Online Program

Bringing baby-friendly to New Jersey: Breastfeeding outcomes for a statewide implementation approach

Wednesday, November 6, 2013 : 9:42 a.m. - 10:00 a.m.

Lori B. Feldman-Winter, MD, MPH, Department of Pediatrics, The Children's Regional Hospital at Cooper-CMSRU, Camden, NJ
Anne Merewood, PhD, MPH, IBCLC, Division of General Pediatrics, Boston Medical Center, Boston, MA
Charles E. Denk, PhD, MCH Epidemiology Program, NJ Department of Health and Senior Services, Trenton, NJ
Shreya Durvasala, American College of Obstetricians and Gynecologists, Washington, DC
Erin Bunger, MPH, Office of Nutrition and Fitness, NJ Department of Health, Trenton, NJ
Marc Torjman, PhD, Dept. of Anesthesiology, Cooper Medical School of Rowan University, Camden, NJ
Lisa Asare, MPH, Office of the Deputy Commissioner, New Jersey Department of Health, Trenton, NJ
Fran Gallagher, MEd, AAP New Jersey, Hamilton, NJ
Harriet Lazarus, MBA, AAP New Jersey, Hamilton, NJ
Background: The WHO's Baby-Friendly Hospital Initiative (BFHI) relies on the Ten Steps to Successful Breastfeeding to increase breastfeeding initiation, exclusivity, and duration. Research is needed to determine how implementation of the Ten Steps is associated with breastfeeding outcomes in healthy and sick infants. Objective: To determine whether implementation of the Ten Steps was associated with any breastfeeding and exclusive breastfeeding rates in healthy and sick infants In New Jersey. Methods: This quasi-experimental study examined rates of any and exclusive breastfeeding among healthy and NICU populations in 10 NJ hospitals participating in an intensive, state-supported program to help hospitals attain Baby-Friendly designation. Hospitals varied in the number and choice of Steps on which they focused. We compared NJ Electronic Birth Certificate data pre (2010) and post (2012) intervention and assessed the relationship with the number of Steps mastered. Results: The 10 hospitals implemented or improved performance on 2-10 of the Steps. Rates of any breastfeeding increased by 5.2% (from 71.0 to 76.2%; p<0.0001) in healthy infants and 8.7% (from 58.6% to 67.3%; p<0.0001) among infants discharged from the NICU. Exclusive breastfeeding increased by 11.2% (from 38.6% to 49.8%; p<0.0001) in healthy infants and by 3.1% (from 18.8 to 21.9; p=0.093) for infants discharged from the NICU. The number of steps mastered correlated with the increase in exclusive breastfeeding (R=0.68, p=0.03), and the final number of steps mastered was strongly correlated with the final rate of exclusive breastfeeding by hospital (R=0.82, p=0.004). Conclusion: Any and exclusive breastfeeding increased among healthy and sick newborns with an intervention to implement the Ten Steps, and the increase correlated with the number of Steps mastered.

Learning Areas:

Administer health education strategies, interventions and programs
Program planning
Provision of health care to the public
Public health administration or related administration

Learning Objectives:
Identify the association between widespread implementation of the Ten Steps and infant feeding outcomes.

Keyword(s): Breastfeeding, Policy/Policy Development

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been the principal or co-principal investigator of multiple federally supported grant projects focused on breastfeeding, and health systems related to breastfeeding care. Among my research projects has been the study of Baby-Friendly hospital implementation, including in New Jersey, which is the focus of this presentation. I have extensive knowledge about the project being described in this talk, and have worked in the field of breastfeeding/MCH as a physician/researcher for over 10 years.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.