Impact of baby-friendly hospital practices on breastfeeding in Hong Kong

The World Health Organization (WHO) developed the Baby-Friendly Hospital Initiative to improve hospital maternity-care practices that support breastfeeding. In Hong Kong, while no hospitals have yet received the Baby-Friendly status, efforts have been made to improve breastfeeding support. The aim of this study was to examine the impact of baby-friendly hospital practices on breastfeeding duration. A sample of 1189 breastfeeding mother-infant pairs was recruited from four public hospitals in Hong Kong and followed prospectively for up to 12 months. The primary outcome variable was defined as breastfeeding for ≤8 weeks. Predictor variables included six baby-friendly practices: breastfeeding initiation within 1 hour of birth, exclusive breastfeeding while in hospital, rooming-in, breastfeeding on demand, no pacifiers or artificial nipples, and information on breastfeeding support groups provided upon discharge. Only 45.8% of women breastfed for >8 weeks and only 5% of mothers experienced all six baby-friendly practices. After controlling for all other baby-friendly practices and possible confounding variables, exclusive breastfeeding while in hospital was protective against early breastfeeding cessation (OR=0.63; 95% CI 0.44 to 0.92). Compared with mothers who experienced all six baby-friendly practices, mothers who experienced ≤1 baby friendly practice were almost five times more likely to discontinue breastfeeding (OR=4.49; 95% CI 2.15 to 9.38). Greater exposure to baby-friendly practices would substantially increase Hong Kong women's chances of breastfeeding beyond 8 weeks postpartum. To further improve maternity care practices in Hong Kong hospitals, institutional and administrative support are required to ensure all mothers receive adequate breastfeeding support in accordance with WHO guidelines.