Abstract
ObjectivesTo determine whether hospital breastfeeding-related practices are associated with breastfeeding initiation (BF) and exclusive breastfeeding (EBF) at discharge in a low-income population. MethodsThis is a secondary analysis of the Infant Toddler Feeding Practices Study II (ITFPS-2), a nationally representative sample of low-income mothers enrolled in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC). This analysis included birth mothers who delivered at a hospital, whose infants did not spent time in the NICU, and had survey weighting data. BF and EBF (in women who initiated breastfeeding), hospital practices (rooming in, breastfeeding encouragement from staff, availability of staff who provided breastfeeding support, reception of gift pack, and among those who initiated breastfeeding, breastfeeding in the first hour and on demand, ) and sociodemographic data were collected via interview at 1 month postpartum. Logistic regression analysis, adjusting for maternal age, race and ethnicity, income, breastfeeding history, and delivery type, was conducted. We further adjusted for breastfeeding intentions, assessed in a sub-sample during pregnancy. ResultsThe weighted analytic sample included 394,022 women (n = 311,355 for EBF). Rooming in was positively associated with BF (P < 0.0001). Among those who initiated breastfeeding, doing so within the first hour was associated with EBF (P < 0.0001). Breastfeeding encouragement from staff and availability of breastfeeding support staff were strongly associated with BF (both P < 0.0001), but not with EBF (P = 0.74 and P = 0.08, respectively). Receiving a pro-formula gift pack was associated with a 40% and 50% reduction in the odds of BF and EBF, respectively (both P < 0.0001). Further adjustment for breastfeeding intentions in a sub-sample (n = 250,665 for BF, n = 202,412 for EBF) provided similar findings. ConclusionsHospital practices were associated with breastfeeding practices, regardless of breastfeeding intentions. Limiting pro-formula gifts and providing breastfeeding support at hospitals, either directly or by creating an environment that allows for breastfeeding opportunities, may improve breastfeeding rates in the WIC population. Funding SourcesThe WIC ITFPS-2 is a federal study conducted under the direction of Office of Policy Support in the USDA FNS.
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