utilization. This strategy improves the extent to which individuals and communities use available healthcare services.
  • 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.

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. Health Teaching (Education and Promotion) (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 healthcare providers trained on breastfeeding best practices and support strategies. (Measures workforce development)
  • Number of prenatal and postpartum visits that included breastfeeding education and counseling. (Assesses service delivery)
  • Number of referrals made to connect mothers with lactation consultants, peer counselors, or home visitors for additional support. (Evaluates care coordination)

OUTCOME MEASURES:

  • Total number of mothers who received breastfeeding education and professional support through the program. (Captures program reach)
  • Number of mothers who reported increased knowledge and confidence in breastfeeding after participating in the education and support program. (Measures educational impact)
  • Number of mothers who initiated breastfeeding with the support of the program. (Assesses breastfeeding initiation)

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

PROCESS MEASURES:

  • Percent of breastfeeding education and support services provided by certified lactation consultants or trained professionals. (Measures provider qualifications)
  • Percent of mothers who received a comprehensive breastfeeding assessment and individualized support plan. (Evaluates personalized care)
  • Percent of breastfeeding support services that were provided outside of traditional clinic hours or settings to improve accessibility. (Assesses flexibility)

OUTCOME MEASURES:

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

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

PROCESS MEASURES:

  • Number of community partnerships established to enhance the reach and impact of the breastfeeding education and support program. (Measures collaboration)
  • Number of quality improvement initiatives implemented to monitor and optimize the effectiveness of the program. (Evaluates continuous improvement)
  • Number of support groups or peer networks formed to provide ongoing encouragement and problem-solving for breastfeeding mothers. (Assesses social support)

OUTCOME MEASURES:

  • Number of breastfeeding challenges or complications that were prevented or addressed through timely education and support. (Captures clinical impact)
  • Number of mothers who continued breastfeeding beyond 6 months with the ongoing support of the program. (Measures breastfeeding duration)
  • Number of pediatric health outcomes (e.g., reduced infant hospitalizations, optimal growth and development) attributed to the program's breastfeeding support. (Assesses child health impact)

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

PROCESS MEASURES:

  • - Percent of underserved or high-risk mothers who were actively recruited and engaged in the breastfeeding education and support program. (Measures equitable outreach)
  • - Percent of program materials and resources that were culturally and linguistically tailored to the diverse populations served. (Evaluates cultural responsiveness)
  • - Percent of program funding allocated to address barriers to breastfeeding, such as providing breast pumps or childcare during support sessions. (Assesses resource allocation)

OUTCOME MEASURES:

  • - Percent reduction in breastfeeding disparities among racial, ethnic, or socioeconomic groups participating in the program. (Measures equity impact)
  • - Percent of mothers from disadvantaged communities who reported improved breastfeeding self-efficacy and social support after completing the program. (Captures empowerment)
  • - Percent increase in breastfeeding initiation and duration rates at the population level, particularly among groups with historically lower rates. (Assesses community-level change)

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 Witt, R., Vatti, T., Lasko, L., & Witt, A. M. (2021). Team-Based Breastfeeding Support at a Federally Qualified Health Center: Efficacy, Utilization, and Patient Satisfaction. Breastfeeding Medicine.

2 Edmunds, L. S., Lee, F. F., Eldridge, J. D., & Sekhobo, J. P. (2017). Outcome evaluation of the You Can Do It initiative to promote exclusive breastfeeding among women enrolled in the New York State WIC program by race/ethnicity. Journal of nutrition education and behavior, 49(7), S162-S168.

3 Gleason, S., Wilkin, M. K., Sallack, L., Whaley, S. E., Martinez, C., & Paolicelli, C. (2020). Breastfeeding duration is associated with WIC site-level breastfeeding support practices. Journal of nutrition education and behavior, 52(7), 680-687.

4 Leruth, C., Goodman, J., Bragg, B., & Gray, D. (2017). A multilevel approach to breastfeeding promotion: Using healthy start to deliver individual support and drive collective impact. Maternal and child health journal, 21(1), 4-10.

5 Francis, J., Mildon, A., Stewart, S., Underhill, B., Ismail, S., Di Ruggiero, E., ... & O’Connor, D. L. (2021). Breastfeeding rates are high in a prenatal community support program targeting vulnerable women and offering enhanced postnatal lactation support: a prospective cohort study. International journal for equity in health, 20(1), 1-13.

6 Huang, P., Yao, J., Liu, X., & Luo, B. (2019). Individualized intervention to improve rates of exclusive breastfeeding: A randomised controlled trial. Medicine, 98(47).

7 Van Dellen, S. A., Wisse, B., Mobach, M. P., & Dijkstra, A. (2019). The effect of a breastfeeding support programme on breastfeeding duration and exclusivity: a quasi-experiment. BMC public health, 19(1), 1-12.

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.