Changing Hospital Practices to Increase the Duration of Breastfeeding

OBJECTIVE: To change the breastfeeding policy in a university teaching hospital in accord with the Ten Steps to Successful Breastfeeding of the United Nations Children's Fund and World Health Organization and to assess the impact of hospital practices on the duration of breastfeeding. METHODS: One hundred ninety-two and 392 postpartum women in a maternity ward were interviewed in 1990 and 1993, respectively, regarding how they were feeding their infants and feeding practices in the hospital. Between these two periods, the hospital infant-feeding policy was reviewed and revised in accord with the Ten Steps. Two hundred seventy of the mothers interviewed in 1993 were interviewed again when their infants were 4 months old regarding the duration of full and partial breastfeeding. RESULTS: By 1993, more newborns were put to the breast in the first hour of life (63.2% vs 24.8%); fewer breastfed infants were fed foods other than breast milk (27.9% vs 46.7%); and more mothers received breastfeeding guidance from hospital staff (81.9% vs 61.3%). The duration of breastfeeding in 1993 was longer for women who did not receive formula in the hospital, who were not given discharge packs containing formula and/or coupons, and who roomed-in more than 60% of the time. These associations persisted after controlling for confounding. CONCLUSION: Infant-feeding policies and practices are amenable to change, and policies such as the Baby-Friendly Hospital Initiative may contribute to an increase in the duration of breastfeeding.