Outcomes from the Centers for Disease Control and Prevention 2018 Breastfeeding Report Card: Public Policy Implications

Published:October 14, 2019DOI:https://doi.org/10.1016/j.jpeds.2019.08.059

      Objectives

      To compare the impact of Baby-Friendly designation vs rates of in-hospital breastfeeding initiation on breastfeeding outcomes at 3, 6, and 12 months postdischarge.

      Study design

      Breastfeeding outcome data from the 2018 Centers for Disease Control (CDC) Breastfeeding Report Card were used as a basis for determining outcomes from the corresponding 2015 birth cohort. Linear regression models were used to determine the strength of association of breastfeeding initiation and Baby-Friendly hospital penetrance and attainment of postdischarge breastfeeding rates. All hospital births from all 50 states, 3 territories, and the District of Columbia were included in the study.

      Results

      Statewide breastfeeding initiation rates were positively associated with targeted breastfeeding outcomes. Similar associations were not found for Baby-Friendly hospital designation penetrance.

      Conclusions

      To attain the Healthy People 2020 breastfeeding objectives, future public policy initiatives should consider the interaction of population demographics, individual hospital programs, and public health strategies used to support breastfeeding in states reporting high breastfeeding initiation rates.

      Keywords

      Abbreviations:

      BFHI ( Baby-Friendly Hospital Initiative), CDC ( Centers for Disease Control), HP2020 ( Healthy People 2020), SUPC ( Sudden unexpected postnatal collapse), WHO ( World Health Organization)
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      Linked Article

      • Trends in Breastfeeding Interventions, Skin-to-Skin Care, and Sudden Infant Death in the First 6 Days after Birth
        The Journal of PediatricsVol. 218
        • In Brief
          To determine if implementation of skin-to-skin care and the Baby-Friendly Hospital Initiative (BFHI) contributes to sudden unexpected infant death (SUID) and asphyxia in the first 6 days after birth.
        • Full-Text
        • PDF
      • Breastfeeding, Baby-Friendly, and Safety: Getting the Balance Right
        The Journal of PediatricsVol. 218
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          Breastfeeding has multiple health and social benefits and is regarded by most experts, including the American Academy of Pediatrics, as the optimal feeding practice for newborns. Even so, in the US, rates of breastfeeding initiation and continued breastfeeding at 6 and 12 months remain well below Healthy People 2020 national goals. In 1991, the World Health Organization and the United Nations Children's Fund launched the Baby-Friendly Hospital Initiative to improve breastfeeding initiation at birth and breastfeeding duration through the first year of life.
        • Full-Text
        • PDF
      • Use of cross-sectional design for determining Baby-Friendly success
        The Journal of PediatricsVol. 219
        • In Brief
          The publication by Bass, Gartley, and Kleinman relating breastfeeding rates and Baby-Friendly penetration among states found no correlation, and concluded that the Baby-Friendly Hospital Initiative (BFHI) has been unsuccessful in improving US breastfeeding rates.1 However, we suggest that such a conclusion is incorrect because a cross-sectional study design cannot determine the effectiveness of an intervention. This goal is best accomplished using a randomized control trial, such as PROBIT, which showed a marked improvement in exclusive breastfeeding rates at 3 and 6 months.
        • Full-Text
        • PDF