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Public Health Nutr. 2015 Feb;18(2):189-97. doi: 10.1017/S1368980014000238. Epub 2014 Mar 14.

Evaluating the impact of the Baby-Friendly Hospital Initiative on breast-feeding rates: a multi-state analysis.

Author information

1
1Boston College,Graduate School of Social Work,McGuinn Hall,140 Commonwealth Avenue,Chestnut Hill,MA 02467,USA.
2
2Harvard Kennedy School of Government,Cambridge,MA,USA.
3
3Boston College,Chestnut Hill,MA,USA.
4
5Harvard Medical School and Harvard Pilgrim Health Care Institute,Boston,MA,USA.

Abstract

OBJECTIVE:

To evaluate the impact of the Baby-Friendly Hospital Initiative (BFHI) on breast-feeding initiation and duration overall and according to maternal education.

DESIGN:

Quasi-experimental study using data from five states (Alaska, Maine, Nebraska, Ohio, Washington) that participated in the Pregnancy Risk Assessment Monitoring System from 1999 to 2009. Using differences-in-differences models that included year and hospital fixed effects, we compared rates of breast-feeding initiation and duration (any and exclusive breast-feeding for ≥4 weeks) before and after BFHI accreditation between mothers who gave birth in hospitals that were accredited or became accredited and mothers from matched non-BFHI facilities. We stratified analyses into lower and higher education groups.

SETTING:

Thirteen BFHI hospitals and nineteen matched non-BFHI facilities across five states in the USA.

SUBJECTS:

Mothers (n 11 723) who gave birth in BFHI hospitals and mothers (n 13 604) from nineteen matched non-BFHI facilities.

RESULTS:

Although we did not find overall differences in breast-feeding initiation between birth facilities that received BFHI accreditation compared with non-Baby-Friendly facilities (adjusted coefficient = 0·024; 95 % CI -0·00, 0·51), breast-feeding initiation increased by 3·8 percentage points among mothers with lower education who delivered in Baby-Friendly facilities (P = 0·05), but not among mothers with higher education (adjusted coefficient = 0·002; 95 % CI -0·04, 0·05). BFHI accreditation also increased exclusive breast-feeding for ≥4 weeks by 4·5 percentage points (P = 0·02) among mothers with lower education who delivered in BFHI facilities.

CONCLUSIONS:

By increasing breast-feeding initiation and duration among mothers with lower education, the BFHI may reduce socio-economic disparities in breast-feeding.

KEYWORDS:

Breast-feeding; Maternity hospitals; Programme evaluation

PMID:
24625787
PMCID:
PMC4163534
DOI:
10.1017/S1368980014000238
[Indexed for MEDLINE]
Free PMC Article

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