Baby-Friendly Hospital Research Articles

A prática do quarto e quinto passos da Iniciativa Hospital Amigo da Criança

Objetivos: Verificar o cumprimento do quarto e quinto passos da Iniciativa Hospital Amigo da Criança em uma maternidade de referência no nordeste brasileiro. Metodologia: Pesquisa descritiva de natureza quantitativa, realizada entre março e julho de 2019, com 380 puérperas entrevistadas nas enfermarias do hospital para preenchimento de um formulário. Os dados foram tabulados de acordo com as frequências absolutas e relativas. Resultados: Encontrou-se que 17% dos bebês foram colocados para mamar na sala de parto em cumprimento do quarto passo da Iniciativa Hospital Amigo da Criança, 82% das mães receberam auxílio para amamentar em cumprimento do quinto passo; 79% das mães tinham entre 20 a 30 anos, 61% eram pardas, 71% eram casadas, 57% cursaram Ensino Médio, 69% eram donas de casa, 48% com renda entre 1 e 2 salários mínimos, 42% tinha 2 filhos, 54% não tinham residência própria, todas fizeram pré-natal, 66% fizeram mais de 6 consultas, 79% foi orientada sobre amamentação. Conclusão: Os índices encontrados referentes ao quarto e quintos passos da Iniciativa Hospital Amigo da Criança estão abaixo dos recomendados pelo Ministério da Saúde. Esses resultados reforçam a importância da efetivação do apoio e promoção do aleitamento materno como foco da equipe de enfermagem.

The Relationship Between Place of Birth and Early Breastfeeding Initiation in Indonesia.

In many countries, hospital-based births are associated with the early initiation of breastfeeding, within the first hour postpartum, especially where the Baby Friendly Hospital Initiative guidelines have been adopted. While Indonesia has adopted the guidelines, there is a relatively low rate of early breastfeeding initiation in the country. To determine the relationship between place of birth and early breastfeeding initiation in Indonesia. This study was a retrospective cross-sectional survey using national data from the 2017 Indonesia Demographic and Health Survey (N = 14,279). The association between place of birth and early breastfeeding initiation was examined using logistic regression models, adjusting for potential confounders. The overall prevalence of early breastfeeding initiation in Indonesia was 60.9% with a greater proportion of mothers giving birth in health facilities. In the multivariate model, there was a significant interaction between wealth index, insurance status, and place of birth on the timing of breastfeeding initiation. In the subgroup of mothers residing in middle wealth index households, women who gave birth in clinics and hospitals had lower odds of early breastfeeding initiation compared to those who gave birth at home (0.56; 0.34, 0.90; p = .018) and (0.58; 0.40, 0.85; p = .005), respectively. Place of birth was significantly associated with early breastfeeding initiation. There is a need to consider health disparities and to strengthen the implementation of the WHO guidelines, Baby Friendly Hospital Initiative, and International Code of Marketing of Breastmilk Substitutes, to increase early breastfeeding initiation in Indonesia.

Determinants of exclusive breastfeeding in infants of six months and below in Malawi: a cross sectional study

BackgroundUNICEF and WHO recommend that all children should be exclusively breastfed for the first 6 months of life as breastmilk contains all the nutrients an infant needs during this period. In Malawi, exclusive breastfeeding has been declining from 72% (2009), 70.2% (2014) and 61% in the most recent survey (2015–16). We aimed to determine factors associated with exclusive breastfeeding in Malawi.MethodsWe used data from the Malawi Demographic and Health Survey (MDHS) 2015–2016. Survey records for 2059 mothers of children aged 6 months and below were identified and potential factors influencing infant feeding were examined. Logistic regression analysis was carried out to model determinants of exclusive breastfeeding (EBF).ResultsEBF declined in proportion to the age of the infant. Significant associations with continuing EBF were age of the mother, ethnicity of the mother, sex of infant and number of siblings. Members of the Tumbuka (OR = 1.71, CI. 1.13–2.59) and Ngoni (OR = 2.05, CI. 1.38–3.05) communities were more likely to practice EBF. In addition, mothers with female babies (OR = 1.35, CI. 1.08–1.70) and those with 3–4 children (OR = 1.47, CI. 1.04–2.08) were more likely to engage in EBF.ConclusionWe identify important variations in EBF practices among population sub-groups in Malawi that need to be considered when framing health education messaging. Work is needed to assess the impact of more targeted messaging, whether delivered via ‘ten steps’ to successful breastfeeding under Baby Friendly Hospital Initiative (BFHI) programming or other health education and awareness campaigns to sensitize communities on implications of some cultural practices on the lives of babies. The potential role for mass media, targeted Health Surveillance Assistants’ (HSA) home visits and male involvement also require exploration.

