title: Breast-feeding policies and practices in Canadian hospitals providing maternity care.
abstract: OBJECTIVE
  To determine the extent to which policies and practices of Canadian hospitals providing maternity care are consistent with the World Health Organization (WHO)/UNICEF 10 Steps to Successful Breastfeeding, the WHO International Code of Marketing of Breast-Milk Substitutes and the WHO/UNICEF Baby Friendly Hospital Initiative.
  
  
  METHODS
  Cross-sectional mailed survey.
  
  
  METHODS
  Canada.
  
  
  METHODS
  Representatives of 572 hospitals providing maternity care across Canada were sent a questionnaire in the spring and summer of 1993, 523 (91.4%) responded.
  
  
  METHODS
  Self-reported implementation of policies and practices concerning infant feeding; hospitals were grouped according to location, size (number of live births per year) and university affiliation status.
  
  
  RESULTS
  Although 58.4% (296/507) of the respondents reported that their hospital had a written policy on breast-feeding, only 4.6% (21/454) reported having one that complied with all of the WHO/UNICEF steps surveyed. This figure dropped to 1.3% (6/453) when compliance with the WHO code (distribution of free samples of formula to formula-feeding and breast-feeding mothers) was added. Hospitals in Quebec and the Prairie provinces were significantly more likely than those in Ontario to give free samples of formula to both breast-feeding (OR 2.39 [95% confidence interval (Cl) 1.39 to 4.09] and 20.22 [95% Cl 9.27 to 44.33] respectively) and formula-feeding mothers (OR 1.82 [95% Cl 1.07 to 3.11] and 8.03 [95% Cl 3.29 to 19.6] respectively), after adjustment for hospital size and university affiliation status.
  
  
  CONCLUSIONS
  There are considerable variations in the implementation of individual WHO steps and provisions of the WHO code according to hospital location, size and university affiliation status. Very few Canadian hospitals meet all of the criteria that would enable them to be considered "baby friendly" according to the WHO/UNICEF definition.
authors.affiliation: Department of Family Medicine, Sir Mortimer B. Davis-Jewish General Hospital, Montreal, Oue.
authors.forename: C A
authors.initials: CA
authors.lastname: Levitt
authors.forename: J
authors.initials: J
authors.lastname: Kaczorowski
authors.forename: L
authors.initials: L
authors.lastname: Hanvey
authors.forename: D
authors.initials: D
authors.lastname: Avard
authors.forename: G W
authors.initials: GW
authors.lastname: Chance
mesh_terms: D001942:Breast Feeding; D002170:Canada; D003430:Cross-Sectional Studies; D017408:Guidelines as Topic; D006276:Health Facility Size; D006302:Health Services Research; D006784:Hospitals, Teaching; D006801:Humans; D007225:Infant Food; D007231:Infant, Newborn; D008389:Marketing of Health Services; D009775:Obstetrics and Gynecology Department, Hospital; D016134:Organizational Policy; D012386:Rooming-in Care; D011795:Surveys and Questionnaires; D014944:World Health Organization