Effect on Baby-Friendly Hospital Steps When Hospitals Implement a Policy to Pay for Infant Formula

Abstract

Background:

The Baby-Friendly Hospital Initiative requires hospitals to pay market price for infant formula. No studies have specifically examined the effect of hospitals paying for infant formula on breastfeeding mothers’ exposure to Baby-Friendly steps.

Objectives:

To investigate the effect of hospitals implementing a policy of paying for infant formula on new mothers’ exposure to Baby-Friendly steps and examine the effect of exposure to Baby-Friendly steps on breastfeeding rates.

Methods:

We used a repeated prospective cohort study design. We recruited 2 cohorts of breastfeeding mother–infant pairs (n = 2470) in the immediate postnatal period from 4 Hong Kong public hospitals and followed them by telephone up to 12 months postpartum. We assessed participants’ exposure to 6 Baby-Friendly steps by extracting data from the medical record and by maternal self-report.

Results:

After hospitals began paying for infant formula, new mothers were more likely to experience 4 out of 6 Baby-Friendly steps. Breastfeeding initiation within the first hour increased from 28.7% to 45%, and in-hospital exclusive breastfeeding rates increased from 17.9% to 41.4%. The proportion of mothers who experienced all 6 Baby-Friendly steps increased from 4.8% to 20.5%. The risk of weaning was progressively higher among participants experiencing fewer Baby-Friendly steps. Each additional step experienced by new mothers decreased the risk of breastfeeding cessation by 8% (hazard ratio = 0.92; 95% CI, 0.89-0.95).

Conclusion:

After implementing a policy of paying for infant formula, breastfeeding mothers were exposed to more Baby-Friendly steps, and exposure to more steps was significantly associated with a lower risk of breastfeeding cessation.

Keywords

Baby-Friendly Hospital breastfeeding Hong Kong infant formula

Get full access to this article

View all access options for this article.

References

American Academy of Pediatrics. Policy statement: breastfeeding and the use of human milk. Pediatrics. 2012;129(3):e827-e841.

World Health Organization. Global Strategy for Infant and Young Child Feeding. Geneva: World Health Organization; 2003.

Biro

Sutherland

Yelland

Hardy

Brown

. In-hospital formula supplementation of breastfed babies: a population-based survey. Birth. 2011;38(4):302-310.

Parry

Chau

Tarrant

. Predictors and consequences of in-hospital formula supplementation for healthy breastfeeding newborns. J Hum Lact. 2013;29(4):527-536.

Tender

Janakiram

Arce

. Reasons for in-hospital formula supplementation of breastfed infants from low-income families. J Hum Lact. 2009;25(1):11-17.

Chung

Raman

. Breastfeeding and maternal and infant health outcomes in developed countries. Evid Rep Technol Assess (Full Rep). 2007;(153):1-186.

Asole

Spinelli

Antinucci

Di Lallo

. Effect of hospital practices on breastfeeding: a survey in the Italian Region of Lazio. J Hum Lact. 2009;25(3):333-340.

Declercq

Labbok

Sakala

O’Hara

. Hospital practices and women’s likelihood of fulfilling their intention to exclusively breastfeed. Am J Public Health. 2009;99(5):929-935.

Perrine

Scanlon

Odom

Grummer-Strawn

. Baby-Friendly hospital practices and meeting exclusive breastfeeding intention. Pediatrics. 2012;130(1):54-60.

10.

DiGirolamo

Grummer-Strawn

Fein

. Effect of maternity-care practices on breastfeeding. Pediatrics. 2008;122:S43-S49.

11.

Chantry

Dewey

Peerson

Wagner

Nommsen-Rivers

. In-hospital formula use increases early breastfeeding cessation among first-time mothers intending to exclusively breastfeed. J Pediatr. 2014;164(6):1339-1345.

12.

World Health Organization. Protecting, Promoting, and Supporting Breastfeeding: The Special Role of Maternity Services. Geneva, Switzerland: World Health Organization/UNICEF; 1989.

13.

Rosenberg

Stull

Adler

Kasehagen

Crivelli-Kovach

. Impact of hospital policies on breastfeeding outcomes. Breastfeed Med. 2008;3(2):110-116.

14.

Hawkins

Stern

Baum

Gillman

. Compliance with the Baby-Friendly Hospital Initiative and impact on breastfeeding rates. Arch Dis Child Fetal Neonatal Ed. 2014;99(2):F138-F143.

15.

Martens

. What do Kramer’s Baby-Friendly Hospital Initiative PROBIT studies tell us? A review of a decade of research. J Hum Lact. 2012;28(3):335-342.

16.

Merten

Dratva

Ackermann-Liebrich

. Do baby-friendly hospitals influence breastfeeding duration on a national level? Pediatrics. 2005;116(5):e702-e708.

17.

Brodribb

Kruske

Miller

. Baby-friendly hospital accreditation, in-hospital care practices, and breastfeeding. Pediatrics. 2013;131(4):685-692.

18.

Fallon

Crepinsek

Hegney

O’Brien

. The Baby-Friendly Hospital initiative and breastfeeding duration: relating the evidence to the Australian context. Birth Issues. 2005;14(3):90-95.

19.

Hawkins

Stern

Baum

Gillman

. Evaluating the impact of the Baby-Friendly Hospital Initiative on breast-feeding rates: a multi-state analysis. Public Health Nutr. 2015;18(2):189-197.

20.

Tarrant

Fong

. Impact of baby-friendly hospital practices on breastfeeding in Hong Kong. Birth. 2011;38(3):238-245.

21.

Murray

Ricketts

Dellaport

. Hospital practices that increase breastfeeding duration: results from a population-based study. Birth. 2007;34(3):202-211.

22.

World Health Organization. International Code of Marketing of Breast-Milk Substitutes. Geneva: World Health Organization; 1981.

