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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/for home visitors,[3] providing professional counseling support,[4] and/for 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...

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):

  • 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 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 breastfeeding education programs aligned with WHO/UNICEF Baby-Friendly Hospital Initiative standards. (Assesses alignment with global best practices) Number of tailored breastfeeding education materials developed with community input. (Evaluates relevance and engagement)

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

  • Percent of breastfeeding education sessions incorporating hands-on skills training and problem-solving scenarios. (Evaluates adherence to best practices) Percent of support services available in languages representative of the community served. (Assesses health literacy and usability)

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

  • Number of interprofessional trainings conducted to integrate breastfeeding support across prenatal, postpartum, and pediatric care. (Shows provider training and capacity) Number of local health improvement plans incorporating multicomponent breastfeeding support programs. (Assesses integration into existing plans) Number of breastfeeding-related complications prevented through timely education and support interventions. (Measures clinical impact) Number of community-level policy changes supporting breastfeeding, influenced by program data and outcomes. (Assesses broader public health impact)

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

  • Percent of program staff and peer counselors recruited from communities experiencing breastfeeding challenges. (Evaluates representation) Percent of program resources allocated to addressing social challenges affecting breastfeeding (e.g., workplace support, food security). (Assesses strategic deployment) Percent reduction in breastfeeding initiation and duration gaps across groups sharing key personal characteristics. (Measures changes in health outcomes) Percent improvement in breastfeeding rates in communities with previously low breastfeeding prevalence. (Assesses population-level health impacts)

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.