Impact of Baby-Friendly Hospital Practices on Breastfeeding in Hong Kong

Authors

  • Marie Tarrant RN, MPH, PhD,

    1. Marie Tarrant is an Associate Professor and Daniel Y. T. Fong is an Assistant Professor at the School of Nursing, University of Hong Kong; Kendra M. Wu is a Doctoral Student at the School of Public Health, University of Hong Kong; Irene L. Y. Lee is Cluster General Manger (Nursing) in the Hong Kong West Cluster, Queen Mary Hospital; Emmy M. Y. Wong is Assistant Professor in the Department of Health and Physical Education, Hong Kong Institute of Education; Alice Sham is the General Manager (Nursing) at Kwong Wah Hospital; Christine Lam is a Nurse Specialist in the Department of Obstetrics and Gynaecology, Queen Elizabeth Hospital, Hong Kong; and Joan E. Dodgson is an Associate Professor at the College of Nursing & Health Innovation, Arizona State University, Phoenix, Arizona, United States of America.
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  • Kendra M. Wu BSc, MSc, MMedSc,

    1. Marie Tarrant is an Associate Professor and Daniel Y. T. Fong is an Assistant Professor at the School of Nursing, University of Hong Kong; Kendra M. Wu is a Doctoral Student at the School of Public Health, University of Hong Kong; Irene L. Y. Lee is Cluster General Manger (Nursing) in the Hong Kong West Cluster, Queen Mary Hospital; Emmy M. Y. Wong is Assistant Professor in the Department of Health and Physical Education, Hong Kong Institute of Education; Alice Sham is the General Manager (Nursing) at Kwong Wah Hospital; Christine Lam is a Nurse Specialist in the Department of Obstetrics and Gynaecology, Queen Elizabeth Hospital, Hong Kong; and Joan E. Dodgson is an Associate Professor at the College of Nursing & Health Innovation, Arizona State University, Phoenix, Arizona, United States of America.
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  • Daniel Y. T. Fong PhD,

    1. Marie Tarrant is an Associate Professor and Daniel Y. T. Fong is an Assistant Professor at the School of Nursing, University of Hong Kong; Kendra M. Wu is a Doctoral Student at the School of Public Health, University of Hong Kong; Irene L. Y. Lee is Cluster General Manger (Nursing) in the Hong Kong West Cluster, Queen Mary Hospital; Emmy M. Y. Wong is Assistant Professor in the Department of Health and Physical Education, Hong Kong Institute of Education; Alice Sham is the General Manager (Nursing) at Kwong Wah Hospital; Christine Lam is a Nurse Specialist in the Department of Obstetrics and Gynaecology, Queen Elizabeth Hospital, Hong Kong; and Joan E. Dodgson is an Associate Professor at the College of Nursing & Health Innovation, Arizona State University, Phoenix, Arizona, United States of America.
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  • Irene L. Y. Lee RN, RM, MHA, MPHC,

    1. Marie Tarrant is an Associate Professor and Daniel Y. T. Fong is an Assistant Professor at the School of Nursing, University of Hong Kong; Kendra M. Wu is a Doctoral Student at the School of Public Health, University of Hong Kong; Irene L. Y. Lee is Cluster General Manger (Nursing) in the Hong Kong West Cluster, Queen Mary Hospital; Emmy M. Y. Wong is Assistant Professor in the Department of Health and Physical Education, Hong Kong Institute of Education; Alice Sham is the General Manager (Nursing) at Kwong Wah Hospital; Christine Lam is a Nurse Specialist in the Department of Obstetrics and Gynaecology, Queen Elizabeth Hospital, Hong Kong; and Joan E. Dodgson is an Associate Professor at the College of Nursing & Health Innovation, Arizona State University, Phoenix, Arizona, United States of America.
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  • Emmy M. Y. Wong RN, MN, PhD,

    1. Marie Tarrant is an Associate Professor and Daniel Y. T. Fong is an Assistant Professor at the School of Nursing, University of Hong Kong; Kendra M. Wu is a Doctoral Student at the School of Public Health, University of Hong Kong; Irene L. Y. Lee is Cluster General Manger (Nursing) in the Hong Kong West Cluster, Queen Mary Hospital; Emmy M. Y. Wong is Assistant Professor in the Department of Health and Physical Education, Hong Kong Institute of Education; Alice Sham is the General Manager (Nursing) at Kwong Wah Hospital; Christine Lam is a Nurse Specialist in the Department of Obstetrics and Gynaecology, Queen Elizabeth Hospital, Hong Kong; and Joan E. Dodgson is an Associate Professor at the College of Nursing & Health Innovation, Arizona State University, Phoenix, Arizona, United States of America.
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  • Alice Sham RN, RM, MSc, MBA,

