In‐hospital supplementation and subsequent breastfeeding practices in Finland: A cross‐sectional population‐level study

Background The Baby‐Friendly Hospital Initiative suggests that in‐hospital supplementation should be avoided unless medically indicated. The supporting evidence is contradictory, as nonexperimental studies have shown an association between supplementation and decreased breastfeeding rates, whereas trials have failed to do so. The aim of this study was to investigate whether in‐hospital supplementation is associated with exclusive breastfeeding to the age of 5 months and any breastfeeding to the age of 12 months in full‐term, normal‐weight singleton infants. Methods This is a secondary analysis of national‐level, cross‐sectional survey data. The data were collected in child health clinics in Finland. Families attending a regular health examination with a child aged 2 weeks to 12 months were eligible to participate. Full‐term, normal‐weight, singleton infants (n = 3025) were included in this study. Multivariate logistic regression was performed using in‐hospital supplementation and socioeconomic characteristics as covariates and exclusive and any breastfeeding as outcomes. Results In total, 55.3% (n = 1631) of the infants received in‐hospital supplementation. After controlling for socioeconomic factors, in‐hospital supplementation was associated with decreased exclusive breastfeeding to the age of 5 months and with a decrease in any breastfeeding to the age of 7 months. Conclusions Our findings suggest that noncontrolled supplementation, without a trial's rigorous procedures of care, is associated with decreased breastfeeding postdischarge. Both donor milk and infant formula use were associated with lower breastfeeding rates, although the association was stronger with formula use. In clinical settings, liberal, nonmedically indicated supplementation should be avoided.