Duration of Surgery, Ventilation, and Length of Hospital Stay Do Not Affect Breastfeeding in Newborns After Early Cleft Lip Repair.

There are minimal data available on nutrition after early repair of cleft lip and the factors influencing initiation of breastfeeding. This study assessed the impact of the length of surgery, length of ventilation support, and duration of hospital stay on breastfeeding rates after early cleft lip surgery. This is a prospective observational cohort study comparing 2 hospitals providing early surgical repair of facial clefts from January 2014 to December 2016. Both hospitals are designated as Baby-Friendly Hospitals. Demographic and anthropometric data from mothers and newborns were recorded. Tertiary neonatal and pediatric surgery center. Hospital A: 61 newborns, Hospital B: 157 newborns. Early (day 5 to 14) cheiloplasty in newborns with cleft lip or cleft lip and palate. Influence of duration of hospital stay, length of operation, and artificial ventilation on the rate of breastfeeding. Significantly, more newborns were breastfed following early surgical repair of an isolated cleft lip compared to those with both cleft lip and palate, in both hospitals (hospital A 82% vs 0%, P = .0001, hospital B 66% vs 5%, P = .0001). Duration of hospital stay, length of operation, and duration of artificial ventilation did not significantly affect the rate of breastfeeding. The factors associated with early cleft lip repair (length of operation, length of ventilation support, and duration of hospital stay) do not affect breastfeeding rate.

Bir Çocuk Sağlığı İzlem Polikliniğinde 4. ve 6. Ay Sadece Anne Sütü İle Beslenme Oranları ve Anne Eğitim Düzeyi Ön Çalışma Sonuçları

Amac: Cocuk Sagligi Izlem Poliklinigimizde (CSIP) takip edilen bebeklerin 4. ve 6. aylardaki sadece anne sutu (SAS) ile beslenme durumlarinin yillara gore degisimlerini ve anne egitim durumu ile iliskisini incelemektir. Gerec ve Yontem: Tanimlayici tipteki calismamizda 2013-2017 yillari arasinda dogan ve CSIP’de izlenen cocuklarin kisisel takip dosyalari retrospektif olarak incelenmistir. Cocuklarin beslenme sekilleri ve anne egitim durumlari ile ilgili bilgiler incelenen dosyalardan elde edilmistir. Bulgular: Dorduncu ayda SAS ile beslenme oraninin 2013 yilinda %60,6 iken 2017 yilinda %75,5 oldugu; 6. ayda SAS ile beslenme oraninin 2013 yilinda %28,2 iken 2017 yilinda %46 oldugu saptanmistir. Dorduncu ay ve 6. ayda sadece formula ile beslenme oranlari 2013 yilinda sirasiyla %9,9 ve %11,5 iken, 2017 yilinda sirasiyla %3,4 ve %2,5 e gerilemistir. 2013 ve 2017 yillari arasinda SAS ile beslenme istatiksel olarak anlamli derecede artmistir. Sadece formula ile beslenme oranlarinda ise istatistiksel olarak anlamli bir azalma olmustur. Dorduncu ayda ve 6. ayda SAS ile beslenme, universite mezunlarinda daha yuksek bulunmustur. Sonuc: CSIP’de sadece anne sutu ile beslenme oranlari yillar icerisinde artis gostermektedir. Cocuk sagliginin duzenli izlemi, emzirme danismanligi ve bebek dostu hastane uygulamalarinin bu artista etkili oldugunu dusunmekteyiz.

Cost-effectiveness analysis of Baby-Friendly Hospital Initiative in promotion of breast-feeding and reduction of late neonatal infant mortality in Brazil.

