Baby Friendly Hospital Designation and Breastfeeding Outcomes Among Maryland WIC Participants

Susan M. Gross, Dania Orta-Aleman, Amy Kovar Resnik, Kirstie Ducharme-Smith, Marycatherine Augustyn, Jo Anne Silbert-Flagg, Nadine Rosenblum, Laura E. Caulfield

Research output: Contribution to journalArticlepeer-review


Objectives: The Baby-Friendly Hospital Initiative is an effective intervention to support maternal practices around breastfeeding. However, little is known about its impact on participants of the Special Supplemental Nutrition Program for Women, Infants and Children (WIC). The purpose of this study was to evaluate whether Baby Friendly Hospital (BFH) designation in Maryland improved breastfeeding practices among Special Supplemental Nutrition Program for Women, Infants and Children (WIC) participants. Methods: Breastfeeding practices of WIC participants (22,543 mother-infant dyads) were analyzed utilizing WIC management information system de-identified data from four Maryland WIC agencies during 2010–12 and 2017–19. Participants lived in areas served by a hospital that became BFH in 2016 or remained non-BFH. Pre–post implementation breastfeeding practices (breastfeeding initiation, at 3 months and 6 months) of women associated with a BFH were compared to women associated with a non-BFH using propensity score weighting and a difference-in-difference modeling. Results: From pre to post intervention no differences in breastfeeding initiation or any breastfeeding at 6 months were attributable to BFH status. There was some evidence that BFH designation in 2016 was associated with an absolute percent change of 2.4% (P = 0.09) for any breastfeeding at 3 months. Discussion: Few differences in breastfeeding outcomes among WIC participants were attributable to delivery in a BFH. Results from this study inform policy about maternity practices impacting WIC breastfeeding outcomes. More study needed to determine the impact of BFH delivery on differences in breastfeeding outcomes between sub-groups of women.

Original languageEnglish (US)
Pages (from-to)1153-1159
Number of pages7
JournalMaternal and child health journal
Issue number5
StatePublished - May 2022


  • Baby Friendly Hospital Initiative
  • Breastfeeding
  • Special Supplemental Nutrition Program for Women Infants and Children (WIC)

ASJC Scopus subject areas

  • Epidemiology
  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology
  • Public Health, Environmental and Occupational Health


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