Overview. Employers who offer on-site child care provide employees with child care options at work. Care may be provided free of charge, partially subsidized as part of an employee benefit package, or provided at market rates.
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. What Works for Health (WWFH) Database (County Health Rankings and Roadmaps)
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. 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.
There are currently no ESMs that use this strategy. As Title V agencies begin to incorporate this strategy into ESMs, examples will be available here. Until then, you can search for ESMs that have similar intervention components in the ESM database.
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).
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Quadrant 1:
Measuring Quantity of Effort ("What/how much did we do?")
- Number of employers provided with guidance on implementing on-site child care policies. (Measures the reach of technical assistance efforts.)
- Number of employees potentially impacted by employers receiving on-site child care guidance. (Estimates the scale of the employed population reached.)
- Number of on-site child care policy templates, toolkits or resources developed and disseminated. (Quantifies the tools created to support policy implementation.)
- Number of workplaces that establish on-site child care after receiving policy guidance. (Tracks the number of sites adopting the practice due to the intervention.)
- Number of employees who use on-site child care to support breastfeeding continuation after maternity leave. (Links on-site child care policies to a key outcome of interest.)
- Number of on-site child care programs that include breastfeeding-friendly design features (e.g., lactation spaces). (Measures integration of breastfeeding accommodations.)
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Quadrant 2:
Measuring Quality of Effort ("How well did we do it?")
- Percent of on-site child care policy guidance materials that are user-friendly and appropriate for the employer audience. (Assesses quality and relevance of resources.)
- Percent of employers receiving guidance that represent high-need industries with lower-wage workers. (Evaluates focus on workplaces with greatest potential impact.)
- Percent of on-site child care policy development processes that engage employees who are parents. (Measures meaningful input from key stakeholders and end-users.)
- Percent of employees who report improved perceptions of workplace support for breastfeeding after on-site child care is available. (Captures impact on subjective norms.)
- Percent of on-site child care programs that adhere to best practices in breastfeeding support. (Assesses the quality and consistency of policy implementation.)
- Percent of working mothers who feel on-site child care makes breastfeeding easier to maintain. (Measures perceived impact on breastfeeding enablers.)
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Quadrant 3:
Measuring Quantity of Effect ("Is anyone better off?")
- Number of on-site child care programs that offer breastfeeding education to providers and parents. (Tracks integration of child care and breastfeeding support services.)
- Number of state or local breastfeeding coalitions advocating for on-site child care policies. (Measures alignment with broader breastfeeding promotion efforts.)
- Number of businesses providing on-site child care that also have workplace lactation support policies. (Assesses adoption of comprehensive breastfeeding-friendly practices.)
- Number of mothers using on-site child care who breastfeed for at least 6 months. (Measures impact on breastfeeding duration, a public health benchmark.)
- Number of on-site child care programs reporting improved provider knowledge and attitudes about breastfeeding. (Captures secondary benefits of on-site programs.)
- Number of businesses providing on-site child care that are recognized as breastfeeding-friendly workplaces. (Tracks external validation and positive reinforcement.)
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Quadrant 4:
Measuring Quality of Effect ("How are they better off?")
- Percent of on-site child care policy guidance that addresses unique needs of small businesses or specific sectors. (Assesses tailoring of resources to different contexts.)
- Percent of employers engaged that have a high proportion of workers who are BIPOC or from underserved communities. (Measures focus on advancing health equity.)
- Percent of on-site child care centers providing culturally responsive services to diverse families. (Evaluates equitable implementation and family-centeredness.)
- Percent increase in breastfeeding rates among low-income employees after on-site child care policy implemented. (Assesses impact on socioeconomic disparities.)
- Percent of infants in on-site child care who receive breastmilk, compared to community average. (Measures policy impact on a key infant health indicator.)
- Percent of employers with on-site child care reporting lower health care costs and improved productivity. (Captures broader societal and economic benefits.)
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Note. When looking at your ESMs, SPMs, or other strategies:
- Move from measuring quantity to quality.
- Move from measuring effort to effect.
- Quadrant 1 strategies should be used sparingly, when no other data exists.
- 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.