23.

World Health Organization, UNICEF. Baby-Friendly Hospital Initiative: Revised, Updated and Expanded for Integrated Care. Geneva, Switzerland: World Health Organization/UNICEF; 2009.

24.

Perez-Escamilla

Pollitt

Lonnerdal

Dewey

. Infant feeding policies in maternity wards and their effect on breast-feeding success: an analytical overview. Am J Public Health. 1994;84(1):89-97.

25.

Baby Friendly Hospital Initiative. UNICEF Guidelines: Part IV. Ending the Distribution of Free and Low-Cost Supplies of Infant Formula to Health Care Facilities: Assisting Government Action and Gaining Industry Commitment. Geneva, Switzerland: UNICEF; 1992.

26.

Baby Friendly Hospital Initiative Hong Kong Association. World Breastfeeding Week 2013: Annual Summary. Hong Kong: Baby Friendly Hospital Initiative Hong Kong Association; 2013.

27.

Organisation for Economic Co-operation and Development. OECD Family database: breastfeeding rates. http://www.oecd.org/social/family/43136964.pdf. Accessed July 9, 2013.

28.

Tarrant

Fong

. Breastfeeding and weaning practices among Hong Kong mothers: a prospective study. BMC Pregnancy Childbirth. 2010;10:27.

29.

Department of Health. Optimising breastfeeding practices: a link to life long health. http://www.chp.gov.hk/files/pdf/ncd_watch_feb2014.pdf. Accessed July 23, 2015.

30.

Bai

Fong

Tarrant

. Factors associated with breastfeeding duration and exclusivity in mothers returning to paid employment postpartum. Matern Child Health J. 2015;19(5):990-999.

31.

Tarrant

Dodgson

. Factors contributing to early breastfeeding cessation among Chinese mothers: an exploratory study. Midwifery. 2014;30(10):1088-1095.

32.

Panel on Health Services. Latest arrangement for non-local pregnant women giving birth in Hong Kong. http://www.legco.gov.hk/yr11-12/english/panels/hs/papers/hs0507cb2-1863-1-e.pdf. Accessed July 23, 2015.

33.

Merewood

Philipp

. Becoming Baby-Friendly: overcoming the issue of accepting free formula. J Hum Lact. 2000;16(4):279-282.

34.

Srinivas

Swiler

Marsi

Taylor

. Eradicating reliance on free artificial milk. J Hum Lact. 2015;31(1):53-56.

35.

LaFraniere

. Mainland Chinese flock to Hong Kong to give birth. The New York Times. February 22, 2012.

36.

World Health Organization. Indicators for Assessing Breast-Feeding Practices. Geneva, Switzerland: World Health Organization; 1991.

37.

Dodgson

Tarrant

Fong

DYT

Peng

Hui Choi

EWH

. Breastfeeding patterns of primiparous mothers in Hong Kong. Birth. 2003;30(3):195-202.

38.

Cleves

Gould

Gutierrez

Marchenko

. An Introduction to Survival Analysis Using Stata. 3rd ed. College Station, TX: Stata Press; 2010.

39.

Stata statistical software: release 13.1 [computer program]. College Station, TX: StataCorp LP; 2013.

40.

Thorley

. Free supplies and the appearance of endorsement: distribution of tobacco to soldiers and artificial infant formula to new mothers. J Hum Lact. 2015;31(2):213-215.

41.

Kaplan

Graff

. Marketing breastfeeding—reversing corporate influence on infant feeding practices. J Urban Health. 2008;85(4):486-504.

42.

Riordan

Wambach

. Breastfeeding and Human Lactation. 4th ed. Sudbury, MA: Jones and Bartlett; 2010.

43.

Montgomery

Hale

, Academy of Breastfeeding Medicine Protocol C. ABM clinical protocol #15: analgesia and anesthesia for the breastfeeding mother. Breastfeed Med. 2006;1(4):271-277.

44.

Dewey

Nommsen-Rivers

Heinig

Cohen

. Risk factors for suboptimal infant breastfeeding behavior, delayed onset of lactation, and excess neonatal weight loss. Pediatrics. 2003;112(3):607-619.

45.

Leung

Lam

. Breast-feeding and its relation to smoking and mode of delivery. Obstet Gynecol. 2002;99(5):785-794.

46.

Nickel

Labbok

Hudgens

Daniels

. The extent that noncompliance with the ten steps to successful breastfeeding influences breastfeeding duration. J Hum Lact. 2013;29(1):59-70.

47.

DiGirolamo

Grummer-Strawn

Fein

. Maternity care practices: implications for breastfeeding. Birth. 2001;28(2):94-100.

48.

Lam

. Report of Hospital Authority breastfeeding survey 2014. Presented at: Hospital Authority Breastfeeding Conference: Understanding the Babies—Improving the Practices; 2014; Hong Kong.

49.

Scanlon

Serdula

. The validity and reliability of maternal recall of breastfeeding practice. Nutr Rev. 2005;63(4):103-110.

50.

Natland

Andersen

Nilsen

Forsmo

Jacobsen

. Maternal recall of breastfeeding duration twenty years after delivery. BMC Med Res Methodol. 2012;12:179.

51.

Tarrant

Yuen

Cheung

Chan

. Determinants of 2009 A/H1N1 influenza vaccination among pregnant women in Hong Kong. Matern Child Hlth J. 2013;17(1):23-32.

52.

World Health Organization. Protecting, Promoting, And Supporting Breastfeeding: The Special Role of Maternity Services. Geneva, Switzerland: World Health Organization/UNICEF; 1989.

53.

Baby-Friendly Hospital Initiative in the United States. The Ten Steps to Successful Breastfeeding. Albany, NY: Baby-Friendly USA; 2010.