Baby-Friendly Hospitals, Social Determinants of Health, and Disparities in Breastfeeding Initiation in a Low-Income Population, 2017–2020

Abstract

Background: Organizational-level interventions (i.e., Baby-Friendly Hospital Initiative) that support breastfeeding and target breastfeeding initiation are critical to reducing breastfeeding disparities and promoting breastfeeding equity. Research Aim: To determine the association between delivery in a Baby-Friendly accredited hospital and breastfeeding initiation among United States recipients of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Washington DC, the majority of whom report their race as Black. Method: We conducted a secondary analysis of de-identified program data collected as part of routine WIC visits from the Washington DC WIC program, 2017–2020. Women who delivered a firstborn, singleton infant were included ( N = 8,225). Multivariable logistic regression models accounted for social determinants of health and other factors. One set of models included a binary exposure variable (Baby-Friendly accredited vs. non-accredited hospitals), and another set included a categorical exposure variable for hospitals (1) Baby-Friendly accredited, (2) Baby-Friendly activities but not accredited, and (3) neither Baby-Friendly activities nor accredited. Results: Breastfeeding initiation was 57.4% ( n = 1988) for women delivering in accredited hospitals versus 55.4% ( n = 2540) in non-accredited hospitals and multivariable model results were non-significant ( OR = 0.95, 95% CI [0.86, 1.05]). However, more women initiated breastfeeding who delivered in either accredited hospitals (57.4%, n = 1988) or hospitals with Baby-Friendly activities but not accredited (55.9%, n = 2430) compared to those delivering in hospitals with neither (45.3%, n = 110), and multivariable models results concurred (Baby-Friendly accredited hospitals OR = 1.44, 95% CI [1.07, 1.94]; Baby-Friendly activities but not accredited, ( OR = 1.55, 95% CI [1.16, 2.09]). Conclusion: Organizational-level interventions that create hospital environments supportive of breastfeeding initiation are important to promote equity in breastfeeding, but underlying social determinants of breastfeeding outcomes must be addressed.