Do Breastfeeding Policies and Practices in Neonatal Intensive Care Units Differ by Baby-Friendly Hospital Initiative Status?

The Baby-Friendly Hospital Initiative (BFHI) was launched in 1991 by the World Health Organization and United Nations International Children's Emergency Fund to promote and support breastfeeding within hospitals. Prior studies have assessed the associations between BFHI and breastfeeding, but there is limited evidence examining the policies and practices in neonatal intensive care units (NICUs) that, in turn, may influence breastfeeding. The goal of this analysis was to assess whether BFHI status was associated with breastfeeding policies and practices in NICUs in a sample of U.S.-based hospitals. A cross-sectional survey was sent to hospital administrators at 1,285 facilities (817 BFHI and 468 non-BFHI) throughout all regions of the United States and assessed whether hospitals were implementing breastfeeding support policies and practices in NICUs. Pearson's chi-squared and Fisher's exact tests were performed to assess associations between BFHI status and reported 6 breastfeeding policies and 11 breastfeeding practices. Among all 259 respondents (BFHI: 68/102 [67%], non-BFHI: 73/157 [47%]), Baby-Friendly status was significantly associated with having specific breastfeeding practices in the NICU (67% versus 47%, = 0.001). More BFHI compared with non-BFHI hospitals reported assessing milk supply of mothers (90% versus 75%, = 0.026) and communicating the medical benefits of breastfeeding (91% versus 75%, = 0.012) to new parents. There were, however, no differences by BFHI status in the other breastfeeding policies and practices.