To analyse the cost-effectiveness of Baby-Friendly Hospital Initiative (BFHI) in promoting breast-feeding during the first hour of life (BFFHL) and reducing late neonatal mortality. Cost-effectiveness economic assessment from the health system perspective, preceded by a prospective cohort of mother-baby followed from birth to 6 months of life. The direct costs associated with two health outcomes were analysed: intermediate end point (BFFHL) and final end point (reduction in late neonatal mortality). Study was carried out in six hospitals in the city of São Paulo (Brazil), three being Baby-Friendly Hospitals (BFH) and three non-BFH. Mothers with 24 h postpartum, over 18 years old, single fetus and breast-feeding at the time of the interview were included. Poisson regressions adjusted for maternal age and level of education were estimated to identify factors related to BFFHL and late neonatal mortality. Sensitivity analysis was performed to ensure robustness of the economic assessment. Cost-effectiveness analysis showed that BFHI was highly cost-effective in raising BFFHL by 32·0 % at lower cost in comparison with non-BFHI. In addition, BFHI was cost-effective in reducing late neonatal mortality rate by 13·0 % from all causes and by 13·1 % of infant mortality rate from infections. The cost-effectiveness of the BFHI in promoting breast-feeding and reducing neonatal mortality rates justifies the investments required for its expansion within the Brazilian health system.

A change laboratory for maternity care in Brazil: Pilot implementation of Mother Baby Friendly Birthing Initiative

Disrespectful and abusive treatment of women during childbirth is a worldwide problem. This research aimed to develop and implement a Mother Baby-Friendly Hospital Initiative (MBFHI) in an academic maternity hospital in Brazil and evaluate how change could be sustained. Change Laboratory principles guided a process of action research, which was conducted between 2017 and 2019. Clinicians and managers joined the researchers in discussion sessions to redesign routines and care pathways. Observation, interviews, focus groups, and historical and documentary analysis provided information about the existing activity system, which we analysed qualitatively using MBFHI criteria to identify themes. Evidence of inappropriate obstetric interventions and impersonal interactions between clinicians and patients stimulated us to devise innovative solutions. The challenges identified by this exercise included: poor infrastructure and ambience; difficulty adhering to evidence-based protocols; social and professional hierarchies; and clinicians being poorly educated about women's rights. Although challenges remained, positive changes included a friendlier environment, improved patient privacy, and fewer unnecessary procedures. Resources released by these changes allowed us, collaboratively, to track the further implementation and sustainability of change. We conclude that the Change Laboratory can help motivated clinicians and managers humanise patients’ experiences, make care more evidence-based, and expand learning of mother-friendly maternity care. Tensions and contradictions between education and patient care reported here may resonate in settings other than maternity care.

Effectiveness of the baby-friendly community initiative in promoting exclusive breastfeeding among HIV negative and positive mothers: a randomized controlled trial in Koibatek Sub-County, Baringo, Kenya

BackgroundAlthough the baby-friendly community initiative (BFCI) has been proposed as a community-level approach to improve infant feeding practices, there is little data on its variation in effectiveness by HIV status. We conducted a study to determine the effectiveness of BFCI in changing knowledge and attitudes towards exclusive breastfeeding (EBF) and increasing the rates among HIV negative and HIV positive women in rural Kenya.MethodsA community-based cluster-randomized controlled trial was implemented from April 2015 to December 2016 among 901 women enrolled across 13 clusters. The intervention groups received a minimum of 12 personalized home-based counselling sessions on infant feeding by trained community health volunteers from their first or second trimester of pregnancy until 6 months postpartum. Other interventions included education sessions at maternal child clinics, mother-to-mother support group meetings and bi-monthly baby-friendly gatherings targeting influencers. The control group received standard health education at the facility and during monthly routine home visits by community health volunteers not trained on BFCI. Primary outcome measures were the rates of EBF at week 1, months 2, 4 and 6 postpartum. Secondary outcomes included knowledge and attitudes regarding breastfeeding for HIV-exposed infants. Statistical methods included analysis of covariance and logistic regression.ResultsAt 6 months, EBF rates among HIV negative mothers were significantly higher in the BFCI intervention arm compared to the control arm (81.7% versus 42.2% p = 0.001). HIV positive mothers in the intervention arm had higher EBF rates at 6 months than the control but the difference was not statistically significant (81.8% versus 58.4%; p = 0.504). In HIV negative group, there was greater knowledge regarding EBF for HIV-exposed infants in the intervention arm than in the control (92.1% versus 60.7% p = 0.001). Among HIV positive mothers, such knowledge was high among both the intervention and control groups (96% versus 100%, p > 0.1). HIV negative and positive mothers in the intervention arm had more favourable attitudes regarding EBF for HIV-exposed infants than the control (84.5% versus 62.1%, p = 0.001) and (94.6% versus 53.8% to p = 0.001) respectively.ConclusionsBFCI interventions can complement facility-based interventions to improve exclusive and continued breastfeeding knowledge, attitudes, and behaviours among HIV negative and positive women.

