Breastfeeding rates in US Baby-Friendly hospitals: Results of a national survey

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.