Exclusive breastfeeding in hospital predicts longer breastfeeding duration in Canada: Implications for health equity

Birth. 2018 Dec;45(4):440-449. doi: 10.1111/birt.12345. Epub 2018 Mar 2.


Background: Breastfeeding has many established health benefits for women and children. We examined the association between maternal education, newborn feeding in hospital, and long-term breastfeeding duration.

Methods: We studied 3195 Canadian mother-infant dyads in the CHILD pregnancy cohort. Newborn feeding was documented from hospital records. Caregivers reported sociodemographic factors and infant feeding at 3, 6, 12, 18, and 24 months.

Results: Overall, 97% of newborns initiated breastfeeding and 74% were exclusively breastfed in hospital. Exclusively breastfed newborns were ultimately breastfed longer compared with those who received formula supplementation during their hospital stay (median 11.0 vs 7.0 months, P < .001). After controlling for maternal age, ethnicity, birth mode, and gestational age, exclusively breastfed newborns had a 21% reduced risk of breastfeeding cessation (HR = 0.79, 0.71-0.87). This effect was strongest among women without a postsecondary education (HR = 0.65, 0.53-0.79).

Discussion: Exclusive breastfeeding in hospital is associated with longer breastfeeding duration, particularly among women of lower socioeconomic status. Initiatives that support exclusive breastfeeding of newborns in hospital could improve long-term breastfeeding rates and help reduce health inequities arising in early life.

Keywords: breastfeeding exclusivity and duration; hospital practices; maternal-child health equity; newborn feeding; perinatal care.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Breast Feeding / statistics & numerical data*
  • Canada / epidemiology
  • Female
  • Health Equity*
  • Hospitals
  • Humans
  • Infant, Newborn
  • Length of Stay / statistics & numerical data
  • Longitudinal Studies
  • Male
  • Perinatal Care / organization & administration*
  • Proportional Hazards Models
  • Young Adult

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