Effect on Baby-Friendly Hospital Steps When Hospitals Implement a Policy to Pay for Infant Formula

Marie Tarrant, Kris Y.W. Lok, Daniel Y.T. Fong, Kendra M. Wu, Irene L.Y. Lee, Alice Sham, Christine Lam, Dorothy Li Bai, Ka Lun Wong, Emmy M.Y. Wong, Noel P.T. Chan, Joan E. Dodgson

Research output: Contribution to journalArticlepeer-review

17 Citations (Scopus)


Background: The Baby-Friendly Hospital Initiative requires hospitals to pay market price for infant formula. No studies have specifically examined the effect of hospitals paying for infant formula on breastfeeding mothers' exposure to Baby-Friendly steps. Objectives: To investigate the effect of hospitals implementing a policy of paying for infant formula on new mothers' exposure to Baby-Friendly steps and examine the effect of exposure to Baby-Friendly steps on breastfeeding rates. Methods: We used a repeated prospective cohort study design. We recruited 2 cohorts of breastfeeding mother-infant pairs (n = 2470) in the immediate postnatal period from 4 Hong Kong public hospitals and followed them by telephone up to 12 months postpartum. We assessed participants' exposure to 6 Baby-Friendly steps by extracting data from the medical record and by maternal self-report. Results: After hospitals began paying for infant formula, new mothers were more likely to experience 4 out of 6 Baby-Friendly steps. Breastfeeding initiation within the first hour increased from 28.7% to 45%, and in-hospital exclusive breastfeeding rates increased from 17.9% to 41.4%. The proportion of mothers who experienced all 6 Baby-Friendly steps increased from 4.8% to 20.5%. The risk of weaning was progressively higher among participants experiencing fewer Baby-Friendly steps. Each additional step experienced by new mothers decreased the risk of breastfeeding cessation by 8% (hazard ratio = 0.92; 95% CI, 0.89-0.95). Conclusion: After implementing a policy of paying for infant formula, breastfeeding mothers were exposed to more Baby-Friendly steps, and exposure to more steps was significantly associated with a lower risk of breastfeeding cessation.

Original languageEnglish
Pages (from-to)238-249
Number of pages12
JournalJournal of Human Lactation
Issue number2
Publication statusPublished - May 2016
Externally publishedYes


  • Baby-Friendly Hospital
  • breastfeeding
  • Hong Kong
  • infant formula

ASJC Scopus subject areas

  • Obstetrics and Gynaecology


Dive into the research topics of 'Effect on Baby-Friendly Hospital Steps When Hospitals Implement a Policy to Pay for Infant Formula'. Together they form a unique fingerprint.

Cite this