Title: Baby-friendly hospital practices in Shiraz

Introduction: There is evidence that the Baby-Friendly Hospital Initiative (BFHI) results in improved breastfeeding outcomes in Western countries but little is known of its impact in Middle-Eastern countries. The aim of this study was to investigate the extent to which a cohort of urban Iranian mothers experienced baby-friendly hospital practices, and in turn the impact of individual and cumulative practices on the duration of full breastfeeding to six months postpartumMethods: This study aimed to investigate the impact of BFHI practices on duration of full breastfeeding in a cohort of 700 Iranian mothers recruited from maternity hospitals in Shiraz and followed-up prospectively for 6 months. Data on breastfeeding outcomes were collected at 1, 3, 4 and 6 months postpartum. Chi Square analysis was used to explore the bivariate association of maternal characteristics and infant characteristics with each of the seven steps. The relationship between each BFHI step and the likelihood of discontinuing full breastfeeding was investigated in a bivariate Cox proportional hazard regression analysis for the total sample. Finally, a stepwise, multivariable Cox regression analysis was conducted initially as a base model using categorised number of BFHI steps as the primary explanatory variable and duration of full breastfeeding as the outcome.Results: Mothers reported experiencing on average 3.9 (SD 1.13, range 1 to 7) steps and only 28% of infants were fully breastfed to 6 months. There was a protective dose-response relationship for primiparous (p for trend = .022), but not multiparous mothers (p for trend = .069), between the number of steps a woman was exposed to and the likelihood of her discontinuing full breastfeeding within six months postpartum. For both primiparous and multiparous mothers, lack of exposure to Steps 4 and 6 was associated with an increased likelihood of discontinuing full breastfeeding.Conclusion: Although the initiation of breastfeeding in this cohort was near universal, and nine out of ten infants were still being breastfed at 6 months of age, only a quarter of infants were fully breastfed at 6 months of age. Greater exposure to BFHI practices would substantially increase primiparous mothers’ chances of fully breastfeeding to 6 months. Continual monitoring of the BFHI steps and repeated education of healthcare staff are required to ensure that Iranian mothers receive adequate breastfeeding support.

Keywords:

Baby-Friendly Hospital Initiative , hospital practices , breastfeeding duration