Impact After Passage of Public Health Laws Supporting Breastfeeding Mothers: NY Experience

In 2009, NY passed a Breastfeeding (BF) Mothers Bill of Rights (§2505-a) and began public reporting of hospital-specific BF prevalences (§2803-j).  Changes over time in written hospital BF policies; staff attitudes and maternity care practices (hospital surveys); and mother-reports of BF support (Pregnancy Risk Assessment Monitoring System (PRAMS)) were assessed.  Correlations between changes in attitudes and improvement in written policies and reported implementation of maternity care practices (“Ten Steps”) were determined.

The number of hospital BF policy components required by NY regulation or legislation and the number of Ten Steps implemented increased between 2009 and 2011 (both p<.001).  Greater awareness by hospital administrators of hospital-specific BF rates was associated with more emphasis on promoting BF (p<.02).  More emphasis on promoting BF and changes in organizational culture were correlated with greater improvement in written hospital BF policies (p<.02 and p<.0001, respectively) and number of “Ten Steps” implemented (both p<.01)

The mother-reported PRAMS data from 2009 to 2011 corroborated improvement in recommended maternity care practices and BF supports. Among mothers who breast fed, there were increases in: receiving BF education and instructions; being able to feed infant frequently, early, and in response to infant demand; having infant room-in; receiving BF support and contact information at discharge; and not receiving gift bags with formula (all trends, p<.05).  Mothers also reported increased exclusive BF during hospital stay (33.9% to 40.6%) (p<.001).

These findings suggest implementation of state legislation can lead to improved hospital policies and maternity care practices and increased prevalence of exclusive BF.