Can the Ten Step breastfeeding support practices be supported in settings serving low wealth populations without the goal of BFHI achievement?

Background: The achievement of the Ten Steps to Successful Breastfeeding has been shown to be associated with breastfeeding increases in hospital studies seeking Baby-friendly status. This project was unique in that it was undertaken to support the Ten Steps in hospitals that serve low-wealth populations and that did not necessarily intend to seek Baby-friendly status. Methods: Six participating hospitals were systematically assigned to intervention and initial control/later intervention groups. Data were collected from all hospitals at baseline, midterm (after the intervention with the first group), and after intervention with both groups. Data collected included breastfeeding and exclusive breastfeeding rates, health worker KAP, key informant interview, and two methods to assess achievement of the steps. Findings: Data from the three rounds will be presented. Midterm findings include intervention-attributable improvements both in Steps and in breastfeeding rates: 8 out of the 10 steps had intervention associated improvement (i.e., no positive impact on prenatal education or use of pacifiers). Also, both any breastfeeding and exclusive breastfeeding showed intervention-attributable increases, 2.1% and10.3%, respectively. Discussion: Attempts were made to remedy deficiencies in the second phase. Hospital-based studies published to date have reported on hospitals that intended to seek Baby-friendly status. This study selected hospitals serving low wealth populations. This demonstrates the impact in a situation previously unstudied. Conclusions: Improvements are possible in these settings, and improvements in quality of services and breastfeeding outcomes are possible with a goal of increasing the number of steps in place.