Breastfeeding rates in US Baby-Friendly hospitals: results of a national survey.
ABSTRACT 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.
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.
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.
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.
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ABSTRACT: The Baby-Friendly Hospital Initiative (BFHI) aims to promote and support breastfeeding. Globally, around 20,000 facilities have been designated Baby-Friendly. In Austria, however, only 16% of the maternity units have received BFHI-certification. Internationally, few studies have investigated facilitating or hindering factors for BFHI implementation. The need to extend BFHI-certification rates has been investigated previously, but little is known about why maternity units decide to become BFHI-certified, how BFHI is installed at the unit level, and which factors facilitate or impede the operation of the BFHI in Austria and how barriers are overcome. Using a qualitative approach, (health) professionals' perceptions of the selection, installation, as well as facilitators of and barriers to the BFHI were investigated. 36 semi-structured interviews with persons responsible for BFHI implementation (midwives, nurses, physicians, quality manager) were conducted in three Austrian maternity units. Data were analyzed using thematic analysis. Interviewees mentioned several motives for selecting the BFHI, including BFHI as a marketing tool, improvement of existing services, as well as collaboration between different professional groups. In each hospital, "change agents" were identified, who promoted the BFHI, teamed up with the managers of other professional groups and finally, with the manager of the unit. Installation of BFHI involved the adoption of project management, development and dissemination of new standards, and training of all staff. Although multiple activities were planned to prepare for actually putting the BFHI into practice, participants mentioned not only facilitating, but also several hindering factors. Interpretations of what facilitated or impeded the operation of BFHI differed among and between professional groups. Successful implementation of the BFHI in Austria depends on a complex interplay of multiple factors including a consensual "bottom-up" selection process, followed by a multifaceted installation stage. Even these activities may be perceived as a hindrance for non-BFHI-certified hospitals. Findings also suggest that despite active preparation, several barriers have to be overcome when BFHI is actually incorporated into routine practices. BFHI seems to pose a great challenge to health professionals' work routines and, thus, clear structural changes of such routines as well as ongoing monitoring and support activities are required.International Breastfeeding Journal 12/2015; 10(1):3.
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ABSTRACT: The diversity of our world is staggering. Sex, gender, gender identity and expression, sexual orientation, class, language, race, color, culture, ethnicity, nationality, marital status, geography, immigration, generation, religion, ability, size, and age are among the characteristics that make people similar to and different from each other. Systems of oppression and its concomitant, unearned privilege, corrupt these characteristics into fictitious markers of worth that determine the degree of access to power and opportunities afforded to individuals and their communities. Systems of privilege/oppression are a global and local reality.1 They vary in their exact nature from one place and time to another and are the cause of social inequities of all kinds, including in the field of breastfeeding. The call to eliminate racial and other social inequities in breastfeeding rates, access to breastfeeding support, and access to the International Board Certified Lactation Consultant (IBCLC) credential is increasingly voiced and heard by individuals and organizations in the field of breastfeeding.2-8 In the United States, for example, the 2013 “Inequity in Breastfeeding Support Summit” addressed the effect of institutional racism, power, and white privilege as well as heterosexism and cisgenderism on breastfeeding and maternal-infant health. In 2014, the International Board of Lactation Consultant Examiners, International Lactation Consultant Association, and Lactation Education, Accreditation and Approval Review Committee co-hosted the “Lactation Summit” to address a broad range of inequities—including those resulting from racism, classism, heterosexism, cisgenderism, and nationalism—within the lactation consultant profession. Also in 2014, the US Breastfeeding Committee’s Fifth National Breastfeeding Coalitions Conference included an emphasis on decreasing racial inequity in access to breastfeeding support. These efforts join the monumental work of many other US-based organizations such as the African American Breastfeeding Network, Black Mothers’ Breastfeeding Association, International Center for Traditional Childbearing, Mahogany Moms Breastfeeding Coalition, …Journal of Human Lactation 02/2015; 31(1):32-35. · 1.98 Impact Factor
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ABSTRACT: Abstract The goals of this article are to provide a review of key interventions and strategies that impact initiation and duration of breastfeeding with particular focus on low-income African American mothers' maternal psychological vulnerabilities during the early postpartum period using a social ecological perspective as a guiding framework. Although modest gains have been achieved in breastfeeding initiation rates in the United States, a projected gap remains between infant feeding practices and national Healthy People breastfeeding goals set for 2020, particularly among African Americans. These disparities raise concerns that socially disadvantaged mothers and babies may be at increased risk for poor postnatal outcomes because of poorer mental health and increased vulnerability to chronic health conditions. Breastfeeding can be a protective factor, strengthening the relationship between mother and baby and increasing infant health and resilience. Evidence suggests that no single intervention can sufficiently address the multiple breastfeeding barriers faced by mothers. Effective intervention strategies require a multilevel approach. A social ecological perspective highlights that individual knowledge, behavior, and attitudes are shaped by interactions between the individual woman, her friends and family, and her wider historical, social, political, economic, institutional, and community contexts, and therefore effective breastfeeding interventions must reflect all these aspects. Current breastfeeding interventions are disjointed and inadequately meet all African American women's social and psychological breastfeeding needs. Poor outcomes indicate a need for an integrative approach to address the complexity of interrelated breastfeeding barriers mothers' experience across layers of the social ecological system.Breastfeeding Medicine 11/2014; · 1.73 Impact Factor