title: Baby-friendly hospital accreditation, in-hospital care practices, and breastfeeding.
abstract: OBJECTIVE
  To investigate the effect of Baby-Friendly Hospital Initiative (BFHI) accreditation and hospital care practices on breastfeeding rates at 1 and 4 months.
  
  
  METHODS
  All women who birthed in Queensland, Australia, from February 1 to May 31, 2010, received a survey 4 months postpartum. Maternal, infant, and hospital characteristics; pregnancy and birth complications; and infant feeding outcomes were measured.
  
  
  RESULTS
  Sample size was 6752 women. Breastfeeding initiation rates were high (96%) and similar in BFHI-accredited and nonaccredited hospitals. After adjustment for significant maternal, infant, clinical, and hospital variables, women who birthed in BFHI-accredited hospitals had significantly lower odds of breastfeeding at 1 month (adjusted odds ratio 0.72, 95% confidence interval 0.58-0.90) than those who birthed in non-BFHI-accredited hospitals. BFHI accreditation did not affect the odds of breastfeeding at 4 months or exclusive breastfeeding at 1 or 4 months. Four in-hospital practices (early skin-to-skin contact, attempted breastfeeding within the first hour, rooming-in, and no in-hospital supplementation) were experienced by 70% to 80% of mothers, with 50.3% experiencing all 4. Women who experienced all 4 hospital practices had higher odds of breastfeeding at 1 month (adjusted odds ratio 2.20, 95% confidence interval 1.78-2.71) and 4 months (adjusted odds ratio 2.93, 95% confidence interval 2.40-3.60) than women who experienced fewer than 4.
  
  
  CONCLUSIONS
  When breastfeeding-initiation rates are high and evidence-based practices that support breastfeeding are common within the hospital environment, BFHI accreditation per se has little effect on both exclusive or any breastfeeding rates.
authors.affiliation: School of Medicine, Discipline of General Practice, The University of Queensland, Queensland, Australia w.brodribb@uq.edu.au
authors.forename: Wendy
authors.initials: W
authors.lastname: Brodribb
authors.forename: Sue
authors.initials: S
authors.lastname: Kruske
authors.forename: Yvette D
authors.initials: YD
authors.lastname: Miller
mesh_terms: D000068:Accreditation; D000328:Adult; D001942:Breast Feeding / Q000706:statistics & numerical data*; D015331:Cohort Studies; D005260:Female; D019538:Health Care Surveys; D006306:Health Surveys; D006761:Hospitals / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007224:Infant Care / Q000592:standards* / Q000706:statistics & numerical data; D007231:Infant, Newborn; D016015:Logistic Models; D015999:Multivariate Analysis; D011181:Postnatal Care / Q000592:standards* / Q000706:statistics & numerical data; D011793:Queensland; D012189:Retrospective Studies