Initiation of breastfeeding in an inner-city patient population: Cross-sectional study

Breastfeeding is an important contributor to child health, but many infants, especially in disadvantaged populations, are not breastfed. Patient records for infants seen in the 8 Philadelphia Department of Public Health-operated FQHC look-alikes during their first year of life were reviewed to determine the proportion who had initiated and sustained breastfeeding in this patient population. 100 charts at each center were randomly selected from infants born from June 1, 2005 through May 31, 2007 who had at least one well child visit during the first year of life. Feeding methods and other data were determined from nursery discharge reports and physician and nurse notes in the chart. Observations were weighted to reflect different probabilities of selection at centers with different patient population sizes. The population was overwhelmingly minority (57% Black, 14% Hispanic, 9% Asian, 6% White, 15% other or not recorded). Forty-two percent had initiated breastfeeding and 7.5% breastfed for 180 days. In this low-income patient population, race/ethnicity, mother's age, birthweight, and premature birth were not significantly associated with breastfeeding initiation or maintenance. There were significant differences in initiation rates between patients born in different hospitals, and between patients seen in different health centers. These relationships did not change in regression analyses controlling for the potential predictors reviewed. Hospital differences in breastfeeding initiation may reflect practice variations such as adoption of the Baby Friendly Hospital Initiative and use of commercial hospital discharge packs as well as demographic differences, e.g., between immigrant and native-born mothers, and the influence of acculturation.