Case Studies

New York Engages Partners to Improve Breastfeeding Outcomes 

The Bureau of Community Chronic Disease Prevention at the New York State Department of Health (NYS DOH) worked with NICHQ to develop and lead hospitals in a quality improvement initiative to increase exclusive breastfeeding rates. From 2010-2017, NICHQ provided guidance to 44 hospitals to test and implement sustainable changes to maternity care practices and hospital policies to be consistent with New York State hospital regulations, public health laws and evidence-based best practices.  

Studies have shown that breastfeeding is both a risk reduction and health promotion strategy for mothers and babies. From lowering the risk of certain types of breast and ovarian cancer in mothers, to reducing the risk of becoming obese and developing type 2 diabetes in children, the benefits of breastfeeding can be seen across generations. The evidence is strong, yet breastfeeding rates in the U.S. remain well below the Healthy People 2020 objectives. Even more alarming are the substantial racial and ethnic disparities that still exist, with only 33 percent of non-Hispanic black infants and 32 percent of Hispanic infants being exclusively breastfed, compared to 56 percent of white infants.

Our Approach

NICHQ facilitated a pilot and two successive breakthrough series learning collaboratives, allowing hospital improvement teams across New York State to test and implement changes in their maternity care practices shown to support improved breastfeeding outcomes. NICHQ convened hospital administrators, physician champions, staff nurses, family partners and representatives from local Supplemental Nutrition Programs for Women, Infants and Children (WIC) to work collaboratively and better support women and their families to meet their breastfeeding goals. By leveraging the content expertise of local faculty members and training them in quality improvement methodologies, NICHQ presented hospitals with evidence-based strategies and resources to implement sustainable changes in their facilities, which aligned with the Ten Steps to Successful Breastfeeding.

The Results

With gaps in maternity practices that support breastfeeding, the state of New York was presented with an opportunity to transform the way hospitals provide care to women and families in their community. The work's results include:

  • The hospitals engaged in the two cohorts improved their aggregate exclusive breastfeeding rates by more than 10 percent.
  • Two cohorts improved mothers’ abilities to recognize cues that their babies were hungry by 57 percent. Now, more mothers can breastfeed based on their baby’s satiation rather than according to a timed schedule, which promotes breastmilk production and reduces formula over-feeding.
  • One cohort increased rooming-in rates by 33 percent. Evidence shows that sharing a room during the hospital stay can help mothers learn feeding cues and establish feeding patterns prior to discharge, thereby increasing the duration of breastfeeding. Now, each year, nearly 30,339 infants benefit from rooming-in during the hospital stay.
  • Contributed to five hospitals receiving Baby-Friendly hospital designation. As a result, more families are receiving evidence-based information and support to help them safely initiate and continue breastfeeding. And through participation in this learning collaborative, the remaining 39 hospitals are one step closer to aligning their maternity care practices with the Baby-Friendly requirements.
  • Strengthened a partnership between the NYS DOH and the WIC Program at the state and local level, allowing both agencies to collaborate and better coordinate their work so that more hospitals are aware of the breastfeeding support offered by local WIC agencies.
breastfeeding mother and baby


The approximately 62,000 infants born across these New York State hospitals each year are benefiting from environments tailored to support better breastfeeding practices and education. By creating new policies and developing robust partnerships at the state and local level, New York is ensuring that thousands of babies will continue to receive the best start possible.

Looking for a change agent to enhance your initiative?

  Contact us to get started!