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Am J Public Health. 2009 May;99(5):929-35. doi: 10.2105/AJPH.2008.135236. Epub 2009 Mar 19.

Hospital practices and women's likelihood of fulfilling their intention to exclusively breastfeed.

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  • 1Department of Maternal and Child Health, Boston University School of Public Health, 715 Albany St, Talbot W540, Boston, MA 02118, USA.



We sought to assess whether breastfeeding-related hospital practices reported by mothers were associated with achievement of their intentions to exclusively breastfeed.


We used data from Listening to Mothers II, a nationally representative survey of 1573 mothers who had given birth in a hospital to a singleton in 2005. Mothers were asked retrospectively about their breastfeeding intention, infant feeding at 1 week, and 7 hospital practices.


Primiparas reported a substantial difference between their intention to exclusively breastfeed (70%) and this practice at 1 week (50%). They also reported hospital practices that conflicted with the Baby-Friendly Ten Steps, including supplementation (49%) and pacifier use (45%). Primiparas who delivered in hospitals that practiced 6 or 7 of the steps were 6 times more likely to achieve their intention to exclusively breastfeed than were those in hospitals that practiced none or 1 of the steps. Mothers who reported supplemental feedings to their infant were less likely to achieve their intention to exclusively breastfeed: primiparas (adjusted odds ratio [AOR] = 4.4; 95% confidence interval [CI] = 2.1, 9.3); multiparas (AOR = 8.8; 95% CI = 4.4, 17.6).


Hospitals should implement policies that support breastfeeding with particular attention to eliminating supplementation of healthy newborns.

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