An Evaluation of the CDC's Community-Based Breastfeeding Supplemental Cooperative Agreement: Reach, Strategies, Barriers, Facilitators, and Lessons Learned.
BACKGROUND
Community-based organizations (CBOs) have an important role to play in promoting breastfeeding continuation among mothers. The Centers for Disease Control and Prevention's Nutrition, Physical Activity, and Obesity Program's Cooperative Agreement Breastfeeding Supplement funded 6 state health departments to support CBOs to implement community-based breastfeeding support activities.


OBJECTIVE
Study objectives were to (1) describe the reach of the Cooperative Agreement, (2) describe breastfeeding support strategies implemented by state health departments and CBOs, and (3) understand the barriers and facilitators to implementing community-based breastfeeding support strategies.


METHODS
Qualitative and quantitative data were abstracted from state health departments' final evaluation reports. Qualitative data were analyzed for common themes using deductive and inductive approaches.


RESULTS
Within the 6 states funded by the Cooperative Agreement, 66 primary CBOs implemented breastfeeding support strategies and reported 59 256 contacts with mothers. Support strategies included incorporating lactation services into community-based programs, training staff, providing walk-in locations for lactation support, connecting breastfeeding mothers to resources, and providing services that reflect community-specific culture. Community partnerships, network building, stakeholders' commitment, and programmatic and policy environments were key facilitators of program success.


CONCLUSIONS
Key lessons learned include the importance of time in creating lasting organizational change, use of data for program improvement, choosing the right partners, taking a collective approach, and leveraging resources.
Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health, Atlanta, GA, USA plilleston@gmail.com.
Pamela
P
Lilleston
Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Diabetes Translation, Atlanta, GA, USA.
Kunthea
K
Nhim
Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Nutrition, Physical Activity, and Obesity, Atlanta, GA, USA.
Gia
G
Rutledge
D001942:Breast Feeding; D002487:Centers for Disease Control and Prevention, U.S.; D005260:Female; D006293:Health Promotion / Q000379:methods / Q000458:organization & administration*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010043:Outcome and Process Assessment, Health Care; D011181:Postnatal Care / Q000379:methods / Q000458:organization & administration*; D015397:Program Evaluation; D055818:Public-Private Sector Partnerships / Q000458:organization & administration; D036301:Qualitative Research; D014481:United States
breastfeeding; breastfeeding support; community support; community-based; process evaluation; program evaluation