The Effect of the Baby Friendly Hospital Initiative on Exclusive Breastfeeding Rates in Hospitals

Abstract

BackgroundExclusive breastfeeding is associated with an increased level of protection from maternal and infant morbidity and mortality. The Baby Friendly Hospital Initiative (BFHI) was launched in 1991 to positively influence breastfeeding outcomes by recognizing hospitals with optimal practices in mother/infant care. There is limited research examining the influence of the BFHI on exclusive breastfeeding rates, and how these rates may be influenced by other factors.Study ObjectiveThe aim of this study is to examine the relationship between population demographics, including poverty and race, and exclusive breastfeeding outcomes in hospitals with and without the BFHI designation.MethodsData was obtained from the Joint Commission, a leading agency in hospital accreditation, and included 283 BFHI hospitals and 1071 hospitals without the BFHI designation. Demographic variables were applied to the data set and included total population; proportion of white, African American, Hispanic, Asian; educational status and household income, as computed for the zip code surrounding each hospital. Relationships were explored using linear regression. We additionally built a multiple linear regression model in an attempt to determine how well we can predict exclusive breastfeeding rates.ResultsThe proportion of whites, number of residents with a bachelor's degree, and income were all positively related to exclusive breastfeeding rates within the hospital (p<0.0001). By contrast, the proportion of African Americans, proportion of Hispanics, and number in the population at less than 200% of the poverty line were negatively related to exclusive breastfeeding rates within the hospital (p<0.0001). Hospitals with BFHI designation had exclusive breastfeeding rates that were on average 10–15% higher than hospitals without BFHI designation, regardless of demographics. Using a multiple linear regression model we were able to explain 22% of the variability in exclusive breastfeeding rates.ConclusionsBFHI designation is associated with significantly higher exclusive breastfeeding rates independent of demographic variables. However, we recognize that our model was limited in its ability to explain the variability in the exclusive breastfeeding rates. We suggest areas for improvement of the model, including additional possible explanatory variables, which could be the subject of future research.Support or Funding InformationNo funding was received for this research.