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

Public Health Nutr. 2015 Feb;18(2):189-97. doi: 10.1017/S1368980014000238. Epub 2014 Mar 14.


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.

Keywords: Breast-feeding; Maternity hospitals; Programme evaluation.

Publication types

  • Evaluation Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Breast Feeding*
  • Centers for Disease Control and Prevention, U.S.
  • Educational Status
  • Evidence-Based Medicine*
  • Female
  • Hospitals, Maternity
  • Humans
  • Infant, Newborn
  • Longitudinal Studies
  • Male
  • Matched-Pair Analysis
  • Mothers / education
  • Nutrition Policy*
  • Patient Compliance*
  • Public Health Surveillance
  • Spatio-Temporal Analysis
  • United Nations
  • United States
  • World Health Organization