Abstract
Background
The effect of Breastfeeding Self-efficacy (BFSE) and the Baby-Friendly Hospital Initiative’s (BFHI) 10 Steps on breastfeeding initiation, continuation and exclusivity, is well established. However, direct evidence about the association between the experience of the 10 steps and self-efficacy is limited.
Objective
To assess the association between adherence to the ‘Ten Steps to Successful Breastfeeding’, sociodemographic factors and other predictors with breastfeeding self-efficacy (BFSE) at 48 h and at one month postpartum.
Methods
Implementation of the 10 Steps was assessed based on the self-reported experience on of a consecutive sample of 568 mothers’ across all public (N = 5) and 29 (of 35) private maternity clinics. Data were collected within the first 24–48 h after birth using the WHO/UNICEF Baby Friendly Hospital Initiative questionnaire (Section 4), Sociodemographic information of the participants was also gathered at baseline. BFSE was assessed within 48 h and at 1st month postpartum based on the BFSE-SF scale. Associations of the 10 Steps with BFSE were explored in stepwise linear regression models, examining individual questionnaire items as well as the level of implementation (no, partial or full) of each step except for Step 6 (exclusivity).
Results
Rooming-in emerged as the maternity practice most consistently associated with BFSE both within the first 48 h (β-coeff= 0.38 95 % CI: 0.22, 0.54) and at 1st month (β-coeff= 0.30 95 % CI: 0.12, 0.48). Step 4 (early initiation of BF) and Step 10 (guidance to community support) showed associations with BFSE only within 48 h after birth. Furthemore, mothers who experienced Step 8 (feeding on demand) and Step 9 (no use of a pacifier) were more likely to exhibit higher BFSE levels in the 1st month. Intention to EBF during the first six months and previous breastfeeding experience were identified as significant predictors of BFSE at both 48 h and one month postpartum.
Conclusion
Baby Friendly hospital’s “10 Steps” have varying influence on breastfeeding self-efficacy. Given the role of BFSE in breastfeeding continuation and exclusivity, understanding which practices most enhance it is vital. However, the bi-directional nature of the association should be further explored, as women with higher self-efficacy may also be more likely to seek or advocate for these practices.