Date of Award




Document Type


Degree Name

Doctor of Public Health (DrPH)


Department of Epidemiology and Biostatistics



Content Description

1 online resource (iii, 102 pages) : color illustrations, map.

Dissertation/Thesis Chair

David Strogatz

Committee Members

Barbara A Dennison, Trang Nguyen, Marilyn A Kacica


breastfeeding, maternity care, mPINC, PRAMS, Breastfeeding, Breastfeeding promotion, Hospitals, New mothers

Subject Categories

Public Health


Prevalence of breastfeeding initiation in New York State (NYS) nearly meets Healthy People 2020 goals. Improvements in breastfeeding duration and exclusive breastfeeding (EBF) have lagged behind those achieved for initiation. Implementation of Ten Steps to Successful Breastfeeding in hospital maternity care has improved breastfeeding initiation, duration and exclusivity; but data on the independent association with specific Steps have been equivocal. Utilizing NYS-linked data from the Maternity Practices in Infant Nutrition and Care (mPINC) and the Pregnancy Risk Assessment Monitoring System (PRAMS), the associations of individual maternity care practices/Steps with breastfeeding behaviors were evaluated. Analyses included mothers who participated in PRAMS and gave birth to a healthy infant in a NYS hospital that participated in mPINC in 2007. The weighted sample represented 116,198 new mothers, 15.9% of whom did not initiate breastfeeding. For mothers who initiated breastfeeding, 75% breastfed for eight weeks or longer and 36.8% breastfed exclusively eight weeks or longer. Mothers giving birth in a hospital reporting incomplete achievement of Step 7 ‘practice rooming-in’ had twice the odds (AOR=2.14 (95% CI:1.19,3.88 ) of not initiating breastfeeding, after adjustment for maternal demographic and hospital characteristics. Mothers who gave birth in a hospital that reported achieving Step 5 ‘Show mothers’ how to breastfeed’ had a RR=1.77 (95% CI: 1.42-2.20) for EBF eight weeks or longer, after adjustment for maternal demographic and hospital characteristics. Mothers at hospitals fully implementing Step 5 were 50% more likely to breastfeed for at least 2 months (RR=1.54, 95% CI: 1.18-2.02). No other separate maternity care practices/Steps were significantly associated with these breastfeeding outcomes. Full implementation of ‘rooming-in’ by hospitals serving populations at higher risk for non-initiation may reduce disparities in breastfeeding initiation. Among women who initiate breastfeeding, levels of EBF and recommended duration are substantially below 50%. Ensuring mothers are shown how to breastfeed by trained providers during their hospital stay is especially warranted since Step 5 predicted EBF and duration. The socio-ecological model of breastfeeding suggests the importance of other maternity care practices/Steps may be revealed by analyses of interactions representing interdependent influences on breastfeeding decisions.

Included in

Public Health Commons