Quality Improvement Project to Decrease Incidence and NICU admissions secondary to hypothermia in a Baby Friendly Hospital

Introduction: Newborns are susceptible to hypothermia due to heat loss secondary to high ratio of surface area to body weight, reduced glycogen and fat stores, and environment factors. NYU Winthrop was the first hospital on Long Island to receive the designation of Baby Friendly. As infants in baby-friendly hospitals are allowed to room in with the mom, there is increased risk of hypothermia. In our institution there was no protocol for managing hypothermia in the Mother Baby Unit (MBU), leading to unnecessary NICU admissions. Global aim: Decrease overall incidence of hypothermia in MBU …

Quality Improvement Project to Decrease Incidence and NICU admissions secondary to hypothermia in a Baby Friendly Hospital

Quality Improvement Project to Decrease Incidence and NICU admissions secondary to hypothermia in a Baby Friendly Hospital

Knowledge and Attitude of Nursing Staff on Baby-friendly Hospital Initiative Practices in a Tertiary Hospital

Background: Within a hospital setting, health professionals play a key role in providing the right information on breastfeeding and often this source are the nurses who have the primary opportunity to counsel, support and educate mothers on breastfeeding. The Baby Friendly Health Initiative (BFHI) has helped to motivate facilities providing maternity and newborn services worldwide to better support breastfeeding.
 Objective: The aim of this study is to help identify the knowledge gaps on the BFHI practices among nursing staff in a tertiary care center in Kathmandu.
 Methodology: A total of 27 nursing staff who encounter pregnant women admitted in the hospital up until post-delivery discharge were selected for the study. Data on knowledge of baby-friendly hospital initiative and attitude towards breastfeeding practices was collected using a structured interview between October and December 2019. Statistical analysis was done using SPSS version 20.
 Results: Only 41% were acquainted with the ten steps to successful breastfeeding of BFHI, out of whom more than half (55%) had a good level of knowledge. Majority of the participants showed a fairly correct attitude towards BFHI practices, except for the belief that there is no harm in introducing pre-lacteal feeds to babies. The opinion on demand feeding and the time of introduction of complementary feeding seemed to vary. 
 Conclusion: There is an urgent need to re-evaluate the present knowledge of our nursing staff and to ensure they impart the right information. The only way to achieve this is through advocacy and training to promote, support and protect breastfeeding.

The effects of a hospital-based perinatal breastfeeding program on exclusive breastfeeding in Taiwan: a quasi-experimental study

Objective: To examine if a perinatal breastfeeding program would improve the exclusive breastfeeding rate at a baby-friendly hospital. Background: The Ten Steps to Successful Breastfeeding and Baby-Friendly Hospital Initiative have been widely used to improve breastfeeding outcomes worldwide. A hospital-based multi-strategy intervention may provide an opportunity to increase breastfeeding in different countries. Study design and methods: The study used a quasi-experimental design. Data was collected in a Baby Friendly hospital. A total of 60 mother-infant dyads were included. The experimental group took part in the multi-component perinatal breastfeeding program, while the control group received routine care. The multi-strategy program included prenatal breastfeeding education, birth kangaroo mother care (skin-to-skin contact and non-separation practices) at first breastfeed, continuous 24-hour rooming-in, ongoing kangaroo mother care with breastfeeding on cue, and hospital support visits. The exclusive breastfeeding rate was measured at hospital discharge, and one-month postpartum. Results: The mothers who participated in the intervention had a greater exclusive breastfeeding rate at hospital discharge and one month postpartum than those in the control group. In the experimental group, 90% of the infants completed the first feeding within two hours after birth. At discharge, 93.3% of the mothers in the experimental group and 53.3% in the control group were exclusively breastfeeding. At one month postpartum, 83.3% of the mothers in the experimental group and 36.7% in the control group were still exclusively breastfeeding. Discussion: The intervention program used in the current study is different to previous studies. The current intervention not only included prenatal education and postpartum support, but also included birth kangaroo mother care at first breastfeed and ongoing kangaroo mother care with breastfeeding on cue. Breastfeeding should be promoted through perinatal comprehensive clinical and social support starting in the prenatal period and continuing through intrapartal, postpartum, and follow-up periods. Conclusion: This study was the first study to use a hospital-based multi-strategy intervention including the non-separation of mother-infant dyads and other breastfeeding support for mothers in Taiwan. The program was associated with a significant improvement in the exclusive breastfeeding rate at one month postpartum.

