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.
Objectives The implementation of the “10 Step” programme of WHO/UNICEF for breastfeeding promotion (BFP) in maternity hospitals is considered as a key for long-term breastfeeding success of mothers worldwide. The objective of this work was to determine whether this expectation also holds true for Germany. Methods The nationwide SuSe II study (2017–19) is a combination of a cross-sectional survey in maternity hospitals and a prospective follow-up of mother-infant pairs (0.5, 2, 4, 6, 12 months postpartum (pp)) recruited in the participating hospitals. All German maternity hospitals were invited to complete an online questionnaire assessing BFP based on the 10 Steps. Mothers reported if they were breastfeeding and if the infant received any other fluid or food. Relevant factors for exclusive breastfeeding (EBF) during the first 4 months pp were determined in 5 multivariable models with variable selection through backward elimination according to the likelihood ratio. Results One hundred and three hospitals (15% out of 692) recruited 929 mothers (33% of eligible mothers) who had tried to breastfeed, with a compliance of about 90%. During hospital stay, 74% of mothers exclusively breastfed, 77% at discharge, 74% 2 weeks, 70% 2 months and 58% 4 months pp. Hospitals had implemented between 2 and 10 Steps (median 7). Until 4 months pp, the rate of EBF was higher, if mothers had given birth in hospitals with a high BFP (≥9 Steps) compared to medium (6–8 Steps) or low promotion (≤5 Steps). Even after adjusting for potential confounders, high BFP compared to medium and low promotion significantly increased the modeled odds of mothers for EBF during hospital stay (p = 0.000), at discharge (p = 0.005) and 2 months pp (p = 0.002). Maternal breastfeeding experience and absence of a pacifier significantly increased the modeled odds of mothers for EBF at all 5 time points pp. Conclusions Implementation of at least 9 of the 10 Steps for BFP in hospitals was related to mothers' breastfeeding success in the first 2 months. It is noteworthy that this association was found even at the high level of BFP in hospitals and the high initial breastfeeding rates in the SuSe II study. Funding Sources Funding: Federal Ministry of Food and Agriculture Client: German Society for Nutrition.
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