title: Impact of State Legislation on Hospital Breastfeeding Support in New York.
abstract: OBJECTIVE
  The purpose of this study was to evaluate whether 2 state mandates, both implemented in 2010, had an impact on NY hospitals providing maternity care. Specifically, we measured changes in hospital staff's awareness, attitudes, and promotion of breastfeeding (BF), maternity care practices, and hospital breastfeeding policies and tested whether they were related to implementation of the Breastfeeding Mothers' Bill of Rights or the mandate for public reporting of hospital-specific BF measures.
  
  
  METHODS
  In 2009 and 2011, written hospital BF policies were collected and evaluated using a 28-item review tool and hospital BF surveys were conducted. The surveys assessed hospital culture and staff attitudes associated with BF promotion and support and recommended maternity care practices.
  
  
  METHODS
  NY hospitals providing maternity care services and hospital staff.
  
  
  METHODS
  Changes over time in hospital BF policies (BF policy score) and implementation of recommended maternity care practices (9 of Ten Steps to Successful BF) were evaluated. The relationships and correlations between these changes in staff awareness, hospital culture, and BF promotion were determined.
  
  
  RESULTS
  Between 2009 and 2011, there were increases in BF policy scores, maternity care practices implemented, and lactation staff (P < .001). Greater awareness by hospital administrators of BF measures was associated with more emphasis in promoting BF (P = .02). Hospitals reporting much more emphasis in promoting BF or reporting large changes in organizational culture had greater increases in BF policy scores and the recommended maternity care practices implemented (P < .05).
  
  
  CONCLUSIONS
  These findings suggest that state mandates requiring key BF policies and support in hospitals and public reporting of BF rates may have led to increased emphasis and promotion of BF, improvement in hospital BF policies, and increased implementation of maternity care practices supporting BF. Implementation of similar policies by other states, combined with rigorous evaluation, is needed to replicate these findings and assess the long-term impact on maternal and infant health outcomes.
authors.affiliation: New York State Department of Health, Albany, New York (Drs Dennison, Nguyen, and Fan and Mr Xu); and School of Public Health, University at Albany, State University of New York, Rensselaer, New York (Drs Dennison and Jurkowski).
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Dennison
authors.forename: Trang Q
authors.initials: TQ
authors.lastname: Nguyen
authors.forename: Changning
authors.initials: C
authors.lastname: Xu
authors.forename: Wei
authors.initials: W
authors.lastname: Fan
authors.forename: Janine M
authors.initials: JM
authors.lastname: Jurkowski