2007 CDC National Survey of Maternity Practices in Infant Nutrition and Care (mPINC)
Introduction
Evidence
shows that several specific practices in intrapartum medical care
settings can significantly affect breastfeeding rates and duration of
breastfeeding among women. Birth facility policies and practices that
create a supportive environment for breastfeeding begin prenatally and
continue through discharge. In 2007, the Centers for Disease Control and
Prevention (CDC), in collaboration with Battelle Centers for Public
Health Research and Evaluation, completed a national survey of maternity
care feeding practices and policies, entitled the Maternity Practices in
Infant Nutrition and Care (mPINC) Survey , at all facilities in the
United States and Territories providing intrapartum care. The survey was
sent to all U.S. hospitals (n=3,143) and birth centers (n=138) with
registered maternity beds, with a request that it be completed by the
person at the birth facility who had the most knowledge regarding the
facility’s maternity and infant feeding practices. Data were obtained
from a total of 2,690 (82%) of the facilities and are being analyzed.
CDC plans to repeat the survey to assess changes over time.
Questionnaires
Two versions of the questionnaire were developed that were identical in
content but that contained minor differences in wording to reflect the
relevant type of staff and type of birth facility (hospital versus birth
center; hereafter “birth facilities”) being surveyed. The survey
contained 52 questions regarding the birth facility’s maternity
practices, training, personnel, policy, and facility characteristics.
Questions included a variety of response options, including yes/no,
ordinal responses (e.g., few, some, many, most), percentages, lists of
program components (e.g., elements of a worksite lactation program), or
reasons for a given practice (e.g., why mothers and infants are
separated).
You can download the questionnaires here:
- Birth Center Survey
(PDF-356k) - Hospital Survey
(PDF-156k)
Results
Survey results have been analyzed by creating summary scores based on 34
questions related to maternity and infant feeding practices. Scores were
categorized into one of seven maternity care practice domains: labor and
delivery; postpartum breastfeeding assistance; postpartum contact
between mother and infant; postpartum feeding of breastfed infants;
breastfeeding support upon discharge; staff breastfeeding training and
education; and structural and organizational factors related to
breastfeeding.
Responses to specific items on the survey were scored according to an
algorithm developed and reviewed by experts in the field denoting the
evidence and best practices to promote breastfeeding within the health
care setting. Scores were calculated for each item, then item scores
were averaged to create a score for each of the 7 domains noted above,
and averages of the domain scores were used to create a total mPINC
score. Possible scores ranged from 0—100, with higher scores denoting
better maternity care practices. Details on the mPINC scoring algorithm,
including rationale and explanations, can be found at
Overview of the mPINC Scoring Algorithm.
Results from the survey indicate that birth facilities in most states
are not providing maternity care that is fully supportive of
breastfeeding. In addition, the southern region of the U.S., typically
the region with the lowest breastfeeding rates (see Map 1:
Percent of Children Ever Breastfed by State among Children Born in
2004), has the lowest
maternity care practices scores. More information on the current status
of maternity care practices nationally, as well as by state, can be
found in the June 13, 2008, MMWR article, “Breastfeeding-Related
Maternity Practices among Hospitals and Birth Centers – United States,
2007.”
In addition to providing an overview of maternity care practices within
the U.S., facility-specific benchmark reports are being provided to each
facility that completed a survey. The benchmark reports compare a
facility’s individual scores on each of the maternity practice domains
and the total score with those of facilities in their state and with
facilities of a similar size (i.e., number of births annually)
nationally. These reports will help facilities identify maternity care
practices they can change to better support breastfeeding. Aggregate
state-level data will be shared with state health departments to
facilitate their work with hospitals and birth centers in improving
breastfeeding care.
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Page last updated: June 10, 2008
Content Source: Division of Nutrition, Physical Activity and Obesity, National Center for Chronic Disease Prevention and Health Promotion