Date of Award

Fall 2018

Document Type

Open Access Dissertation


Health Services and Policy Management

First Advisor

Saundra Glover


Objective: The purpose of this study was to determine whether hospital practices are associated with breastfeeding initiation and breastfeeding duration for ≥10 weeks.

Methods: We analyzed the 2013-2015 South Carolina Pregnancy Risk Assessment Monitoring System (PRAMS) data. The population of interest was mothers who delivered a single live birth in the hospital. The infant was alive and living with the mother at the time of the survey. Chi-square and logistic regression were used to examine breastfeeding initiation and duration among all women who delivered in a hospital and those who stated that they initiated breastfeeding while in the hospital.

Results: Logistic regression was used to analyze hospital staff practices, categorized as the eight steps of the Ten Steps to Successful Breastfeeding, to determine if they were significantly associated with mothers initiating breastfeeding in the hospital as well as the duration of breastfeeding for ≥10 after discharge. In an analysis breastfeeding initiation, six of the eight Steps were found to have a significant association. The Steps that were found to be significantly associated were STEP 3 (OR 6.43, p =0.0011), STEP 4 (OR 28.12, p=

STEP 7 (OR 3.14, p=0.0057), and STEP 8 (OR 6.56, p=<.0001).

For breastfeeding duration, there were three Steps significantly associated with breastfeeding duration of ≥10 weeks. They were STEP 5 (OR 0.41, p=0. 0.0031), STEP 6 (OR 4.55, p=

Conclusions: Our finding suggests that if hospitals focus on policies that support the increase of hospital staff practices that are positively associated with mother's breastfeeding initiation while she is in the hospital, breastfeeding rates in those hospitals could potentially increase. Hospitals that are not designated as baby-friendly but implement or continue practices that support/facilitate breastfeeding could potentially experience rates similar to those facilities deemed Baby-Friendly.

Hospital practices that were found to be significantly associated with breastfeeding initiation and duration were significant regardless of the mother's race, marital status, education, poverty level, BMI, or mental health status. However, cultural competency is important and should be included in their processes.