Office of Epidemiology and Research, Division of Research

Advancing Applied MCH Research

Analysis Of The Policy Process To Improve Comprehensive And Coordinated Systems For Breastfeeding Equity

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Project Number: R40 MC 26824
Grantee: University of Washington
Department/Center: Health Services/Ctr for Public Hlth Nutrition
Project Date: 04/01/2014

Final Report


Principal Investigator

Donna Johnson, Ph.D
Professor, Health Services
305 Raitt Hall
Seattle, WA  98195-3410
Phone: (206) 685-1068


  • Women/Maternal
  • Perinatal/Infancy (0-12 months)


Breastfeeding promotes the healthy development of Maternal and Child Health (MCH) populations, but there are disparities in access to the benefits of breastfeeding. Breastfeeding decisions are influenced by contextual and environmental factors across the social-ecological model. A coordinated system of breastfeeding care (MCH Bureau Strategic Research Issue #I), should be built on public health service systems and infrastructures that include culturally competent preconception, pregnancy, and postpartum services in communities; hospital maternity services; and supportive environments at worksites and child care settings. Inequalities in these environments are associated with disparities in breastfeeding rates (Strategic Issue #II). Evidence based strategies have been developed for optimal support of breastfeeding in hospitals, clinics, child care and worksites, but these are not consistently adopted, implemented, or maintained (Strategic lssue #lll). This project will take advantage of unique, comprehensive, coordinated, multi-level breastfeeding policy initiatives in Washington State to analyze efforts to improve policies that influence access, quality, and integration of breastfeeding services. It will assess key determinants of policy adoption at the state level (through legislation and administrative codes), in communities, and in health care, worksite, and child care settings. It will identify factors that impede or enhance the implementation of evidence-based breastfeeding polices and practices. For this policy analysis, extant policy process and implementation frameworks will be applied to systematically answer these questions: 1) Which factors impede or facilitate the processes of getting breastfeeding policies adopted by state legislatures and government agencies, health care settings, and businesses?; 2) Which factors account for successes in implementing breastfeeding policies and practices in four institutional sectors (hospitals, community clinics, child care, and worksites)?; 3) In what ways do these factors vary across geographic and demographic differences? Under the guidance of an advisory group, researchers will use a mixed methods approach to analyze data from 130 interviews with those involved in the policy development and implementation processes; policy process documents such as legislative transcripts and meeting minutes; and media coverage. Information will also be collected about implementation of 10 evidence-based "steps" that have been developed for each of the four institutional sectors. Following an iterative and rigorous process, data will be coded on key constructs from extant models and emergent themes. Results will be synthesized to describe successes and failures in each setting and identify factors associated with sustainable success. MCH leaders will be able to apply the results of this study to improve policies, practices, and environments as part of comprehensive approaches to increasing breastfeeding rates and reducing disparities.




Breastfeeding, Child Care, Health Disparities, Nutrition & Diet, Primary Care , Health Education & Family Support , Coordination of Services, Capacity & Personnel

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