Case Studies

Increasing Breastfeeding Rates

The CDC awarded NICHQ a first-of-its kind, nationwide quality improvement initiative--Best Fed Beginnings--aimed at increasing breastfeeding rates by helping hospitals improve maternity care practices. NICHQ created a collaborative learning system to help 90 hospitals test, implement and sustain system-level change to increase breastfeeding and ultimately achieve Baby-Friendly designation.

The United States lags behind most developed countries in breastfeeding rates. Yet, breastfeeding is one of the most effective preventive health measures, presenting benefits for both infants and mothers. Studies show babies with any amount of exposure to breastfeeding have better long-term health outcomes.

Our Approach

NICHQ brought together a team of improvement advisors and content experts from across the country to refine the key drivers for change. Following, we developed a driver diagram and change package to guide participating hospitals to improve maternity care practices. We recommended assembling multidisciplinary teams, including a physician champion, a maternal/child nurse champion, a senior administrative leader, a parent partner and community representatives. Using NICHQ’s unique change management approach, teams convened for in-person learning sessions, virtual webinar coaching meetings, and one-on-one support to learn how to overcome challenges to systems change and implement the change package in their unique setting. NICHQ continuously engaged with team participants and faculty to supplement change efforts through our private online resource sharing and data hub, the Collaboratory. We also collaborated with the United States Breastfeeding Committee to strengthen prenatal and postpartum breastfeeding support outside the hospital.

The Results

A nationwide initiatives of 90 maternity care hospitals resulted in:

  • 80 percent of participating hospitals were designated as Baby-Friendly
  • Best Fed Beginnings nearly doubled the number of Baby-Friendly designated hospitals in the U.S.
  • Exclusive breastfeeding rates increased 22 percent in participating hospitals
NICHQ - Increasing Breastfeeding Rates


With transformative and rapid change to achieve Baby-Friendly designation at hospitals nationwide, 218,000 more infants are delivered each year benefitting from breastfeeding, giving both baby and mother the best possible start and better long-term health outcomes.

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Follow the story of two teams in NICHQ’s Best Fed Beginnings initiative as they take the final steps toward becoming Baby-Friendly designated and reflect back on the journey of this groundbreaking, nationwide quality improvement project.