The role of breastfeeding promotion in German hospitals for exclusive breastfeeding duration. Issue 2 (25th January 2022) - Hockamp, Nele
Abstract: Breastfeeding promotion and support in hospitals is expected to have a positive impact on maternal breastfeeding outcomes. The objective of this study is to examine the association between breastfeeding promotion in maternity hospitals in Germany and exclusive breastfeeding (EBF) rates during the first 4 months. Thus, a nationwide cross‐sectional web‐based survey of breastfeeding promotion was conducted in 103 hospitals. Mother–infant pairs ( n = 962) were recruited at these hospitals for a prospective web‐based survey of breastfeeding status at five‐time points, that is, during a hospital stay, at discharge as well as after 0.5, 2, and 4 months. The hospital analysis was based on the "10 Steps to Successful Breastfeeding" of the World Health Organization and the United Nations Children's Fund, adapted for Germany. Their degree of implementation was stratified by a breastfeeding promotion index (BPI) as low (≤5 steps), medium (6–8 steps), and high (≥9 steps). The association between the BPI and the odds of EBF at each of the five‐time points was estimated by multivariable regression models, adjusting for various maternal factors. At all time points, the proportion of EBF among mothers from high BPI hospitals exceeded the proportion of those from medium or low BPI hospitals. A high BPI was associated with higher odds of EBF during the hospital stay and at discharge, while maternal factors for EBF such as breastfeeding experience and no early use of a pacifier persisted beyond. The high commitment of hospitals and tailored support of mothers is essential for EBF. Abstract : By repeated assessments of breastfeeding status during the first 4 months after birth in a nationwide survey, it was shown that a high level of breastfeeding promotion in the hospital is necessary to get exclusive breastfeeding (EBF) started. Modifiable and nonmodifiable maternal factors remained relevant for EBF beyond the hospital period. Thus, high breastfeeding engagement of hospitals needs to be complemented by tailored pre‐ and postdischarge support for mothers as a critical component of sustained breastfeeding success. Key messages: A high breastfeeding promotion index (BPI) favours exclusive breastfeeding (EBF) in the hospital environment, while maternal factors persisted beyond. Even in a country with a high level of maternal and child care, breastfeeding promotion in hospitals plays a significant role in the successful start of breastfeeding. Maternal factors, primarily breastfeeding experience and no early use of a pacifier, were persistent and stronger predictors of EBF than the BPI. The steps that need to be improved most refer to breastfeeding information, early breastfeeding initiation, and alternative feeding methods. High hospital commitment complemented by tailored, individualised postdischarge support of mothers are critical components for sustained breastfeeding success.