Breastfeeding Policies and Practices in Tennessee Hospitals

Objectives: The purpose of this study was to identify the level of compliance to the Baby Friendly Hospital Initiative (BFHI) in hospitals in Tennessee, to identify differences in infant feeding policies and practices based on hospital ownership type and to identify if breastfeeding disparities are related to the infant feeding policies and practices of those hospitals.

Methods: Eighty hospitals/maternity centers were surveyed in Tennessee. Thirty-seven hospitals responded to a mailed survey relating to the hospital infant feeding policies and practices as defined by the WHO/UNICEF BFHI’s Ten Steps to Successful Breastfeeding. Compliance was modeled as a function of hospital patient characteristics.

Results: Compliance with the BFHI criteria varied greatly for each of the Ten Steps to Successful Breastfeeding. The lowest compliance was found for Step 10, which encourages fostering of external breastfeeding resources such as breastfeeding support groups. Step 7, which supports rooming-in for the mother and infant, was not well supported. The greatest compliance was found for Step 8, which encourages mothers to breastfeed on demand. When predicting compliance based on hospital patient population characteristics, maternal education and marital status were the strongest predictors for poor compliance to Step 5, which encourages hospital staff to train mothers on how to maintain lactation.

Conclusions: Overall, compliance for the Ten Steps for Successful Breastfeeding in Tennessee hospital was poor. Further investigation is needed to determine how hospitals can improve the promotion of breastfeeding in the first days of life, especially among high-risk mothers.