Feature ArticlesBreastfeeding as a Quality Measure Demonstrating Levers of the National Quality StrategyJolles, Diana R. PhD, CNM; Hoehn-Velasco, Lauren PhD Author Information Department of Midwifery and Women's Health, Frontier Nursing University, Versailles, Kentucky (Dr Jolles); and Department of Economics, Georgia State University, Atlanta (Dr Hoehn-Velasco). Corresponding Author: Diana R. Jolles, PhD, CNM, 241 E Sky Light St, Tucson AZ 85737 ([email protected]). Disclosure: The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Each author has indicated that he or she has met the journal's requirements for Authorship. Submitted for publication: February 2, 2021; accepted for publication: March 29, 2021. The Journal of Perinatal & Neonatal Nursing 35(3):p 221-227, July/September 2021. | DOI: 10.1097/JPN.0000000000000577 Buy Metrics Abstract The purpose of this study is to explore the National Quality Strategy (NQS) levers (measurement and feedback, public reporting, learning and technical assistance, and certification) on state and national breastfeeding performance. The research evaluates the NQS levers of measurement and feedback and public reporting using secondary data analysis of publicly reported data from the National Immunization Survey and the Centers for Disease Control and Prevention Breastfeeding Report Cards between 2008 and 2018, the latest years available. Linear regression explores the association between the prevalence of state-level Baby-Friendly hospitals and state-level breastfeeding rates. Subsequent analyses use event study to test whether state-level Baby-Friendly hospital adoption is associated with higher breastfeeding rates. A 10% increase in Baby-Friendly hospitals at the state level is associated with increased population breastfeeding rates by nearly 5% and a decrease in early formula use (before 2 days of life) by 2% to 9%. Breastfeeding increased by 2% to 5% in the first 2 years following state-level Baby-Friendly initiatives, with subsequent increases up to 10% in the next 4 years. The National Quality Strategy levers of measurement and public reporting combined with certification and learning and technical assistance are associated with increases in exclusive breastfeeding, a national quality metric. © 2021 Wolters Kluwer Health, Inc. All rights reserved.