Are you Baby-Friendly™? After 20 years, do US maternity staff know the answer?

Background: UNICEF and the WHO launched the Baby-Friendly Hospital Initiative (BFHI) in 1991; in 2011, just over 100 out of a possible 3,500 US hospitals are Baby-Friendly certified. Instituting Baby-Friendly policies is a documented method to improve breastfeeding practices in the hospital setting. When answering questions in related studies on maternity practices, hospital staff have erroneously described their hospital as Baby-Friendly certified. Our goal was to determine whether maternity staff could correctly identify their hospital's status with regard to Baby-Friendly in a large telephone survey. Methods: Research assistants called all 1206 hospitals (Baby-Friendly and not) in 20 states, and asked to be connected to the maternity service. They asked the person answering that phone: “Is your hospital a Baby-Friendly hospital?”, and recorded the respondent's answer and job title. Results: According to publicly available data from Baby-Friendly USA, 41 of the 1206 hospitals (3%) were Baby-Friendly™. However, staff at 644 hospitals (53%), incorrectly stated their hospital was Baby-Friendly. By contrast, staff at all 41 Baby-Friendly hospitals correctly identified their status. Respondents' positions were 53% RNs, 20% Nurse Managers/Unit Directors, 8% medical/technical assistants, 12% secretaries and 7% other. Accuracy of response did not vary dependent on the respondent's position (p=0.09), but respondents in the 9 states with Baby-Friendly hospitals were significantly more likely to be accurate than respondents in the 11 states with no Baby-Friendly hospitals. There was no linear relationship between the number of Baby-Friendly hospitals in a state, and accuracy of response. Conclusion: Although the BFHI was established 20 years ago, over half of maternity staff in US hospitals responding to a comprehensive telephone survey were either not aware of the meaning of “Baby-Friendly hospital”, or incorrectly believed their hospital to be Baby-Friendly certified. Staff response is an unreliable way to measure Baby-Friendly status.