Hospital-based Quality Improvement Collaborative to Improve Maternity Care Practices Supportive of Breastfeeding

In the United States, breastfeeding rates vary by race/ethnic groups, see https://www.cdc.gov/nccdphp/dnpao/data-trends-maps/index.html. Black mothers disproportionately experience a number of barriers to breastfeeding, including lack of knowledge about breastfeeding and insufficient education and support in health care settings, see https://www.liebertpub.com/doi/10.1089/bfm.2014.0152; https://www.cdc.gov/mmwr/volumes/68/wr/mm6834a3.htm?s_cid=mm6834a3_w.   The implementation of evidence-based maternity practices supportive of breastfeeding is lower among birthing hospitals in US neighborhoods with larger black populations, see https://pubmed.ncbi.nlm.nih.gov/25144543/. The use of these practices increases rates of breastfeeding initiation, duration, and exclusivity. Improvements in the implementation of breastfeeding supportive, evidence- based maternity practices in birthing hospitals in four southern states have shown a reduction in black-white disparities in breastfeeding initiation, see https://pubmed.ncbi.nlm.nih.gov/30659064/. With the emergence and continued longevity of the COVID-19 pandemic, hospitals continue to balance implementing maternity practices supportive of breastfeeding with measures to prevent and control infection (Perrine et al., 2020; Available at Implementation of Hospital Practices Supportive of Breastfeeding in the Context of COVID-19 — United States, July 15–August 20, 2020 | MMWR (cdc.gov)). Since infant feeding decisions and outcomes are largely shaped by experiences in hospitals, an initiative to improve maternity care practices and policies that support breastfeeding in these facilities is critical. The Baby-Friendly Hospital Initiative (BFHI) designates as “Baby-Friendly” hospitals that demonstrate they meet the criteria for providing optimal feeding care for healthy newborns. The Ten Steps to Successful Breastfeeding are a set of evidence-based hospital practices and policies that form the core of the Baby-Friendly Hospital Initiative (BFHI). Although more than 27% of US births now occur in Baby-Friendly facilities, considerable work is still needed to ensure that quality maternity care that optimally supports lactation is provided to all lactating individuals and their infants.   b. Healthy People 2030 A goal of the Healthy People 2030 initiative is to achieve health equity, eliminate disparities, and improve the health of all groups. This NOFO supports the overarching goal to eliminate health disparities, achieve health equity, and attain health literacy to improve the health and well-being of all and the goal to improve the health and safety of infants. This NOFO specifically supports the following Healthy People 2030 topic areas: Increase the proportion of infants who are breastfed exclusively through age 6 months – MICH-15, see Increase the proportion of infants who are breastfed exclusively through age 6 months — MICH‑15 - Healthy People 2030 | health.go Increase the proportion of infants who are breastfed at 1 year – MICH-16, see Increase the proportion of infants who are breastfed at 1 year — MICH‑16 - Healthy People 2030 | health.gov Project Description  a. Approach The table below is the breastfeeding logic model specific to this effort and includes strategies and activities, and short, intermediate, and long-term outcomes. Outcomes in bold represent intended effects resulting from these activities. Strategies Short-term Outcomes (1-2 years) Intermediate Outcomes (3-5 years) Long-Term Outcomes   Recruit US and territorial maternity hospitals to take part in the quality improvement initiative Provide tailored training and technical assistance to hospitals regarding culturally sensitive approaches to safely implement evidence-based breastfeeding supportive maternity care Provide tailored training, technical assistance, and tools to assist hospitals in using quality improvement approaches to implement evidence-based breastfeeding supportive maternity care   Increase reach of breastfeeding quality improvement initiatives among US and territorial maternity hospitals serving a high proportion of families less likely to start or continue breastfeeding Increase training and capacity of direct maternity staff to use culturally sensitive approaches to safely provide evidence- based breastfeeding supportive maternity care Increase hospitals’ use of quality improvement approaches to implement evidence-based breastfeeding supportive maternity care Increase evidence-based care to birthing families and lactating persons Increase initiation of breastfeeding, particularly among families at higher risk of not breastfeeding   Increase breastfeeding of infants at higher risk of not breastfeeding Reduce use of supplemental infant formula among breastfeeding infants within infants’ first 2 days of life (unless medically necessary) Reduce racial/ethnic disparities in breastfeeding initiation   Strategies and Activities in support of this effort: Recruit US and territorial maternity hospitals to take part in the quality improvement initiative Recruit and enroll US and territorial maternity hospitals, serving a high proportion of families less likely to start or continue breastfeeding, to take part in the project. Provide tailored training and technical assistance to hospitals regarding culturally sensitive approaches to safely implement evidence-based breastfeeding supportive maternity care Coordinate hospital training and technical assistance activities Facilitate the safe implementation of the Ten Steps to Successful Breastfeeding Provide tailored training, technical assistance, and tools to assist hospitals in using quality improvement approaches to implement evidence-based breastfeeding supportive maternity care Monitor implementation and evaluate effectiveness of training and technical assistance strategies, using a quality improvement approach Provide support (financial, training, technical assistance, and tools) for hospitals to safely implement evidence based maternity care supportive of breastfeeding, the Ten Steps to Successful Breastfeeding b. Purpose The purpose of this project is to continue to support the CDC’s Hospitals Promoting Breastfeeding Work. This work builds on the experience and lessons learned from previous projects focused on: Increasing the number of hospitals implementing evidence based maternity care for lactating individuals and their infants Providing training, technical assistance, and tools to help hospitals implement and sustain evidence based maternity care for lactating individuals and their infants Increasing support in maternity hospitals serving a high proportion of families less likely to start or continue breastfeeding Ensuring maternity care supportive of breastfeeding is delivered consistently and equitably c. Outcomes The outcomes of this NOFO include: Increase reach of breastfeeding quality improvement initiatives among US and territorial maternity hospitals serving a high proportion of families less likely to start or continue breastfeeding Increase evidence-based care to birthing families and lactating persons Increase initiation of breastfeeding, particularly among families at higher risk of not breastfeeding d. Performance Measures ​​​​​​​ Performance Measures Performance measures will include progress made on the following: Number and percentage of US and territorial maternity hospitals serving a high proportion of families less likely to start or continue breastfeeding. Number of hospitals implementing six or more of the Ten Steps to Successful Breastfeeding.   Number of infants who are breastfed: ever. Evaluation Plan CDC will provide technical assistance as requested by the recipient so that the recipient can collect relevant information on measures and conduct evaluations that determine the impact of CDC funding on increasing the number of participating hospitals that are safely implementing evidence based maternity care. CDC will provide technical assistance as requested by the recipient to develop a framework to guide evaluation for the funded project. This will include monitoring activities and strategy implementation, conducting evaluations on the effectiveness of the activities at achieving expected outcomes, and describing contextual factors that may influence outcomes.