Marie Tarrant1, Kris Y W Lok2, Daniel Y T Fong2, Kendra M Wu3, Irene L Y Lee4, Alice Sham5, Christine Lam6, Dorothy Li Bai2, Ka Lun Wong2, Emmy M Y Wong7, Noel P T Chan2, Joan E Dodgson8. 1. School of Nursing, The University of Hong Kong, Hong Kong tarrantm@hku.hk. 2. School of Nursing, The University of Hong Kong, Hong Kong. 3. School of Public Health, The University of Hong Kong, Hong Kong. 4. Queen Mary Hospital, Hong Kong. 5. United Christian Hospital, Kowloon, Hong Kong. 6. Department of Obstetrics and Gynaecology, Queen Elizabeth Hospital, Kowloon, Hong Kong. 7. Department of Health and Physical Education, The Hong Kong Institute of Education, Hong Kong. 8. College of Nursing and Healthcare Innovation, Arizona State University, AZ, USA.
Abstract
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. OBJECTIVES: 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). CONCLUSION: 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.
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. OBJECTIVES: 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). CONCLUSION: 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.
Authors: Christine Y K Lau; Daniel Y T Fong; Vincci H S Chan; Kris Y W Lok; Judy W Y Ng; Chu Sing; Marrie Tarrant Journal: Matern Child Health J Date: 2021-10-20
Authors: Kris Y W Lok; Charlotte L Y Chow; Heidi S L Fan; Vincci H S Chan; Marie Tarrant Journal: BMC Pregnancy Childbirth Date: 2020-05-01 Impact factor: 3.007