Abstract
Objectives
The Baby-Friendly Hospital Initiative is an effective intervention to support maternal practices around breastfeeding. However, little is known about its impact on participants of the Special Supplemental Nutrition Program for Women, Infants and Children (WIC). The purpose of this study was to evaluate whether Baby Friendly Hospital (BFH) designation in Maryland improved breastfeeding practices among Special Supplemental Nutrition Program for Women, Infants and Children (WIC) participants.
Methods
Breastfeeding practices of WIC participants (22,543 mother-infant dyads) were analyzed utilizing WIC management information system de-identified data from four Maryland WIC agencies during 2010–12 and 2017–19. Participants lived in areas served by a hospital that became BFH in 2016 or remained non-BFH. Pre–post implementation breastfeeding practices (breastfeeding initiation, at 3 months and 6 months) of women associated with a BFH were compared to women associated with a non-BFH using propensity score weighting and a difference-in-difference modeling.
Results
From pre to post intervention no differences in breastfeeding initiation or any breastfeeding at 6 months were attributable to BFH status. There was some evidence that BFH designation in 2016 was associated with an absolute percent change of 2.4% (P = 0.09) for any breastfeeding at 3 months.
Discussion
Few differences in breastfeeding outcomes among WIC participants were attributable to delivery in a BFH. Results from this study inform policy about maternity practices impacting WIC breastfeeding outcomes. More study needed to determine the impact of BFH delivery on differences in breastfeeding outcomes between sub-groups of women.
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Data Availability
Data not associated with a data respository.
Code Availability
Not applicable.
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Acknowledgements
We appreciate the contributions of the Johns Hopkins Team: Patricia Bell-Waddy, Ilene Cervantes del Toro, Jennifer Chen, Chloe Dillaway, Danielle Gaskin and Johns Hopkins WIC staff and the Maryland WIC Program: Jennifer Wilson, Sherri Sabol, Timothy Bringardner, Kristin Perry, Jessica Rosenberger, Maria Carunungan, Connie Riddick, and Tracy Leef and the staff of Harford/Cecil County, Howard County, Frederick County, Southern Maryland Local WIC agencies.
Funding
This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number R40MC30762, Maternal and Child Health Field-initiated Innovative Research Studies Program. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.
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SMG conceptualized and designed the study, supervised data collection and data analyses, drafted the initial manuscript and reviewed and revised the manuscript. DOA collected data, carried out the analyses and contributed to the initial manuscript and reviewed and revised the manuscript. AKR conceptualized and designed the study, coordinated data collection, contributed to the initial manuscript and reviewed and revised the manuscript. KDS reviewed and revised the manuscript. MA, NR and JSF conceptualized and designed the study and reviewed and revised the manuscript. LC conceptualized and designed the study, supervised data analyses, contributed to the initial manuscript and reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
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The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
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This study was reviewed and approved by the Johns Hopkins Bloomberg School of Public Health Institutional Review Board and the Maryland Department of Health Institutional Review Board via expedited review.
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Gross, S.M., Orta-Aleman, D., Resnik, A.K. et al. Baby Friendly Hospital Designation and Breastfeeding Outcomes Among Maryland WIC Participants. Matern Child Health J 26, 1153–1159 (2022). https://doi.org/10.1007/s10995-022-03410-9
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DOI: https://doi.org/10.1007/s10995-022-03410-9