A 5-year follow-up study of hospital breastfeeding policies in the Philadelphia area: a comparison with the ten steps.

The purpose of this study was to describe the current status of hospital breastfeeding policies and practices in the Philadelphia area, to assess hospitals' current implementation levels of the Ten Steps to Successful Breastfeeding, and to compare current implementation levels with 1994 baseline data. Most surveyed hospitals were fully implementing 5 of the Ten Steps. Thirty-seven percent of the hospitals were classified as high implementers and 63% as partial implementers of the Ten Steps overall. Key factors that affect implementation of each step were identified through in-depth discussions. Areas identified as needing the greatest attention were breastfeeding education of health care professionals and mothers, prenatal and postdischarge outreach to mothers, and the restriction of infant supplementation. Additionally, ethnic diversity and cultural beliefs of the mother-infant couple that influence breastfeeding choices need to be considered.