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Eugene Declercq, PhD, Miriam H. Labbok, MD, MPH, Carol Sakala, PhD, MPH and MaryAnn O'Hara, MD, MPH

At the time of the study Eugene Declercq was with School of Public Health, Boston University, MA. Miriam H. Labbok was with the School of Public Health, University of North Carolina, Chapel Hill. Carol Sakala was with Childbirth Connections, New York, NY. MaryAnn O'Hara was with the University of Washington, Seattle.

Correspondence: Requests for reprints can be sent to Eugene Declercq, Department of Maternal and Child Health, Boston University School of Public Health, 715 Albany St, Talbot W540, Boston, MA 02118 (e-mail: declercq{at}bu.edu).

Objectives. We sought to assess whether breastfeeding-related hospital practices reported by mothers were associated with achievement of their intentions to exclusively breastfeed.

Methods. We used data from Listening to Mothers II, a nationally representative survey of 1573 mothers who had given birth in a hospital to a singleton in 2005. Mothers were asked retrospectively about their breastfeeding intention, infant feeding at 1 week, and 7 hospital practices.

Results. Primiparas reported a substantial difference between their intention to exclusively breastfeed (70%) and this practice at 1 week (50%). They also reported hospital practices that conflicted with the Baby-Friendly Ten Steps, including supplementation (49%) and pacifier use (45%). Primiparas who delivered in hospitals that practiced 6 or 7 of the steps were 6 times more likely to achieve their intention to exclusively breastfeed than were those in hospitals that practiced none or 1 of the steps. Mothers who reported supplemental feedings to their infant were less likely to achieve their intention to exclusively breastfeed: primiparas (adjusted odds ratio [AOR] = 4.4; 95% confidence interval [CI] = 2.1, 9.3); multiparas (AOR = 8.8; 95% CI = 4.4, 17.6).

Conclusions. Hospitals should implement policies that support breastfeeding with particular attention to eliminating supplementation of healthy newborns.

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