The purpose of this study was to describe the current status of hospital breastfeeding policies and practices in the Philadelphia area, to assess hospitals' current implementation levels of the Ten Steps to Successful Breastfeeding, and to compare current implementation levels with 1994 baseline data. Most surveyed hospitals were fully implementing 5 of the Ten Steps. Thirty-seven percent of the hospitals were classified as high implementers and 63% as partial implementers of the Ten Steps overall. Key factors that affect implementation of each step were identified through in-depth discussions. Areas identified as needing the greatest attention were breastfeeding education of health care professionals and mothers, prenatal and postdischarge outreach to mothers, and the restriction of infant supplementation. Additionally, ethnic diversity and cultural beliefs of the mother-infant couple that influence breastfeeding choices need to be considered.
In 1991, UNICEF and WHO launched the Baby Friendly Hospital Initiative, a global initiative promoting breastfeeding within hospitals. This article describes the development and use of a detailed questionnaire to acquire baseline data on hospital breastfeeding policies in the southeastern Pennsylvania Delaware Valley and to classify hospitals by their level of implementation of the Baby Friendly Hospital Initiative. The purpose of the questionnaire is twofold: a) to describe and analyze hospitals' breastfeeding policies and practices, and b) to classify hospitals with respect to their level of implementation of each of the Ten Steps and the implementation of the Ten Steps overall.
INTRODUCTIONThe national health objectives for the current decade make a strong commitment to the elimination of disparities in birth outcomes, yet no clear path has proven successful. In urban settings, disparities in birth outcomes may reflect differences in other variables that contribute to overall poor community health-late entry into care, substance abuse~tobacco, alcohol, and drugs!, lack of access to specialty care, fragmented health insurance coverage, poverty, poor housing, stress, and intermittent work patterns.The community health worker model approach responds to this context of women's lives. Community health worker programs for at risk pregnant and newly parenting women focus on outreach and health promotion that build on women's strengths, decrease unhealthy behaviors, provide support and foster compliance with perinatal health protocols in communities where disparities persist. Such assets-based programs may help narrow the disparities gap. Evaluating these programs requires new measures that define how improvements in women's individual capacities to mitigate contextual factors can contribute to healthier pregnancy outcomes.A multiphase study was designed to evaluate the impact of relationships formed between community health workers and their clients from the perspective of the outreach worker. Results of the focus group phase of this study are reported earlier in this issue. This article summarizes results of a community health worker directed evaluation model.
BACKGROUND
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