Effect of Exposure to Baby-friendly Hospital Practices on Mothers’ Achievement of Their Planned Duration of Breastfeeding

Abstract

To protect, promote, and support breastfeeding, the WHO and UNICEF developed the Baby-Friendly hospital initiatives (BFHI) as a global programme in 1991 (1). The BFHI is a set of 10 maternity practices (10 steps) that hospitals should implement to support breastfeeding. Many studies have examined the effect of BFHI steps on breastfeeding initiation and duration (2, 3). Mothers’ breastfeeding intentions and goals are a significant predictor of actual breastfeeding practices. Despite these plans, many mothers do not achieve their prenatal breastfeeding intentions and do not meet their planned goal. This study aimed to examine the effect of exposure to BFHI on mothers’ achievement of their planned duration of breastfeeding. This study was part of a large prospective cohort study investigating the impact of free infant formula supplied to hospitals and mothers on breastfeeding duration and exclusivity (4). Briefly, 2704 breastfeeding mother-infant pairs were recruited from four public hospitals in Hong Kong. We used multiple logistic regression models to examine the effect of BFHI steps on meeting maternal breastfeeding intentions. Almost 70% of participants planned to exclusively breastfeed, whereas 44.4% achieved their breastfeeding intentions. Step 6, in which newborns had no food or drink other than breast milk (aOR=1.98; 95% CI 1.50-2.62) and step 10, which provided participants with information on breastfeeding support on discharge (aOR=1.50; 95% CI 1.18-1.91) were significantly associated with achieving the planned duration of breastfeeding. In addition, participants who experienced six baby-friendly steps were over four times more likely to achieve their planned duration of breastfeeding when compared with participants who experienced 0 or 1 step (aOR=4.50; 95% CI 2.54-7.96). In conclusion, mothers who are exposed to a greater number of BFHI steps have significantly higher odds in achieving their planned breastfeeding duration. In particular, giving only breast milk in the hospital and providing mothers with breastfeeding support information, may help more mothers achieve their planned breastfeeding duration.