Exposure to Baby-Friendly Hospital Practices and Breastfeeding Outcomes of WIC Participants in Maryland

Kirstie Ducharme-Smith, Susan M. Gross, Amy Resnik, Nadine Rosenblum, Chloe Dillaway, Dania Orta Aleman, Marycatherine Augustyn, Joanne Silbert-Flagg, Laura E. Caulfield

Research output: Contribution to journalArticlepeer-review


Background: The Baby-Friendly Hospital Initiative is an effective intervention to support maternal practices around breastfeeding. However, adherence of hospitals to the Baby-Friendly 10 Steps, as determined from the perspective of women participating in the United States Special Supplemental Nutrition Program for Women, Infants, and Children, has not been assessed. Research Aims: (1) To compare maternal perceptions about maternity practices in Baby-Friendly Hospitals and non-Baby-Friendly Hospitals; (2) to evaluate the associations between degree of exposure to the Baby-Friendly 10 Steps and breastfeeding practices through the first 6 months; and (3) to evaluate whether the receipt of specific Steps was associated with breastfeeding practices through 6 months. Methods: This study was a cross-sectional 2 group comparison, using prospective data collected through a self-report telephone survey and retrospective data gathered from participants’ records. Women (N = 182) participating in four Maryland Special Supplemental Nutrition Program for Women, Infants and Children agencies were recruited. One hundred and eight (59%) participants delivered at designated Baby-Friendly Hospitals; 74 (41%) delivered in non-Baby-Friendly designated hospitals. Logistic regression models were utilized to determine the influence of perceived Step adherence on exclusive breastfeeding. Results: Reported adherence to 10-Steps policies ranged from 10%–85% (lowest for Step 9, highest for Step 10) and only Step 9 (give no pacifiers or artificial nipples to breastfeeding infants) differed according to Baby-Friendly Hospital status. Greater exposure to the 10 Steps was positively associated with exclusive breastfeeding during hospitalization. The lack of perceived adherence to Step 6 (no food or drink other than human milk), Step 9, and the International Code of Marketing of Breast-milk Substitutes (no formula, bottles, or artificial nipples) significantly decreased the likelihood of exclusive breastfeeding through 6 months. Conclusion: Maternal perception of Baby-Friendly Step adherence was associated with exclusive breastfeeding.

Original languageEnglish (US)
Pages (from-to)78-88
Number of pages11
JournalJournal of Human Lactation
Issue number1
StatePublished - Feb 2022


  • Baby-Friendly Hospital Initiative
  • breastfeeding
  • breastfeeding practices
  • infants and children
  • supplemental nutrition program for women

ASJC Scopus subject areas

  • Obstetrics and Gynecology


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