Evaluating the impact of the Baby-Friendly Hospital Initiative on breast-feeding rates: a multi-state analysis

卷:18

Hawkins, Summer Sherburne ; Stern, Ariel Dora ; Baum, Christopher F. ; Gillman, Matthew W.

Boston Coll

关键词: Breast-feeding;    Programme evaluation;    Maternity hospitals;   

DOI  :  10.1017/S1368980014000238

学科分类：食品科学和技术

【 摘 要 】

Objective: To evaluate the impact of the Baby-Friendly Hospital Initiative (BFHI) on breast-feeding initiation and duration overall and according to maternal education. Design: Quasi-experimental study using data from five states (Alaska, Maine, Nebraska, Ohio, Washington) that participated in the Pregnancy Risk Assessment Monitoring System from 1999 to 2009. Using differences-in-differences models that included year and hospital fixed effects, we compared rates of breast-feeding initiation and duration (any and exclusive breast-feeding for >= 4 weeks) before and after BFHI accreditation between mothers who gave birth in hospitals that were accredited or became accredited and mothers from matched non-BFHI facilities. We stratified analyses into lower and higher education groups. Setting: Thirteen BFHI hospitals and nineteen matched non-BFHI facilities across five states in the USA. Subjects: Mothers (n 11 723) who gave birth in BFHI hospitals and mothers (n 13 604) from nineteen matched non-BFHI facilities. Results: Although we did not find overall differences in breast-feeding initiation between birth facilities that received BFHI accreditation compared with non-Baby-Friendly facilities (adjusted coefficient = 0.024; 95% CI -0.00, 0.51), breast-feeding initiation increased by 3.8 percentage points among mothers with lower education who delivered in Baby-Friendly facilities (P = 0.05), but not among mothers with higher education (adjusted coefficient = 0.002; 95% CI -0.04, 0.05). BFHI accreditation also increased exclusive breast-feeding for >= 4 weeks by 4.5 percentage points (P = 0.02) among mothers with lower education who delivered in BFHI facilities. Conclusions: By increasing breast-feeding initiation and duration among mothers with lower education, the BFHI may reduce socio-economic disparities in breast-feeding.