Commercial hospital discharge packs are one of several factors that influence breastfeeding duration and exclusivity. The distribution of these packs to new mothers at hospitals is part of a longstanding marketing campaign by infant formula manufacturers and implies hospital and staff endorsement of infant formula. Commercial hospital discharge pack distribution should be reconsidered in light of its negative impact on exclusive breastfeeding.

Objective: The objective of this study was to explore the association between the Ten Steps of the Baby Friendly Hospital Initiative (BFHI) of the World Health Organization (Geneva, Switzerland) and breastfeeding at 2 days and 2 weeks. Methods: A 65-question institutional survey assessing compliance with the Ten Steps was used to determine an overall breastfeeding Support Score for each of Oregon's 57 birthing hospitals. Hospital breastfeeding outcomes were obtained from the newborn metabolic screening forms. Results: Hospitals' overall breastfeeding Support Scores ranged from 49.4 to 98.2 out of a possible total score of 100. Hospital compliance with individual Steps ranged from 5.3% for Step 2 (staff training) to 93% for Step 4 (helping with breastfeeding initiation) and Step 8 (encouraging feeding on demand). After controlling for institutional differences (by multivariate linear regression) we found that increases in overall hospital breastfeeding Support Scores were associated with increases in breastfeeding percentage at 2 days (p ϭ 0.021) and at 2 weeks postpartum (p ϭ 0.011). In analyzing each Step individually, however, only the presence of a written hospital policy was independently associated with breastfeeding percent (p ϭ 0.028). Conclusions: This institutional-level evaluation corroborates previous findings demonstrating that increased implementation of the Ten Steps is associated with increased breastfeeding. Further, it suggests that hospitals with comprehensive breastfeeding policies are likely to have better breastfeeding support services and better breastfeeding outcomes. Hospitals may consider using these results to prioritize breastfeeding support services through development of hospital breastfeeding policies and to utilize institutional surveys as a component of breastfeeding quality improvement initiatives.

Bedsharing is common in Oregon. The women most likely to bedshare are non-white, single, breastfeeding and low-income. Non-economic factors are also important, particularly among blacks and Hispanics. Campaigns to decrease bedsharing by providing cribs may have limited effectiveness if mothers are bedsharing because of cultural norms.

Maternal smoking is associated with early weaning. Stopping smoking during pregnancy and decreasing the number of cigarettes smoked postpartum may increase breastfeeding duration.