BOSTON – New research from Boston Medical Center assesses the impact of a statewide effort to improve breastfeeding rates in Mississippi, using an evidence-based strategy to evaluate the Communities and Hospitals Advancing Maternity Practices (CHAMPS) program. Published in Maternal & Child Nutrition, this study uses the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework to assess the impact of the program for improving breastfeeding rates in birthing hospitals and the community. RE-AIM has been used to assess the impact of public health programs applied across a range of settings, but no national breastfeeding programs in the U.S., like CHAMPS, have been assessed using an established implementation science framework.
Using the RE-AIM framework, researchers determined that CHAMPS reached 98 percent of eligible birthing women in Mississippi, and 99 percent of eligible Black patients. CHAMPS reached 65 percent of Mississippi’s breastfeeding counselors under the Special Supplementation Nutrition Program for Women, Infants, and Children (WIC).
The proportion of Mississippi WIC families doing any breastfeeding increased from 5 percent to 15 percent when CHAMPS was operating; the number of Baby-Friendly hospitals increased from 0-22, and the average hospital breastfeeding initiation rate rose from 56 percent to 66 percent. As of November 2021, all CHAMPS hospitals in Mississippi retained the Baby-Friendly designation and 100 percent maintained enrollment in the program.
“Broad-scale breastfeeding promotion and engagement initiatives can be successfully implemented and assessed using evidence-based implementation science frameworks,” says Anne Merewood, PhD, MPH, the study’s corresponding author and director of the Center for Health Equity, Education, & Research at BMC. “These methods comprehensively assess the impact of the initiative, beyond a reliance on measuring breastfeeding rates and assess outcomes in maternal child health.”
Broad, measurable, quantitative and qualitative outcomes were used to evaluate CHAMPS within hospital and community settings, including hospital data analysis, nursing staff interviews, breastfeeding rates in local WIC program, and measured engagement within community breastfeeding programs. The results highlight the impact of the work being done by the program to improve the quality of healthcare and advance public health in Mississippi.
CHAMPS is a multi-year quality improvement initiative in the state of Mississippi that has increased breastfeeding rates and reduced racial inequities in breastfeeding. The program successfully engaged with 95 percent of birthing hospitals in Mississippi to increase breastfeeding initiation and exclusivity, skin-to-skin and rooming rates and to decrease racial disparities in breastfeeding. A focus was also placed on hospitals achieving Baby-Friendly designation.
In 1991, the World Health Organization and United Nations Children’s Fund launched the Baby-Friendly Hospital Initiative with the goal of improving breastfeeding rates globally. This initiative helps hospitals support new mothers to successfully initiate and continue breastfeeding their babies. Public health initiatives, like CHAMPS, that use broad-based strategic programing, work with a wide range of stakeholders, and use a variety of evaluation criteria can be successful.
CHAMPS took ambitious steps to tackle barriers including institutional racism and a lack of healthcare engagement with communities. CHAMPS partnered with the organization, Reaching Our Sisters Everywhere (ROSE) in this work, to ensure that an African American perspective guided the work, which was imperative to the success. CHAMPS also partnered with the Mississippi Perinatal Quality Improvement Collaborative and Blue Cross & Blue Shield of Mississippi, which motivated additional hospitals to enroll and engage in the program.
“In our previous research we have found that the CHAMPS program was successful at improving maternity care practices, increasing breastfeeding rates, and decreasing racial disparities in breastfeeding,” says Laura Burnham, MPH, associate director of the Center for Health Equity, Education, & Research at BMC. “Now, using an implementation science framework, we have more evidence of CHAMPS’ accomplishments and what its impact was, and other researchers can use these findings to implement similar programs with the same results elsewhere.”
Researchers recommend that other breastfeeding promotion and support programs should assess the wider impact using similar evidence-based implementation frameworks. Widespread change in health care practices is possible when implemented in partnership with diverse institutions and community groups.
Funding for this study was supported by a Healthy Eating Research grant from the Robert Wood Johnson Foundation.