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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. Breastfeeding Education Programs

Approach. Offer professional support and educational opportunities via videos, trainings, and resources to promote breastfeeding

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Overview. Research indicates that patient care is an essential component of hospital care with providers increasingly relying on the support of both interdisciplinary colleagues and technology to aid in teaching patients and their families before hospital discharge.[1] Studies examined the impact of educational videos delivered bedside to postpartum mothers,[2] one-on-one breastfeeding training during the prenatal and postnatal periods,[3] and providing eHealth resources to mothers and their co-parents[4] to support exclusive breastfeeding.

Evidence. Emerging Evidence. Strategies with this rating typically trend positive and have good potential to work. They often have a growing body of recent, but limited research that documents effects. However, further study is needed to confirm effects, determine which types of health behaviors and conditions these interventions address, and gauge effectiveness across different population groups. (Clarifying Note: The WWFH database calls this "mixed 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.

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 breastfeeding education programs developed and implemented across different settings (e.g., hospitals, prenatal clinics, community centers). (Measures program availability)
  • Number of healthcare professionals trained to provide breastfeeding education and support. (Assesses workforce development)
  • Number of breastfeeding educational resources (e.g., videos, handouts, eHealth tools) distributed to mothers and their support systems. (Evaluates resource dissemination)

OUTCOME MEASURES:

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

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

PROCESS MEASURES:

  • Percent of breastfeeding education programs that utilized evidence-based content and best practices for adult learning. (Measures program quality)
  • Percent of breastfeeding education sessions that included hands-on skills practice and problem-solving activities. (Evaluates interactive learning)
  • Percent of breastfeeding educational resources that were reviewed for accuracy, clarity, and cultural relevance. (Assesses resource quality)

OUTCOME MEASURES:

  • Percent of program participants who reported high satisfaction with the breastfeeding education and support they received. (Measures participant experience)
  • Percent of women who exclusively breastfed their infants at 3 and 6 months postpartum after participating in the educational programs. (Assesses breastfeeding exclusivity)
  • Percent of women who reported feeling more supported and empowered to breastfeed as a result of the education and resources provided. (Captures perceived impact)

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

PROCESS MEASURES:

  • Number of partnerships established between healthcare providers, community organizations, and technology companies to develop and deliver breastfeeding education programs. (Measures cross-sector collaboration)
  • Number of quality improvement initiatives implemented to monitor and enhance the effectiveness of breastfeeding education programs. (Assesses continuous improvement)
  • Number of research studies or evaluations conducted to assess the impact and outcomes of breastfeeding education programs. (Evaluates evidence generation)

OUTCOME MEASURES:

  • Number of breastfeeding challenges or complications that were prevented or addressed as a result of the education and support provided. (Captures preventive impact)
  • Number of women who continued breastfeeding beyond their initial goals after participating in the educational programs. (Measures breastfeeding duration)
  • Number of infants who achieved optimal growth and development milestones while being breastfed, as promoted by the education programs. (Assesses child health outcomes)

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

PROCESS MEASURES:

  • - Percent of breastfeeding education programs that targeted and engaged women from underserved or high-risk populations. (Measures equitable access)
  • - Percent of breastfeeding educational resources that were culturally and linguistically adapted for diverse communities. (Evaluates cultural responsiveness)
  • - Percent of program funding allocated to address barriers to participation, such as providing childcare, transportation, or incentives. (Assesses inclusive support)

OUTCOME MEASURES:

  • - Percent reduction in breastfeeding disparities among racial, ethnic, or socioeconomic groups who participated in the education programs. (Measures equity impact)
  • - Percent of women from communities with historically low breastfeeding rates who reported increased breastfeeding knowledge, skills, and support after participating in the programs. (Captures progress in underserved areas)
  • - Percent increase in breastfeeding initiation and duration rates at the population level, particularly among groups with previously low rates, as a result of widespread breastfeeding education efforts. (Assesses population-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 Shealy KR, Li R, Benton-Davis S, Grummer-Strawn L. The CDC Guide to Breastfeeding Interventions. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention; 2005.

2 Marmet, J., Schmiesing, A., Scheuer, J., Osborn, C., Lunos, S. A., & Pitt, M. B. (2020). Prescribing Video-Based Patient Education in the Hospital Setting: Can Bedside Breastfeeding Videos Affect Exclusive Breastfeeding at Postpartum Discharge?. Hospital pediatrics, 10(3), 266-271.

3 Yılmaz, M., & Aykut, M. (2021). The effect of breastfeeding training on exclusive breastfeeding: a randomized controlled trial. The Journal of Maternal-Fetal & Neonatal Medicine, 34(6), 925-932.

4 Abbass-Dick, J., Sun, W., Newport, A., Xie, F., Godfrey, D., & Goodman, W. M. (2020). The comparison of access to an eHealth resource to current practice on mother and co-parent teamwork and breastfeeding rates: A randomized controlled trial. Midwifery, 90, 102812.

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.