Impact of Baby-Friendly Practices on Breastfeeding: A Multilevel Analysis

Abstract

Objective: The aim of this study was to adopt a multi-level modeling approach in order to identify the major steps in the Baby Friendly practices that lead to initiation of breastfeeding.Methods: A cross-sectional study using self-administered questionnaires was undertaken in Baby-Friendly institutions throughout central and southern Taiwan. The questionnaires focused on the association between the Baby-Friendly practices experienced by mothers and their impact on the initiation of breastfeeding during the immediate postpartum period. We attempted to investigate a possible contextual (aggregate level) effect of institutions on breastfeeding and disentangle contextual from individual influences. Multilevel logistic regression modeling was used to analyze data on 648 mothers who had given birth to healthy infants in 26 institutions. Statistical analysis including descriptive statistics and factor analysis was performed with SPSS for Windows 14.00. Multi-level regression models were per- formed with HLM 6.06 statistical software.Results: There was significant variation in the rates of breastfeeding initiation between institutions. Multi-level models showed that two contextual effects of the Baby-Friendly practices, breast- feeding on demand (step 8) (OR=32.63, CI=2.71-52.84) and breast milk only (step 6) (OR=0.12, CI = 0.02-0.57) was important in explaining the variance in the rates of breastfeeding initiation. After controlling for variables in institutions as well as the mothers' age and socio-economic status, three of the Baby-Friendly practices at individual-level such as continuous breast feeding support (step 10) (OR=1.40, CI =1.04-1.88), breastfeeding on demand (step 8) (OR=1.44, CI=1.06-1.96), and breast milk only (step 6) (OR=1.67, CI=1.25-2.25) was positively associated with the likelihood of initiation of breastfeeding. The full model combining variables at both individual and aggregate levels accounted for 40.09% of the variation in the rates of breastfeeding initiation between institutions.Conclusions: There is the considerable variation between institutions in the rates of breastfeeding initiation. The multilevel findings from the perspectives of post- partum mothers and institutional contextual effects highlights that breastfeeding on demand (step 8) has an important effect on the mother's willingness to breastfeed.