Potential Public Health Impact
Reach: The intervention has potential for broad reach. In 2012, approximately 50.8% of babies born in North Carolina were born in a facility participating in the North Carolina Maternity Center Breastfeeding-Friendly (NCMCBF) Designation Program. However, rural residents have less access to 5-star facilities than urban residents.
Effectiveness: The number of facilities applying for and receiving stars has increased steadily since the project’s inception in 2010. As of March 2014, of the 88 maternity center facilities in North Carolina, 30 received some level of star recognition in the NCMCBF Designation Program, including 10 facilities that reapplied for and received a higher star level from their initial designation.
The CDC collects facility-level breastfeeding data via the Maternity Practices in Infant Nutrition and Care (mPINC) survey, a national survey of maternity care practices and policies conducted every two years. Facilities’ responses are scored using an algorithm developed and reviewed by experts in the field denoting the evidence and best practices to promote breastfeeding within the health care setting. These scores are then compiled into a summary rating, for which possible scores range from 0 to 100, with higher scores denoting better maternity care practices and policies. In North Carolina, the summary rating increased modestly from 61 to 67 between 2009 and 2011.
The CDC also publishes an annual Breastfeeding Report Card, which compiles information from several data sources on breastfeeding rates and hospital practices. Data from the CDC’s Breastfeeding Report Card provide limited evidence of an increase in women’s initiation of breastfeeding in North Carolina since the inception of the NCMCBF Designation Program. However, CDC data are for North Carolina as a whole and not just from those hospitals and maternity centers participating in the NCMCBF Designation Program, and therefore may not fully capture changes in women giving birth in those hospitals and maternity centers.
Adoption: As of March 2014, there were two 1-star, seven 2-star, ten 3-star, seven 4-star, and four 5-star facilities in North Carolina. Of 88 maternity facilities in the state, 30 have participated in the intervention. The facilities are dispersed relatively evenly throughout the state, with rural northeastern North Carolina having fewer facilities pursuing the designation than other parts of the state. Multiple other states have inquired about the program, and two are proceeding with implementation.
Implementation: The intervention involves an in-depth application process that could be readily replicated in other states. A state-level coordinator follows up each application with at least one technical assistance call to provide feedback to hospitals and maternity centers. The NCMCBF Designation Program may be attractive and feasible because it allows hospitals and maternity centers to achieve the BFHI steps incrementally, rather than all at once as required by BFHI. Facilities applying to the NCMCBF Designation Program incur no costs for participating in the program.
Maintenance: The North Carolina State Breastfeeding Coordinator spends 5% FTE (full time equivalent) to administer the program, which demonstrates strong potential for maintenance by state-level public health departments. Hospitals and maternity centers have to re-apply every three years to maintain their designation (i.e., stars) in the program.