The effects of a hospital-based perinatal breastfeeding program on exclusive breastfeeding in Taiwan: a quasi-experimental study

Objective: To examine if a perinatal breastfeeding program would improve the exclusive breastfeeding rate at a baby-friendly hospital. Background: The Ten Steps to Successful Breastfeeding and Baby-Friendly Hospital Initiative have been widely used to improve breastfeeding outcomes worldwide. A hospital-based multi-strategy intervention may provide an opportunity to increase breastfeeding in different countries. Study design and methods: The study used a quasi-experimental design. Data was collected in a Baby Friendly hospital. A total of 60 mother-infant dyads were included. The experimental group took part in the multi-component perinatal breastfeeding program, while the control group received routine care. The multi-strategy program included prenatal breastfeeding education, birth kangaroo mother care (skin-to-skin contact and non-separation practices) at first breastfeed, continuous 24-hour rooming-in, ongoing kangaroo mother care with breastfeeding on cue, and hospital support visits. The exclusive breastfeeding rate was measured at hospital discharge, and one-month postpartum. Results: The mothers who participated in the intervention had a greater exclusive breastfeeding rate at hospital discharge and one month postpartum than those in the control group. In the experimental group, 90% of the infants completed the first feeding within two hours after birth. At discharge, 93.3% of the mothers in the experimental group and 53.3% in the control group were exclusively breastfeeding. At one month postpartum, 83.3% of the mothers in the experimental group and 36.7% in the control group were still exclusively breastfeeding. Discussion: The intervention program used in the current study is different to previous studies. The current intervention not only included prenatal education and postpartum support, but also included birth kangaroo mother care at first breastfeed and ongoing kangaroo mother care with breastfeeding on cue. Breastfeeding should be promoted through perinatal comprehensive clinical and social support starting in the prenatal period and continuing through intrapartal, postpartum, and follow-up periods. Conclusion: This study was the first study to use a hospital-based multi-strategy intervention including the non-separation of mother-infant dyads and other breastfeeding support for mothers in Taiwan. The program was associated with a significant improvement in the exclusive breastfeeding rate at one month postpartum.

Being There: The Development of the International Code of Marketing of Breast-milk Substitutes, the Innocenti Declaration and the Baby-Friendly Hospital Initiative.

Margaret Isabirye Kyenkya (photo) grew up in Uganda with five bothers and six sisters. Her Bachelor of Arts was in Social Work and Social Administration (Makerere University, Uganda), and was followed by a Masters in Sociology, (Nairobi University), and a Certificate in Mother and Child Health (International Child Health Institute, London). Her PhD focused on Hospital Administration inspired by the WHO/UNICEF Baby Friendly Hospital Initiative. She has worked as a researcher, the founder of Non-Governmental Organizations, a Senior United Nations Officer (New York Headquarters and several regions), a Manager in the United States Agency for International Development-funded National Health and Nutrition Projects, and a governmental Health and Nutrition Adviser. A certified trainer in a number of health and nutrition areas, a breastfeeding counselor, and a retired La Leche League Leader, Dr. Kyenkya has significantly influenced the course of lactation support and promotion globally. She stated, "My most precious and valued occupation is that of a mother [of five] and grandmother [of eight]." Dr. Kyenkya currently lives in Atlanta, Georgia, in the United States. (This interview was conducted in-person and transcribed verbatim. It has been edited for ease of readability. MK refers to Margaret Kyenkya; KM refers to Kathleen Marinelli.).

