Hospital-based Quality Improvement Collaborative to Improve Maternity Care Practices Supportive of Breastfeeding | CDC RFA DP 23 0018

Opportunity Information: Apply for CDC RFA DP 23 0018

The Hospital-based Quality Improvement Collaborative to Improve Maternity Care Practices Supportive of Breastfeeding (CDC RFA DP 23 0018) is a CDC-funded cooperative agreement designed to help maternity hospitals strengthen the day-to-day practices and policies that make breastfeeding more achievable for birthing families. The opportunity is grounded in a well-documented gap between what many mothers intend to do (start and continue breastfeeding) and what often happens after delivery, when hospital routines, inconsistent staff support, or outdated policies can unintentionally discourage breastfeeding and lead to earlier-than-planned weaning. The CDC points to research showing a strong dose-response relationship between hospital exposure to the Ten Steps to Successful Breastfeeding and breastfeeding continuation: mothers who experienced more of these evidence-based steps were far less likely to stop breastfeeding early. In other words, the hospital environment matters a lot, and improving it is one of the most direct ways to improve breastfeeding outcomes.

A major driver of this initiative is equity. Breastfeeding rates vary across racial and ethnic groups in the United States, and Black mothers often face disproportionate barriers, including limited access to breastfeeding education and practical support in health care settings. The CDC highlights evidence that hospitals serving communities with larger Black populations are less likely to implement evidence-based maternity care practices supportive of breastfeeding, which can contribute to lower initiation and continuation rates. The grant opportunity explicitly connects quality improvement in hospitals with the potential to reduce Black-white disparities in breastfeeding initiation, noting that prior multi-state work in the South showed promising reductions in these gaps when hospitals improved their maternity care practices. The NOFO also recognizes the ongoing reality of COVID-19 and similar infection control pressures, emphasizing the need for hospitals to safely implement breastfeeding-supportive practices while balancing appropriate infection prevention measures.

The effort is closely aligned with national public health goals, particularly Healthy People 2030 targets related to breastfeeding. Specifically, it supports increasing the proportion of infants who are breastfed exclusively through 6 months (MICH-15) and increasing the proportion of infants who are breastfed at 1 year (MICH-16). By focusing on hospital policies and practices at the point of birth, the CDC is targeting a high-leverage period when feeding plans are most vulnerable to disruption and when supportive care can have lasting downstream effects on breastfeeding duration and exclusivity.

At the center of the approach is a structured quality improvement collaborative that recruits and enrolls U.S. and territorial maternity hospitals, prioritizing those that serve a high proportion of families less likely to start or continue breastfeeding. The collaborative model is meant to spread evidence-based practices more consistently by combining tailored training, hands-on technical assistance, and practical tools that hospitals can use to implement change. The content focus is on the Ten Steps to Successful Breastfeeding, which form the core of the Baby-Friendly Hospital Initiative (BFHI). While BFHI designation is one recognized benchmark for high-quality maternity care supportive of breastfeeding and more than a quarter of U.S. births occur in Baby-Friendly facilities, the CDC stresses that broad, equitable access to these supportive practices is still not where it needs to be. This grant is essentially about moving more hospitals closer to those standards and sustaining improvements over time, regardless of whether a hospital is pursuing formal Baby-Friendly designation.

The NOFO lays out a logic model that connects strategies to outcomes across short-term (1 to 2 years), intermediate (3 to 5 years), and long-term horizons. In the short term, the work aims to expand the reach of breastfeeding quality improvement initiatives into more hospitals that serve populations at higher risk of not breastfeeding, and to build staff capacity to deliver culturally sensitive, evidence-based care. Another early goal is increasing hospitals' ability to use quality improvement methods (for example, structured testing of changes, tracking measures over time, and iterative refinement) to implement and maintain breastfeeding-supportive practices. Over the intermediate term, these activities are intended to increase delivery of evidence-based maternity care to birthing families and lactating persons, increase breastfeeding initiation and continuation among groups at higher risk of not breastfeeding, and reduce the use of supplemental formula during the first two days of life unless medically necessary. The long-term vision is improved breastfeeding outcomes overall and a reduction in racial and ethnic disparities, especially disparities in breastfeeding initiation.