    1. Marie Tarrant is an Associate Professor and Daniel Y. T. Fong is an Assistant Professor at the School of Nursing, University of Hong Kong; Kendra M. Wu is a Doctoral Student at the School of Public Health, University of Hong Kong; Irene L. Y. Lee is Cluster General Manger (Nursing) in the Hong Kong West Cluster, Queen Mary Hospital; Emmy M. Y. Wong is Assistant Professor in the Department of Health and Physical Education, Hong Kong Institute of Education; Alice Sham is the General Manager (Nursing) at Kwong Wah Hospital; Christine Lam is a Nurse Specialist in the Department of Obstetrics and Gynaecology, Queen Elizabeth Hospital, Hong Kong; and Joan E. Dodgson is an Associate Professor at the College of Nursing & Health Innovation, Arizona State University, Phoenix, Arizona, United States of America.
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  • Christine Lam RN, RM, MMW, IBCLC,

    1. Marie Tarrant is an Associate Professor and Daniel Y. T. Fong is an Assistant Professor at the School of Nursing, University of Hong Kong; Kendra M. Wu is a Doctoral Student at the School of Public Health, University of Hong Kong; Irene L. Y. Lee is Cluster General Manger (Nursing) in the Hong Kong West Cluster, Queen Mary Hospital; Emmy M. Y. Wong is Assistant Professor in the Department of Health and Physical Education, Hong Kong Institute of Education; Alice Sham is the General Manager (Nursing) at Kwong Wah Hospital; Christine Lam is a Nurse Specialist in the Department of Obstetrics and Gynaecology, Queen Elizabeth Hospital, Hong Kong; and Joan E. Dodgson is an Associate Professor at the College of Nursing & Health Innovation, Arizona State University, Phoenix, Arizona, United States of America.
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  • Joan E. Dodgson RN, MPH, PhD

    1. Marie Tarrant is an Associate Professor and Daniel Y. T. Fong is an Assistant Professor at the School of Nursing, University of Hong Kong; Kendra M. Wu is a Doctoral Student at the School of Public Health, University of Hong Kong; Irene L. Y. Lee is Cluster General Manger (Nursing) in the Hong Kong West Cluster, Queen Mary Hospital; Emmy M. Y. Wong is Assistant Professor in the Department of Health and Physical Education, Hong Kong Institute of Education; Alice Sham is the General Manager (Nursing) at Kwong Wah Hospital; Christine Lam is a Nurse Specialist in the Department of Obstetrics and Gynaecology, Queen Elizabeth Hospital, Hong Kong; and Joan E. Dodgson is an Associate Professor at the College of Nursing & Health Innovation, Arizona State University, Phoenix, Arizona, United States of America.
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  • Funding for this study was provided by the Health and Health Services Research Fund, Government of the Hong Kong Special Administrative Region, Hong Kong SAR (Grant No. 05060721), the University of Hong Kong, Hong Kong SAR (Grant No. 10207306), the University of Hong Kong Strategic Research Theme of Public Health, and the School of Nursing, University of Hong Kong.

Address correspondence to Marie Tarrant, RN, MPH, PhD, School of Nursing, 4/F, William M. W. Mong Block, Li Ka Shing Faculty of Medicine, 21 Sassoon Road, Hong Kong.

Abstract

Abstract:  Background:  The World Health Organization (WHO) developed the Baby-Friendly Hospital Initiative to improve hospital maternity care practices that support breastfeeding. In Hong Kong, although no hospitals have yet received the Baby-Friendly status, efforts have been made to improve breastfeeding support. The aim of this study was to examine the impact of Baby-Friendly hospital practices on breastfeeding duration.

Methods:  A sample of 1,242 breastfeeding mother-infant pairs was recruited from four public hospitals in Hong Kong and followed up prospectively for up to 12 months. The primary outcome variable was defined as breastfeeding for 8 weeks or less. Predictor variables included six Baby-Friendly practices: breastfeeding initiation within 1 hour of birth, exclusive breastfeeding while in hospital, rooming-in, breastfeeding on demand, no pacifiers or artificial nipples, and information on breastfeeding support groups provided on discharge.

Results:  Only 46.6 percent of women breastfed for more than 8 weeks, and only 4.8 percent of mothers experienced all six Baby-Friendly practices. After controlling for all other Baby-Friendly practices and possible confounding variables, exclusive breastfeeding while in hospital was protective against early breastfeeding cessation (OR: 0.61; 95% CI: 0.42–0.88). Compared with mothers who experienced all six Baby-Friendly practices, those who experienced one or fewer Baby-Friendly practices were almost three times more likely to discontinue breastfeeding (OR: 3.13; 95% CI: 1.41–6.95).

Conclusions:  Greater exposure to Baby-Friendly practices would substantially increase new mothers’ chances of breastfeeding beyond 8 weeks postpartum. To further improve maternity care practices in hospitals, institutional and administrative support are required to ensure all mothers receive adequate breastfeeding support in accordance with WHO guidelines. (BIRTH 38:3 September 2011)

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