Effect on Baby-Friendly Hospital Steps When Hospitals Implement a Policy to Pay for Infant Formula.
BACKGROUND
The Baby-Friendly Hospital Initiative requires hospitals to pay market price for infant formula. No studies have specifically examined the effect of hospitals paying for infant formula on breastfeeding mothers' exposure to Baby-Friendly steps.


OBJECTIVE
To investigate the effect of hospitals implementing a policy of paying for infant formula on new mothers' exposure to Baby-Friendly steps and examine the effect of exposure to Baby-Friendly steps on breastfeeding rates.


METHODS
We used a repeated prospective cohort study design. We recruited 2 cohorts of breastfeeding mother-infant pairs (n = 2470) in the immediate postnatal period from 4 Hong Kong public hospitals and followed them by telephone up to 12 months postpartum. We assessed participants' exposure to 6 Baby-Friendly steps by extracting data from the medical record and by maternal self-report.


RESULTS
After hospitals began paying for infant formula, new mothers were more likely to experience 4 out of 6 Baby-Friendly steps. Breastfeeding initiation within the first hour increased from 28.7% to 45%, and in-hospital exclusive breastfeeding rates increased from 17.9% to 41.4%. The proportion of mothers who experienced all 6 Baby-Friendly steps increased from 4.8% to 20.5%. The risk of weaning was progressively higher among participants experiencing fewer Baby-Friendly steps. Each additional step experienced by new mothers decreased the risk of breastfeeding cessation by 8% (hazard ratio = 0.92; 95% CI, 0.89-0.95).


CONCLUSIONS
After implementing a policy of paying for infant formula, breastfeeding mothers were exposed to more Baby-Friendly steps, and exposure to more steps was significantly associated with a lower risk of breastfeeding cessation.
School of Nursing, The University of Hong Kong, Hong Kong tarrantm@hku.hk.
Marie
M
Tarrant
School of Nursing, The University of Hong Kong, Hong Kong.
Kris Y W
KY
Lok
School of Nursing, The University of Hong Kong, Hong Kong.
Daniel Y T
DY
Fong
School of Public Health, The University of Hong Kong, Hong Kong.
Kendra M
KM
Wu
Queen Mary Hospital, Hong Kong.
Irene L Y
IL
Lee
United Christian Hospital, Kowloon, Hong Kong.
Alice
A
Sham
Department of Obstetrics and Gynaecology, Queen Elizabeth Hospital, Kowloon, Hong Kong.
Christine
C
Lam
School of Nursing, The University of Hong Kong, Hong Kong.
Dorothy Li
DL
Bai
School of Nursing, The University of Hong Kong, Hong Kong.
Ka Lun
KL
Wong
Department of Health and Physical Education, The Hong Kong Institute of Education, Hong Kong.
Emmy M Y
EM
Wong
School of Nursing, The University of Hong Kong, Hong Kong.
Noel P T
NP
Chan
College of Nursing and Healthcare Innovation, Arizona State University, AZ, USA.
Joan E
JE
Dodgson
D000293:Adolescent; D000328:Adult; D001942:Breast Feeding / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence; D006293:Health Promotion / Q000191:economics / Q000379:methods* / Q000592:standards; D006723:Hong Kong; D006801:Humans; D007223:Infant; D041943:Infant Formula / Q000191:economics*; D007231:Infant, Newborn; D011181:Postnatal Care / Q000191:economics / Q000379:methods* / Q000592:standards; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D014886:Weaning; D055815:Young Adult
Baby-Friendly Hospital; Hong Kong; breastfeeding; infant formula