BREAST-FEEDING POLICIES AND PRACTICES IN CANADIAN HOSPITALS PROVIDINGMATERNITY CARE

Objective: To determine the extent to which policies and practices of Canadian hospitals providing maternity care are consistent with the Wo rld Health Organization (WHO)/UNICEF 10 Steps to Successful Breastfeed ing, the WHO International Code of Marketing of Breast-Milk Substitute s and the WHO/UNICEF Baby Friendly Hospital Initiative. Design: Cross- sectional mailed survey. Setting: Canada. Participants: Representative s of 572 hospitals providing maternity care across Canada were sent a questionnaire in the spring and summer of 1993, 523 (91.4%) responded. Outcome measures: Self-reported implementation of policies and practi ces concerning infant feeding, hospitals were grouped according to loc ation, size (number of live births per year) and university affiliatio n status. Main results: Although 58.4% (296/507) of the respondents re ported that their hospital had a written policy on breast-feeding, onl y 4.6% (21/454) reported having one that complied with all of the WHO/ UNICEF steps surveyed. This figure dropped to 1.3% (6/453) when compli ance with the WHO code (distribution of free samples of formula to for mula-feeding and breast-feeding mothers) was added. Hospitals in Quebe c and the Prairie provinces were significantly more likely than those in Ontario to give free samples of formula to both breast-feeding (OR 2.39 [95% confidence interval (CI) 1.39 to 4.09] and 20.22 [95% CI 9.2 7 to 44.33] respectively) and formula-feeding mothers (OR 1.82 [95% CI 1.07 to 3.11] and 8.03 [95% CI 3.29 to 19.6] respectively), after adj ustment for hospital size and university affiliation status. Conclusio n: There are considerable variations in the implementation of individu al WHO steps and provisions of the WHO code according to hospital loca tion, size and university affiliation status. Very few Canadian hospit als meet all of the criteria that would enable them to be considered ' 'baby friendly'' according to the WHO/UNICEF definition.