The effect of Baby‐friendly status on exclusive breastfeeding in U.S. hospitals

Abstract

In 2014, a leading hospital accreditation agency, mandated hospitals publicly report their exclusive breastfeeding (EBF) rates. This new regulation provided an opportunity to explore differences in EBF outcomes using a standardized definition across a large hospital sample in the United States. The purpose of this study was to examine the relationships between population demographics and the Baby-friendly (BF) hospital designation on EBF rates in hospitals throughout the United States. We obtained EBF rates from 121 BF hospitals and 1,608 hospitals without the BF designation. Demographic variables were computed using census tract data for the population surrounding each hospital. Relationships were explored using linear regression. We found that EBF rates were positively correlated with a bachelor's degree, log income, and those who identified as White or Asian and negatively correlated with those without college attendance, individuals living below the poverty line, and those who identified as African American or Hispanic. For all models, the BF designation of a hospital was associated with higher EBF rates (p < 0.01; effect sizes, 0.11-0.49) with the exception of the model containing log income. Using a multiple linear regression model that was allowed to contain more than one independent variable, we were able to explain 22% of the variability in EBF rates. The BF hospital designation was associated with significantly higher EBF rates independent of demographic variables. Support for hospitals to attain the BF hospital designation is a meaningful public health goal.

Infant Feeding Practices and Perceived Optimal Breastfeeding Interventions among Low-Income Women Delivering at a Baby-Friendly Hospital

“…Though the Baby-Friendly Hospital Initiative has been associated with higher rates of exclusive breastfeeding at hospital discharge in one study, 8 another concluded that the Baby-Friendly Hospital Initiative was less effective at increasing exclusive breastfeeding rates for low-income American women compared with higher income American women. 21 Our exclusive breastfeeding rate on PPD2 (31.5%) was within the range of published rates of exclusive breastfeeding at hospital discharge among low-income American women who did not deliver at Baby-Friendly Hospitals (22 22 -40% 23 ), adding weight to the concern that this initiative may not increase exclusive breastfeeding rates for low-income American women.…”

The effect of maternity practices on exclusive breastfeeding rates in U.S. hospitals

“…This is consistent with a study that found infants who were supplemented with something other than breast milk in the hospital were less likely to be breastfed at 6 weeks of age (DiGirolamo et al, 2008). The findings related to hospital demographics and EBF rates were consistent with our previous study (Patterson, Keuler, & Olson, 2017). When comparing the adjusted R 2 of the individual maternity practices, we found a higher adjusted R 2 with the maternity care practices measured in the feeding breastfed infants, labour and delivery, and mother-baby contact domains than in the staff training domain.…”

Exclusive breastfeeding among women with type 1 and type 2 diabetes mellitus

“…Upon arrival to labor and delivery, each woman described her past BF experience and her intention to BF. In our institution, maternity practices include BF within 1 h, no formula supplementation unless indicated, rooming in, on demand BF, full-time lactation consultants and post discharge BF support [ 14 – 16 ]. Furthermore, our institution reports BF data to the Joint Commission as required for hospital accreditation [ 15 ].…”