Published online August 31, 2005
PEDIATRICS Vol. 116 No. 3 September 2005, pp. 628-634 (doi:10.1542/10.1542/peds.2004-1636)
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Breastfeeding Rates in US Baby-Friendly Hospitals: Results of a National Survey

Anne Merewood, MA, IBCLC*,{ddagger}, Supriya D. Mehta, PhD, MHS§, Laura Beth Chamberlain, BA, IBCLC{ddagger}, Barbara L. Philipp, MD*,{ddagger} and Howard Bauchner, MD, MPH*,||

* Department of Pediatrics
§ Department of Emergency Medicine
|| Department of Public Health, Boston University School of Medicine
{ddagger} Department of The Breastfeeding Center, Boston Medical Center, Boston, Massachusetts

Objectives. The objectives of this study were to analyze all available breastfeeding data from US Baby-Friendly hospitals in 2001 to determine whether breastfeeding rates at Baby-Friendly designated hospitals differed from average US national, regional, and state rates in the same year and to determine prime barriers to implementation of the Baby-Friendly Hospital Initiative.

Methods. In 2001, 32 US hospitals had Baby-Friendly designation. Using a cross-sectional design with focused interviews, this study surveyed all 29 hospitals that retained that designation in 2003. Demographic data, breastfeeding rates, and information on barriers to becoming Baby-Friendly were also collected. Simple linear regression was used to assess factors associated with breastfeeding initiation.

Results. Twenty-eight of 29 hospitals provided breastfeeding initiation rates: 2 from birth certificate data and 26 from the medical record. Sixteen provided in-hospital, exclusive breastfeeding rates. The mean breastfeeding initiation rate for the 28 Baby-Friendly hospitals in 2001 was 83.8%, compared with a US breastfeeding initiation rate of 69.5% in 2001. The mean rate of exclusive breastfeeding during the hospital stay (16 of 29 hospitals) was 78.4%, compared with a national mean of 46.3%. In simple linear regression analysis, breastfeeding rates were not associated with number of births per institution or with the proportion of black or low-income patients. Of the Ten Steps to Successful Breastfeeding the 3 described as most difficult to meet were Steps 6, 2, and 7. The reason cited for the problem with meeting Step 6 was the requirement that the hospital pay for infant formula.

Conclusion. 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.

Key Words: breastfeeding • Baby-Friendly Hospital Initiative

Abbreviations: WHO, World Health Organization • UNICEF, United Nations Children’s Fund • BFHI, Baby-Friendly Hospital Initiative • RMS, Ross Mothers’ Survey

Accepted Dec 16, 2004.


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