Does the Baby-Friendly Hospital Initiative increase breastfeeding?

The July Nutrition Society Paper of the Month is from Public Health Nutrition and is entitled ‘Evaluating the impact of the Baby-Friendly Hospital Initiative on breast-feeding rates: a multi-state analysis’.

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Not only does breastfeeding improve the health of mothers and infants, but it also reduces health care costs and has a smaller environmental footprint than formula-feeding. Although currently three-quarters of US women start breastfeeding, women with lower education are much less likely to try. One known barrier is the lack of breastfeeding support that women receive in the hospital.

The Baby-Friendly Hospital Initiative (BFHI) was developed by the World Health Organization and UNICEF in 1991 to promote, protect, and support breastfeeding within the birth facility and after. While more than 20,000 hospitals and birth centers in 156 countries have been designated as Baby-Friendly, there are only 182 BFHI facilities in the US in 43 states and DC. Despite the success of the BFHI on breastfeeding practices internationally, research in the US has been limited. We wanted to determine whether the BFHI increased breastfeeding overall and, particularly, whether it improved breastfeeding among women with lower education.

Using data from 5 states, we compared breastfeeding outcomes between 11,723 mothers who gave birth in 13 BFHI hospitals and 13,604 mothers from 19 non-BFHI birth facilities. Although overall women who gave birth in BFHI hospitals were no more likely to start or continue breastfeeding than women from non-BFHI facilities, we showed that it benefited women with lower education. Only 78% of women with a high school degree or less started breastfeeding, but we found that those women who delivered in BFHI hospitals were 3.8 percentage points more likely to start breastfeeding than women with the same educational attainment who delivered in non-BFHI facilities. In contrast, 90% of women with more than a high school degree started breastfeeding, but giving birth in a BFHI hospital did not further increase their likelihood of starting or continuing breastfeeding.

What are the implications of these findings?

Women with low education benefited the most from giving birth in Baby-Friendly hospitals, suggesting that the BFHI may be one way to help decrease socio-economic disparities in breastfeeding. Currently only 7% of births in the US are in BFHI facilities. Our results support the recommendation to increase the number of BFHI-accredited birth facilities to encourage women to start breastfeeding, but more may be needed to help women continue breastfeeding after discharge.

This paper is freely available for one month via the following link: journals.cambridge.org/ns/jul14

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