A Geospatial Analysis of the Impact of the Baby-Friendly Hospital Initiative on Breastfeeding Initiation in North Carolina:

Background:Significant disparities in breastfeedingsupport and practice exist in North Carolina. The Baby-Friendly Hospital Initiative is a worldwide intervention that encourages birth facilities to adopt specific practices in support of breastfeeding.Research aim:This study aimed to evaluate the impact of the Baby-Friendly Hospital Initiative on breastfeedinginitiation in North Carolina, with special attention to rural areas.Methods:To better understand disparities in breastfeedinginitiation across North Carolina, we conducted a secondary analysis of birth certificate data from 2011 to 2014. Univariate and multivariate logistic regression models were used to estimate the association between breastfeedinginitiation and (a) birth at a Baby-Friendly hospital and (b) maternal residence in a county with a Baby-Friendly hospital. Model residuals were aggregated by county and analyzed for spatial autocorrelation.Results:Birth at a Baby-Friendly hospital was associated with increased odds of breastfeedingin...