Improving breastfeeding in Philadelphia: Using data to guide practice and policy

In order to improve breastfeeding rates in Philadelphia, resident birth certificate data from 2005-2007 were analyzed to determine differences in reported breastfeeding. Logistic regression analysis found breastfeeding varied significantly by birth hospital, gestational age, birthweight, mother's race/ethnicity, and mother's age. In order to further understand factors influencing breastfeeding, a convenience sample of mothers (n=35 with a total n=80 in progress) with infants in public city health centers was surveyed. Preliminary data analysis shows 70% or more of the women surveyed received breastfeeding information and were encouraged to breastfeed while they were pregnant and had women in their families who breastfed. However, once women delivered, only about 40% report being shown how to breastfeed in the hospital or instructed as to when breastfeed a newborn. Most importantly, while only 42% reported receiving breastfeeding support information, 100% of the women reported receiving free formula samples when they left the hospitals. Additionally, only 45% of the women report pediatric staff at the health centers know about and provide useful information for breastfeeding. Many (approximately 30%) of the women reported no longer breastfeeding and only 25% of respondents reported exclusive breastfeeding at the time of the survey. These analyses point to the need to work directly with hospitals and city pediatric clinics to understand variations in breastfeeding practices and policies. Strong policy development by the citywide MCH office in conjunction with lactation training for hospital and clinic staff supported by the MCH office provide viable and consistent mechanisms for improving breastfeeding rates.