Baby-Friendly designated hospitals in the United States have elevated rates of breastfeeding initiation and exclusivity. Elevated rates persist regardless of demographic factors that are traditionally linked with low breastfeeding rates.

Peer counselors increased breastfeeding duration among premature infants born in an inner-city hospital and admitted to the neonatal intensive care unit. Peer counseling programs can help to increase breastfeeding in this vulnerable population.

An effective electric breast pump is an important tool for the management of breastfeeding challenges such as provision of human milk to sick or premature infants. A breast pump is also, in Western culture, critical for breastfeeding mothers who return to work. Obtaining an effective electric breast pump can be particularly difficult for uninsured or impoverished women because of the expense, complicated insurance reimbursements, and scarcity of providers that supply breast pumps to the inner-city community. To address this problem at Boston Medical Center (BMC), an inner-city hospital that serves a poor and minority urban population, members of the Breastfeeding Center worked with a local charity and local insurance companies to increase access to pumps for all women at BMC and to guarantee that every breastfeeding mother with an infant in the neonatal intensive care unit receive a double-setup electric breast pump, regardless of her insurance status or ability to pay.

The effects of Baby-Friendly status on breastfeeding duration in the United States have not been published. The objectives of this study were to obtain breastfeeding rates at 6 months among babies born in a US Baby-Friendly hospital and to assess factors associated with continued breastfeeding at 6 months. The authors randomly selected 350 medical records of infants born in 2003 at Baby-Friendly Boston Medical Center. Of 336 eligible infants, 248 (74%) attended the 6-month well-child visit and 37.1% (92/248) were breastfeeding at 6 months. In multivariate logistic regression, the likelihood of breastfeeding at 6 months was decreased by presence of a feeding problem in the hospital (AOR 0.27; 95% CI 0.07-0.99), whereas the likelihood of breastfeeding at 6 months increased with maternal age (AOR 1.05; 95% CI 1.00-1.10) and for mothers born in Africa (AOR 4.29; 95% CI 1.36-13.5) or of unrecorded birthplace (AOR 3.29; 95% CI 1.38-7.85). Breastfeeding duration is traditionally poor in low-income, black populations in the United States. Among a predominantly low-income and black population giving birth at a US Baby-Friendly hospital, breastfeeding rates at 6 months were comparable to the overall US population.

Support for breastfeeding mothers after they leave the hospital is often inadequate in low-income, inner-city areas where few resources are available. In becoming a Baby-Friendly Hospital, inner-city Boston Medical Center established a breastfeeding telephone support line to overcome this discrepancy. Records of support line calls for the first 5 years of operation were reviewed to record the level of need and determine reasons for use. A total of 1959 calls for 2482 reasons were received between January 1999 and December 2003. The most common reason for calling was "need help obtaining a breast pump" or "need information about breast pumps" (44%; 1096/2482), followed by "breast issue" (7%; 181/2482) and "milk supply question" (7%; 167/2482). The results indicate that inner-city women seek breastfeeding support and demonstrate a substantial need for breast pumps. These findings suggest that the lack of breast pumps may be a barrier to continued breastfeeding for inner-city breastfeeding women.