Date of Award

Fall 5-17-2013

Degree Type


Degree Name

Master of Public Health (MPH)


Public Health

First Advisor

Sheryl Strasser PhD, MPH, MSW, CHES, CPHQ

Second Advisor

Megan Smith, MPH


Background: Breastfeeding is a tremendously important public health topic. Breastfeeding is associated with a myriad of health benefits on nearly all levels within the social ecological model (infants, mothers, families, workplaces, communities and societies). Scientific evidence supports that breastfeeding is associated with decreased obesity and other very costly health conditions that occur across the lifespan. The World Health Organization published 10 guidelines that comprise the Baby Friendly Hospital Initiative [BFHI] standards—which identify birthing facility-level elements that are associated with enhanced breastfeeding adoption rates.

Methods: The purpose of this study was to determine the extent to which birthing facilities in Atlanta incorporate BFHI elements. Lactation policies among hospitals in the City of Atlanta with maternity wards were solicited, reviewed, and rated by two independent reviewers. Additional observations about environmental supports for breastfeeding were also noted.

Results: Four out of 5 eligible hospitals provided their lactation policies for review (80%). Eight of out 10 BFHI elements were present in the 4 hospital policies. One element not present was distribution of reinforcing/educational materials to new mothers—although it was evident in an appendix. Another element that was not clearly stated in one policy was which states that breastfeeding initiation should occur within the first half hour after birth. Observations by reviewers included that ¾ (75%) of study sample were in the midst of drafting new policies. Another note was that ¾ (75%) of study sample was supported by a Centers for Disease Control and Prevention (CDC)/National Initiative for Children’s Healthcare Quality (NICHQ) effort—Best Fed Beginnings.

Conclusions: This study is important as it addresses an unexplored question. Establishing such a baseline reveals that while nearly all the BFHI elements are present within the participating City of Atlanta hospitals, the administrative barriers that pursuit of BFHI accreditation poses should be considered. Given the fact that no hospital in Georgia has BFHI accreditation underscores an important new direction for public health researchers’ attention.