title: Key Program Findings and Insights From the Baby-Friendly Hawaii Project.
abstract: BACKGROUND
  Breastfeeding is the optimal method for infant feeding. In the United States, 81.1% of mothers initiate breastfeeding; however, only 44.4% and 22.3% of mothers are exclusively breastfeeding at 3 and 6 months, respectively. Research aim: The Centers for Disease Control and Prevention provides guidance and funding to state health departments to support strategies to improve breastfeeding policies and practices in the hospital, community, and worksite settings. In 2010, the Hawaii State Department of Health received support from the Centers for Disease Control and Prevention to launch the Baby-Friendly Hawaii Project (BFHP) to increase the number of Hawaii hospitals that provide maternity care consistent with the Ten Steps to Successful Breastfeeding and increase the rate of women who remain exclusively breastfeeding throughout their hospital stay.
  
  
  METHODS
  For this article, we examined the BFHP's final evaluation report and Hawaii breastfeeding and maternity care data to identify the role of the BFHP in facilitating improvements in maternity care practices and breastfeeding rates.
  
  
  RESULTS
  Since 2010, 52 hospital site visits, 58 trainings, and ongoing technical assistance were administered, and more than 750 staff and health professionals from BFHP hospitals were trained. Hawaii's overall quality composite Maternity Practices in Infant Nutrition and Care score increased from 65 (out of 100) in 2009 to 76 in 2011 and 80 in 2013, and Newborn Screening Data showed an increase in statewide exclusive breastfeeding from 59.7% in 2009 to 77.0% in 2014.
  
  
  CONCLUSIONS
  Implementation and findings from the BFHP can inform future planning at the state and federal levels on maternity care practices that can improve breastfeeding.
authors.affiliation: 1 Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Sahra A
authors.initials: SA
authors.lastname: Kahin
authors.affiliation: 2 Office of Public Health Studies, University of Hawaii at Manoa, Honolulu, HI, USA.
authors.forename: Meghan
authors.initials: M
authors.lastname: McGurk
authors.affiliation: 3 Chronic Disease Prevention and Health Promotion Division, Hawaii State Department of Health, Honolulu, HI, USA.
authors.forename: Heidi
authors.initials: H
authors.lastname: Hansen-Smith
authors.affiliation: 1 Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Margaret
authors.initials: M
authors.lastname: West
authors.affiliation: 1 Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Ruowei
authors.initials: R
authors.lastname: Li
authors.affiliation: 4 Loma Linda University Children's Hospital, Loma Linda, CA, USA.
authors.forename: Carolyn Lopez
authors.initials: CL
authors.lastname: Melcher
mesh_terms: D001942:Breast Feeding / Q000523:psychology / Q000706:statistics & numerical data; D006254:Hawaii; D006801:Humans; D007223:Infant; D000068104:Infant Health / Q000706:statistics & numerical data*; D007231:Infant, Newborn; D009035:Mothers / Q000523:psychology / Q000706:statistics & numerical data; D016730:Program Development / Q000379:methods / Q000706:statistics & numerical data; D015397:Program Evaluation / Q000592:standards*; D011634:Public Health / Q000379:methods* / Q000706:statistics & numerical data
keywords: Baby-Friendly Hospital Initiative; Hawaii; Ten Steps to Successful Breastfeeding; breastfeeding; maternity care practices