The Baby-Friendly Hospital Initiative and the Initiation of Breastfeeding in Washington

Thesis (Master's)--University of Washington, 2017-06Background: Though breastfeeding rates have increased over the last 20 years in the United States and in Washington State, increasing the proportion of infants who are breastfed and reducing disparities in breastfeeding rates remain public health priorities. The Baby-Friendly Hospital Initiative (BFHI) aims to improve breastfeeding initiation rates and decrease disparities in breastfeeding. Research Aims: To examine the relationship between giving birth in a BFHI facility and initiation of breastfeeding overall and according to maternal race, education, Women, Infants, and Children (WIC) status, and insurance status. Methods: This population-based study included 73,475 women who gave birth to a single, live-born infant in a Washington State birth facility. Maternal and infant characteristics, infant feeding outcomes, and facility of birth were extracted from Washington State birth certificates. Results: Breastfeeding initiation was very high, with 98.4% and 95.5% of women initiating breastfeeding in BHFI facilities and non-BFHI facilities, respectively. Overall, women who gave birth in a BFHI accredited facility had significantly higher odds of initiating breastfeeding (unadjusted odds ratio 2.90, 95% CI: 2.44, 3.44). After adjusting for race, education, birth country, marital status, parity, WIC status, insurance status, delivery method, and smoking status, the odds of breastfeeding among women who gave birth in a BFHI accredited facility continued to be significantly higher (OR=2.14, 95% CI: 1.79, 2.56). Race, education, WIC status, and insurance were not found to modify the relationship between hospital designation status and breastfeeding. Conclusion: BFHI facilities are effective in improving breastfeeding initiation rates overall, even in a state where breastfeeding initiation is already high