Ohio First Steps for Healthy Babies: A Program Supporting Breastfeeding Practices in Ohio Birthing Hospitals

Background: Ohio First Steps for Healthy Babies (First Steps) is a free, voluntary statewide designation program coadministered by the Ohio Department of Health and the Ohio Hospital Association that promotes breastfeeding-supportive maternity practices aligned with the Baby-Friendly Hospital Initiative (BFHI).Materials and Methods: We examined Ohio birthing hospitals’ participation in First Steps, and changes in breastfeed-ing rates at hospital discharge, over the first 12 quarters of the program (July 15, 2015, to July 14, 2018) for all 110 licensed Ohio birthing hospitals. The 81 (73.6%) that achieved at least 1 step over the study period (designated as First Steps hospitals) were compared to the 29 non-First Steps hospitals, and the 17 that began participation at First Steps startup (July 15, 2015) were identified for additional analysis. Changes in breastfeeding rates were examined using a mixed effects multivariate regression model.Results: Breastfeeding increased significantly over the program period from 73.8% to 76.7% (mean 0.19% per quarter, p = .0002), but without a significant difference in breastfeeding rates between First Steps and non-First Steps hospitals. However, in a pre- and post-program analysis for the 17 hospitals that began participation at First Steps startup (excluding an additional 6 hospitals with BFHI designation), number of quarters in the program, number of steps completed, and number of births in 2015 were significantly associated with breastfeeding rates. Hospitals that completed at least 2 steps every 5 quarters in the First Steps program increased breastfeeding when compared to those not participating in the program.Conclusion: These encouraging results provide a formal evaluation of a best practices BFHI-modelled statewide program.

Working to Create an Oxytocin-rich Environment on a Busy Postnatal Ward

A busy, baby-friendly initiative (BFI)-accredited post-natal ward wanted to create a more oxytocin-rich environment to support mother-and-baby bonding and promote good infant feeding practices. Drawing on the known benefits of parental closeness and touch for babies in neonatal intensive care units (NICUs), a programme to actively promote positive touch was established. This article describes this initiative whereby breastfeeding peer support volunteers (who already provided care on the ward), were felt to be best placed to initiate this programme.

Guidance to reduce the risk of Sudden and Unexpected Postnatal Collapse

Early skin-to-skin contact (SSC) between mothers and healthy term newborns is a key part of the Unicef Baby Friendly Initiative Standards. SSC immediately after birth provides cardiorespiratory stability, improves prevalence and duration of breastfeeding, improves maternalinfant bonding and decreases maternal stress. There is a concern about cases of sudden unexpected postnatal collapse during a period of SSC with the infant prone on the mother´s chest. Said collapse includes both severe apparent lifethreatening event and sudden unexpected early neonatal death in the first week of life. Even if considered rare, consequences are serious with death in half of the cases and remaining disability in majority of the cases reported. For these reasons during SSC and for at least the first 2 hours after delivery, health care personnel in the delivery and recovery room should observe and assess for any sign of decompensation in the infant.

County-Level Health and Demographic Factors and Baby-Friendly Hospital Initiative Facility Birth Rates in the Contiguous US

Abstract Objectives The Baby-Friendly Hospital Initiative (BFHI) is a global effort designed to protect and promote breastfeeding. The BFHI designation in hospitals and birthing facilities may help reduce disparities in breastfeeding in low-resource, vulnerable communities in the US. As such, we evaluated associations between county-level health and demographic factors and birth rates in both established and emerging BFHI facilities. We hypothesized that birth rates among counties with a higher-income, largely White population would be associated with more established BFHI facility births but that rural counties with larger communities of color would be associated with more emerging BFHI facility births. Methods We obtained birth data from American Hospital Association's 2019 survey and information on BFHI designation from Baby-Friendly USA. Next, we geocoded facility locations and then assigned each facility county-level contextual descriptors using demographic information from Robert Wood Johnson's 2019 County Health Rankings data. We employed linear mixed effect modeling to estimate associations between standardized county-level factors and the percentage of emerging and established BFHI facility births after controlling for female population (ages 15–44 years), state grouping structure, and an error structure assumed to be spatially dependent across counties within states. Results Our sample included births from 548 established and 192 emerging BFHI facilities from 1457 counties (about 47% of US counties). We found that violent crime offenses (β 0.04, CI 0.02, 0.06; p = <0.001) and infant mortality were positively associated with birth rates at established facilities. Conversely, higher percentage of teen births (β −0.07, CI −0.1, −0.05; P = <0.001), higher percentage of high school graduates (β −0.02, CI −0.04, −0.001; P = 0.04), and greater rurality (β −0.02, CI −0.04, −0.001; P = 0.04) were negatively associated with established facility birth rates. We did not observe any significant associations for emerging facilities. Conclusions County-level health and demographic factors were significantly associated with percentage of births at established but not BFHI facilities. Targeted interventions to increase BFHI facilities in rural and more vulnerable communities may be warranted. Funding Sources W.K. Kellogg Foundation.

