New study finds hospital practices strongly impact breastfeeding rates

March 19, 2009

Hospital practices, such as supplementing newborns with formula or water or giving them pacifiers, significantly reduce the chances that mothers who intend to exclusively breastfeed will achieve that intention, according to a new study led by a Boston University School of Public Health researcher.

In a study which appears online March 19 in the American Journal of Public Health, a research team led by Eugene Declercq, PhD, professor of Maternal and Child Health, found a significant drop-off between the numbers of mothers who intend to exclusively breastfeed, and those who fulfill that intention one week after giving birth. Among first-time mothers, 70 percent reported an intention to exclusively breastfeed, but only 50 percent achieved that goal at one week.

The study found that hospital practices were strongly related to those outcomes. Specifically, the practice of hospital staff providing formula or water to supplement breastfeeding was significantly related to the failure to achieve exclusive breastfeeding.

Mothers whose infants were not offered supplementation were far more likely to achieve their intention to breastfeed - 4.4 times more likely among primiparas (first-time mothers), and 8.8 times more likely among multiparas.

Other hospital practices also influenced outcomes. First-time mothers who delivered in hospitals that practiced at least six out of seven recommended steps to encourage breastfeeding -- such as helping mothers get started and not giving babies pacifiers - were six times more likely to fulfill their intention to exclusively breastfeed than mothers who reported experiencing one or none of these practices.

"Very often, research studies yield conclusions that don't translate easily into changes in practice or policy," Declercq said. "In this case, the message is loud and clear - hospital practices can make a difference in early breastfeeding success and in particular, every effort should be made to avoid supplementation of healthy babies of mothers who intended to exclusively breastfeed."

The study's findings indicate that many hospitals routinely employ practices that discourage mothers from exclusively breastfeeding, despite large-scale programs, such as the "Baby-Friendly Hospital Initiative" launched by the World Health Organization and UNICEF, to encourage breastfeeding.

About half (49 percent) of first-time mothers who intended to exclusively breastfeed reported that their babies were given water or formula for supplementation, while 74 percent reported being given free formula samples or offers.

"Why are those hospital practices that have been repeatedly shown to increase breastfeeding among new mothers not more consistently instituted in United States hospitals?" Declercq and his co-authors asked. "A large proportion of mothers stop exclusive breastfeeding within the first week, and that action was strongly related to hospital practices."

The authors said the difference between "intention and practice" among women who intend to exclusively breastfeed represents "a huge lost opportunity to encourage and support breastfeeding in the United States." They said the study data suggests that nationwide, more than 400,000 infants a year born to mothers who intended to exclusively breastfeed were instead not benefiting from that option.

The authors cited recommendations from the American Academy of Pediatrics and other medical organizations that infants consume only mother's milk for at least the first six months of life.

The study analyzed data from Listening to Mothers II, a nationally representative survey of 1,573 mothers who had given birth in a hospital to a single infant in 2005. Mothers were asked retrospectively about their breastfeeding intentions, infant feeding practices at one week, and hospital practices.

Source: Boston University