Abstract
This study examined the effect of the Baby‐Friendly Hospital Initiative (BFHI) on the breastfeeding rate in Taiwan and analyzed factors related to BFHI qualification. The assessments included 56 hospitals enlisted for appraisal and 7,563 mothers in the maternity wards of these hospitals. Among the 56 hospitals appraised, 38 (67.9%) passed appraisal. Geographically, 88.5% (23/38) of hospitals are located in northern Taiwan, and only one hospital is situated in eastern Taiwan. All 13 medical centers enlisted for appraisal were qualified as BFHI. Only one private clinic passed the appraisal.
We found close correlation between the location of the hospital and passing the appraisal (χ2 = 12.71, p < 0.01), and between the grade of a hospital and BFHI qualification (χ2 = 9.17, p < 0.05). Of the 10 steps to successful breastfeeding practiced in these hospitals, we found that step 10 got the highest scores, with a gain point rate of 94.64%; nonetheless, step 1 had significant power of discrimination regarding appraisal. Statistically, steps 7, 1, and 2 were more significant than any of the other steps.
Mothers in qualified baby‐friendly hospitals had higher breastfeeding rates than those in non‐qualified hospitals, whether they were surveyed while in maternity wards after delivery (88.1% vs 78.1%) or in their first postnatal month (67.6% vs 59.4%).
In conclusion, our study indicates that health policy intervention has a significant impact on increasing the breastfeeding rate in Taiwan.
Keywords: baby‐friendly hospital, appraisal, breastfeeding outcomes
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References
- 1. American Academy of Pediatrics . Breastfeeding: best for baby and mother. AAP Newsletter. 2000; 2: 2–5. [Google Scholar]
- 2. Chen LM, Ho SL, Chen SM, Chen HT. The Model of Maternal‐Child Health Service — Health Promotion Model for Pregnant and Postpartum Women and Neonate. Taipei: Department of Health, Executive Yuan. 1989. [Google Scholar]
- 3. Taiwan Nurses Association . Breastfeeding Taskforce Manual. Taipei: Department of Health, Executive Yuan. 1993. [Google Scholar]
- 4. Liao CC. The Breastfeeding Promotion Plan in Taiwan. Taipei: Taipei City Health Bureau. 1998. [Google Scholar]
- 5. Department of Health, Executive Yuan . Baby‐Friendly Hospital Appraisal Plan. Taipei: Department of Health, Executive Yuan. 1999. [Google Scholar]
- 6. WHO , Wellstant International . Promoting Breastfeeding in Health Facilities: a Short Course for Administrators and Policy‐Makers. Geneva: WHO/Wellstant. 1996. [Google Scholar]
- 7. Saadeh R, Akre J. Ten steps to successful breastfeeding: A summary of the rationale and scientific evidence. Birth. 1996; 23: 154–160. [DOI] [PubMed] [Google Scholar]
- 8. WHO . Evidence for the Ten Steps to Successful Breastfeeding. Geneva: WHO. 1998. [Google Scholar]
- 9. Anderson E, Geden E. Nurses' knowledge of breastfeeding. Journal of Obstetric, Gynecologic & Neonatal Nursing. 1991; 20: 58–64. [DOI] [PubMed] [Google Scholar]
- 10. Su YC, Chen WD, Chang SC, et al. The promotion of breast‐feeding: an evaluation of a program in the nursery. J Nurs Res (Taiwan). 1994; 2: 217–225. [Google Scholar]
- 11. Wright A, Rice S, Wells S. Changing hospital practices to increase the duration of breastfeeding. Pediatrics. 1996; 97: 669–675. [PubMed] [Google Scholar]
- 12. Righard L, Alade MO. Breastfeeding and the use of pacifiers. Birth. 1997; 24: 116–120. [DOI] [PubMed] [Google Scholar]
- 13. Freed GL, Clark ST, Lohr JA, Sorenson JR. Pediatrician involvement in breastfeeding promotion: a national study of residents and practitioners. Pediatrics. 1995; 96: 490–494. [PubMed] [Google Scholar]
- 14. Dung SW, Su TC, Yang YL, Chang CL. The impact of roomingin care on breastfeeding, mother's emotional disturbance, and feeding method one month after delivery. J Nurs Res (Taiwan). 1995; 3: 181–193. [Google Scholar]
- 15. Gau ML, Chen CH. Midterm report of The effectiveness of implementation of Baby‐Friendly Hospital Initiative on breastfeeding (I). Report of National Science Council Project, Taipei, NSC‐89‐2310‐227‐004, 2000.
- 16. Gau ML. Introduction of Baby‐Friendly Hospital Appraisal Processes. In Taiwan Association of Obstetrics & Gynecology, ed. The Manual of Baby‐Friendly Hospital Appraisal Processes. Taipei: Taiwan Association of Obstetrics & Gynecology. 2000, 4–13. [Google Scholar]
- 17. Department of Health, Executive Yuan . Criteria of Baby‐Friendly Hospital Appraisal. Taipei: Department of Health, Executive Yuan. 2000, Meeting Minutes (#8901254). [Google Scholar]
- 18. Taiwan Association of Obstetrics & Gynecology . Declaratory statute of Baby‐Friendly Hospital Appraisal Process. Taipei: Taiwan Association of Obstetrics & Gynecology. 2000. [Google Scholar]
- 19. DiGirolamo AM, Grummer‐Strawn LM, Fein S. Maternity care practice: implications for breastfeeding. Birth. 2001; 28: 94–100. [DOI] [PubMed] [Google Scholar]