title: Breastfeeding promotion in non-UNICEF-certified hospitals and long-term breastfeeding success in Germany.
abstract: OBJECTIVE
  To assess breastfeeding practices using the World Health Organization/United Nations Children's Fund (WHO/UNICEF) Ten Steps to Successful Breastfeeding for Baby-Friendly Hospitals in unselected non-UNICEF certified German hospitals and to examine the influences of breastfeeding promotion on long-term breastfeeding success as assessed by WHO criteria.
  
  
  METHODS
  Information on the fulfilment of the Ten Steps was collected in 177 randomly chosen maternity hospitals by a postal questionnaire. Breastfeeding duration was assessed in 1487 mothers delivering in these hospitals. Multiple logistic regression was used to estimate the association between a low breastfeeding promotion index, defined as fulfilment of fewer than five steps, and the risk of short-term breastfeeding, less than 4 mo.
  
  
  RESULTS
  A higher breastfeeding promotion index was not associated with early breastfeeding but was significantly associated with full breastfeeding at 4 and 6 mo. After adjusting for confounding factors, delivering in a hospital with a low breastfeeding promotion index was associated with an increased risk of short-term breastfeeding [odds ratio (OR) 1.24], although associations with maternal demographic variables (young age: OR 3.34), low educational level (OR 2.81) and upbringing in East Germany (OR 2.27) were stronger.
  
  
  CONCLUSIONS
  In unselected German hospitals even moderate levels of breastfeeding promotion identified by WHO/UNICEF criteria were associated with long-term breastfeeding success.
authors.affiliation: Department of Epidemiology and Medical Statistics, School of Public Health, University of Bielefeld, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Dulon
authors.forename: M
authors.initials: M
authors.lastname: Kersting
authors.forename: Ralf
authors.initials: R
authors.lastname: Bender
mesh_terms: D000328:Adult; D001942:Breast Feeding; D004522:Educational Status; D005260:Female; D005858:Germany; D006293:Health Promotion / Q000379:methods*; D006771:Hospitals, Maternity; D006801:Humans; D007231:Infant, Newborn; D016015:Logistic Models; D011795:Surveys and Questionnaires; D013997:Time Factors