Maternal Country of Birth and Exclusive Breastfeeding During the First In-Hospital Day in Portugal: The Influence of the Baby-Friendly Hospital Initiative

Abstract

Background Early breastfeeding practices are important determinants of later breastfeeding behaviors and can be influenced by multiple factors. Despite the Baby-Friendly Hospital Initiative reported positive influence on breastfeeding initiation, its influence on the association between maternal country of birth and first day in-hospital breastfeeding has not been examined. Research aims To determine (1) if association between maternal country of birth and first day in-hospital exclusive breastfeeding exists in Portugal and (2) if any association is affected by giving birth in a Baby-Friendly Hospital. Methods Data were drawn from baMBINO—a longitudinal, 2017–2019 nationwide study designed to assess the perinatal health and healthcare experiences of migrant and native Portuguese women. Data from participants (N = 5,340) were collected during their hospital stay from 32 maternity units. Missing data were handled through multiple imputation. After stratifying by Baby-Friendly Hospital Initiative accreditation, a multivariate logistic regression was performed. Results First day in-hospital exclusive breastfeeding rates were high among both migrant and native participants (89.2% vs. 87.4%). Migrants were more likely to exclusively breastfeed when compared to natives (OR = 1.19, 95% CI [1.00, 1.41]). In non-Baby-Friendly Hospitals, a positive association was found between participants from Eastern European countries (aOR = 2.46, 95% CI [1.27, 4.78]) and first day in-hospital exclusive breastfeeding. In accredited hospitals, maternal country of birth did not influence exclusive breastfeeding during the first 24 hr. Conclusions The Baby-Friendly Hospital Initiative attenuates differences between migrant and native participants, promoting optimal breastfeeding practices among natives.