In practical terms, the funded recipient is expected to run or coordinate the collaborative by recruiting hospitals, organizing and delivering training and technical assistance, and helping facilities safely implement the Ten Steps within their local context. The NOFO emphasizes that support should be tailored and culturally sensitive, reflecting the reality that families do not experience the health system uniformly and that effective support must be responsive to community needs. The recipient is also expected to provide resources that may include financial support along with training, technical assistance, and tools, all aimed at enabling hospitals to make and sustain concrete practice changes rather than simply raising awareness.

The purpose statement makes clear that this grant continues and builds on the CDC's Hospitals Promoting Breastfeeding work. That broader body of work has focused on expanding the number of hospitals using evidence-based maternity care practices, helping hospitals implement and sustain those practices with training and tools, and concentrating efforts where need is greatest, particularly in facilities serving families less likely to initiate or continue breastfeeding. Consistency and equity are highlighted as core values: supportive maternity care should not depend on where someone gives birth, their race, or their zip code.

Success under the award is tracked using specific performance measures tied to both hospital participation and implementation progress. These measures include the number and percentage of U.S. and territorial maternity hospitals participating that serve a high proportion of families less likely to start or continue breastfeeding, the number of hospitals implementing six or more of the Ten Steps to Successful Breastfeeding (a practical threshold that signals meaningful implementation rather than minimal change), and the number of infants who are ever breastfed. The evaluation plan is not an afterthought; it is built into the initiative. The CDC indicates it will provide technical assistance to help the recipient collect relevant data, monitor implementation, evaluate whether the strategies are working as intended, and document contextual factors that could influence outcomes (such as staffing challenges, leadership support, policy constraints, patient population needs, or infection control requirements).

From an administrative standpoint, this is a discretionary cooperative agreement administered by the Department of Health and Human Services, Centers for Disease Control and Prevention (NCCDPHP), under CFDA 93.945. Eligibility is broad and includes many public and private entity types: state, county, and local governments; tribal governments and tribal organizations; public and private institutions of higher education; nonprofit organizations (with or without 501(c)(3) status); for-profit organizations (including small businesses); and other entities as clarified in the full notice. The award ceiling is $2,000,000, and the CDC anticipated making one award under this opportunity. The original posting date was January 23, 2023, with an original application due date of March 23, 2023.

Overall, the grant opportunity is aimed at changing what happens in hospitals during the critical window around childbirth by scaling evidence-based, culturally responsive maternity care practices that support breastfeeding, strengthening hospital quality improvement capacity, and intentionally focusing on facilities serving populations most affected by breastfeeding inequities. The expected payoff is better breastfeeding initiation and continuation, fewer unnecessary early formula supplements, and measurable progress toward narrowing racial and ethnic disparities driven in part by uneven access to supportive hospital care.

• The Department of Health and Human Services, Centers for Disease Control - NCCDPHP in the health sector is offering a public funding opportunity titled "Hospital-based Quality Improvement Collaborative to Improve Maternity Care Practices Supportive of Breastfeeding" and is now available to receive applicants.
• Interested and eligible applicants and submit their applications by referencing the CFDA number(s): 93.945.
• This funding opportunity was created on Jan 23, 2023.
• Applicants must submit their applications by Mar 23, 2023 Electronically submitted applications must be submitted no later than 1159 pm ET on the listed application due date.. (Agency may still review applications by suitable applicants for the remaining/unused allocated funding in 2026.)
• Each selected applicant is eligible to receive up to $2,000,000.00 in funding.
• The number of recipients for this funding is limited to 1 candidate(s).
• Eligible applicants include: State governments, County governments, City or township governments, Special district governments, Independent school districts, Public and State controlled institutions of higher education, Native American tribal governments (Federally recognized), Public housing authorities/Indian housing authorities, Native American tribal organizations (other than Federally recognized tribal governments), Nonprofits having a 501(c)(3) status with the IRS, other than institutions of higher education, Nonprofits that do not have a 501(c)(3) status with the IRS, other than institutions of higher education, Private institutions of higher education, For profit organizations other than small businesses, Small businesses, Others (see text field entitled Additional Information on Eligibility for clarification), Unrestricted (i.e., open to any type of entity above), subject to any clarification in text field entitled Additional Information on Eligibility.

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