Determinants of Breastfeeding Among Mexican Women with Higher Education Working in a Private University

Abstract Objectives To examine breastfeeding practices and to identify determinants of breastfeeding duration among Mexican women with high levels of education working in a university. We hypothesized that having a C-section delivery, giving birth at a private hospital, receiving free infant formula at the hospital and/or supplementing breastmilk with other liquids soon after giving birth would be negatively associated with breastfeeding duration. Methods Retrospective, cross-sectional study on mothers 18–50 years of age who worked at a private university in Mexico City (N = 150). We performed descriptive analyses and ran linear regression models to identify determinants of any and exclusive breastfeeding duration for the women's youngest offspring. Results Mean breastfeeding duration was 7.6 months and the mean exclusive breastfeeding duration was 1.81 months. Nearly 60% of the women in the sample had a C-section; almost 70% gave birth at private hospitals; 50% reported to have fed their baby with liquids other than breastmilk within the first three days of their baby´s life; and almost 25% of the women were offered free infant formula at the hospital where their child was born. Findings from the regression models that controlled for sociodemographic characteristics suggest that giving birth at a private vs. a public hospital was significantly associated with 1 month less of exclusive breastfeeding (95% CI: −2.11, 0.10, P < 0.1). Similarly, being offered free infant formula at the hospital was marginally associated with 1.59 months less of exclusive breastfeeding (95% CI: −3.2, 0.02, P < 0.1). Conclusions Breastfeeding outcomes among this group of women are suboptimal. Our findings underscore the need to improve breastfeeding protection, promotion and support in maternity hospitals through adherence to the Ten Steps promoted by the Baby Friendly Hospital Initiative. Funding Sources Universidad Iberoamericana.

Prevalence and Associated Factors of Postpartum Anxiety and Depression Symptoms Among Women in Shanghai, China

BackgroundPostpartum anxiety (PPA) and postpartum depression (PPD) are associated with immediate and long-term health risks for both mothers and babies. The purpose of this paper was to evaluate relationships between sociodemographic, perinatal variables, and PPA and PPD symptoms of parturients 6 weeks postpartum. MethodsA cross-sectional survey with 1204 women who had a healthy and term birth in a baby-friendly hospital, Shanghai, China. PPA and PPD symptoms were measured by using the Self-Rating Anxiety Scale (SAS) and the Edinburgh Postnatal Depression Scale (EPDS). ResultsThe mean score of SAS and EPDS was 40.79 ± 8.48 and 8.18 ± 5.80, respectively. The estimated prevalence of PPA and PPD symptoms was 15.2% and 23.2%, respectively. Multivariable logistic regression analysis showed that the presence of fatigue and PPD symptoms were risk factors for PPA symptoms, whereas having support from family and being satisfied with labor experience were protective factors. In terms of PPD symptoms, its risk factors included smoking before pregnancy, maternal separation from baby, fatigue, encountering difficulties in breastfeeding, and the presence of PPA symptoms. In contrast, the protective factors for PPD symptoms were having support from family and having support from colleagues or friends. LimitationsConvenience sampling and voluntary participation may have led to a selection bias. ConclusionPPA and PPD symptoms occur commonly among parturients in Shanghai, China. The findings from this research provide a better understanding of factors associated with PPA and PPD symptoms and will help guide personalized approaches to the management of postpartum anxiety and depression.