Perceived barriers and facilitators to breast-feeding support practices in hospitals and birthing facilities in the
Bee-Ah Kang1, Sarah Gonzalez-Nahm2, Sara E Benjamin-Neelon1
1Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD21205, United States.
Objective:
The Baby-Friendly Hospital Initiative (BFHI) designation is known to increase breast-feeding rates in the USA. However, less is known about barriers and facilitators to breast-feeding support practices in BFHI hospitals and how they differ from non-BFHI hospitals. We examined what barriers and facilitators are perceived to affect breast-feeding practices among BFHI and non-BFHI hospital administrators and further explored factors that presented challenges to the adoption and continuation of breast-feeding support practices.
Design:
Cross-sectional study was conducted. We measured whether hospitals were implementing 12 breast-feeding support practices and identified barriers and facilitators to the practices. The survey questionnaire included both structured and open-ended questions.
Setting:
This study included hospital administrators from both BFHI and non-BFHI hospitals from all regions of the USA to help elucidate potential differences.
Participants:
A stratified random sample of 50 % of BFHI and 50 % of non-BFHI hospitals was obtained. The final sample size included 113 BFHI and 177 non-BFHI hospital administrators.
Results:
Low interest among mothers was reported as the most significant barrier to providing breast-feeding support among all administrators. Non-BFHI hospital administrators were more likely to report cost, nursing staff and physician resistance and hospital infrastructure as barriers to initiating practices. In-person training was cited as the most important facilitator among both groups.
Conclusions:
Strengthening prenatal education for mothers and trainings for administrative and nursing staff and physicians is warranted in BFHI and non-BFHI hospitals. Staff management and hospital infrastructure need to be improved particularly in non-BFHI hospitals to provide adequate breast-feeding support for mothers.
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