title: Are breastfeeding rates higher among mothers delivering in Baby Friendly accredited maternity units in the UK?
abstract: BACKGROUND
  The promotion and support of breastfeeding is a global priority with benefits for maternal and infant health, particularly in low-income and middle-income countries where its relevance for child survival is undisputed. However, breastfeeding rates are strikingly low in some higher-income countries, including the UK. Evidence to support the effectiveness of public health interventions to increase rates of breastfeeding initiation and duration in this setting is limited. We examined whether mothers were more likely to start and continue to breastfeed if they delivered in a UNICEF UK Baby Friendly accredited maternity unit, in a cohort with a high representation of disadvantaged and lower socioeconomic groups with traditionally low rates of breastfeeding.
  
  
  METHODS
  We analysed maternally reported breastfeeding initiation and prevalence of any breastfeeding at 1 month for 17 359 singleton infants according to maternity unit Baby Friendly Initiative participation status at birth (accredited, certificated, or neither award).
  
  
  RESULTS
  Mothers delivering in accredited maternity units were more likely to start breastfeeding than those delivering in units with neither award [adjusted rate ratio: 1.10, 95% confidence interval (CI) 1.05-1.15], but were not more likely to breastfeed at 1 month (0.96, 95% CI 0.84-1.09), after adjustment for social, demographic, and obstetric factors. Antenatal class attendance (1.14, 95% CI 1.11-1.17), vaginal delivery (1.05, 1.03-1.08), a companion at delivery (1.09, 1.04-1.16), and maternal post-partum hospital stay >24 h (1.06, 1.04-1.09) were also independently associated with breastfeeding initiation.
  
  
  CONCLUSIONS
  Policies to increase the proportion of maternity units participating in the UNICEF UK Baby Friendly Initiative are likely to increase breastfeeding initiation but not duration. Other strategies are required in order to support UK mothers to breastfeed for the recommended duration.
authors.affiliation: Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK. s.bartington@ich.ucl.ac.uk
authors.forename: Suzanne
authors.initials: S
authors.lastname: Bartington
authors.forename: Lucy J
authors.initials: LJ
authors.lastname: Griffiths
authors.forename: A Rosemary
authors.initials: AR
authors.lastname: Tate
authors.forename: Carol
authors.initials: C
authors.lastname: Dezateux
mesh_terms: D000068:Accreditation; D000328:Adult; D001942:Breast Feeding / Q000706:statistics & numerical data*; D005260:Female; D006293:Health Promotion / Q000592:standards*; D006771:Hospitals, Maternity / Q000592:standards*; D006801:Humans; D007231:Infant, Newborn; D018743:Perinatal Care / Q000379:methods / Q000592:standards; D011181:Postnatal Care / Q000379:methods / Q000592:standards*; D017584:Reproductive History; D012923:Social Class; D013997:Time Factors; D006113:United Kingdom