Objectives:
The present study aimed to assess the current state of breastfeeding promotion in hospitals and the prevalence of breastfeeding during the 1st year of life in Germany and to compare the results with a study 20 years earlier.
Design:
In the studies on “breastfeeding and infant nutrition in Germany” named “SuSe”, a cross-sectional survey in hospitals was combined with a subsequent prospective survey of breastfeeding and infant nutrition during the 1st year of life (0.5, 2, 4, 6, 12 months after birth) in mother-infant pairs who were recruited in the hospitals. Written questionnaires and phone calls were used in SuSe I and web-based questionnaires in SuSe II. Breastfeeding promotion and prevalence were evaluated using recommendations from the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF).
Setting:
Two nationwide surveys SuSe I (1997–98) and SuSe II (2017–19).
Participants:
In SuSe I, 177 hospitals and 1717 mother-infant pairs and in SuSe II 109 hospitals and 962 mother-infant pairs were included.
Results:
In SuSe II, hospitals implemented seven of the WHO “Ten Steps to Successful Breastfeeding” to a greater extent than the hospitals in SuSe I. More mothers exclusively breastfed for 4 months (57% vs. 33%) and continued breastfeeding until 6 (78% vs. 48%) and 12 months (41% vs. 13%). In both studies, exclusive breastfeeding decreased between 4 and 6 months of age due to the introduction of complementary feeding.
Conclusions:
In Germany, breastfeeding habits have come closer to the recommendations over the last 20 years.
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.
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