# Breastfeeding Promotion in Maternity Wards From a Socioeconomic View

## TL;DR

This study shows that hospitals in areas with lower socioeconomic status have less breastfeeding promotion, leading to lower breastfeeding rates at discharge.

## Contribution

It demonstrates that head physicians can estimate socioeconomic status to guide breastfeeding promotion efforts.

## Key findings

- Hospitals in lower socioeconomic areas had lower breastfeeding promotion scores.
- Higher socioeconomic status was linked to higher breastfeeding rates at discharge.
- Physicians' estimates of socioeconomic status were more effective than standard indices.

## Abstract

Social disparities in breastfeeding may result in inequalities of maternal and child health‐related future perspectives. In‐hospital breastfeeding promotion, information, and support impact short‐ and long‐term breastfeeding practices. This study, which was performed in 2021/2022 in the context of the COVID‐19 pandemic, examined prepandemic interrelations between in‐hospital breastfeeding promotion, information, and support in the federal state North Rhine‐Westphalia (NRW), Germany, and the socioeconomic structure of the hospitals' catchment areas. Breastfeeding promotion, information, and support were operationalized using a Breastfeeding Promotion Index (BPI) based on the “Ten Steps to Successful Breastfeeding” postulated by the World Health Organisation (WHO) and the United Nations Children's Fund (UNICEF) and adapted for Germany by the National Breastfeeding Committee. The socioeconomic structure of the districts hosting the hospitals was assessed by the German Index of Socioeconomic Deprivation (GISD), which was developed by the Robert Koch Institute and is established for Public Health issues. This was complemented by the head physicians' estimations of the predominant socioeconomic status in their hospitals' catchment areas. Statistical analyses were performed using the non‐parametric Jonckheere‐Terpstra's test. For correlation analyses, Spearman's Rho and Kendall tau c were used. A low socioeconomic status was associated with a lower BPI and, vice versa, a high socioeconomic status with a higher BPI. These relationships were stronger when using the head physicians' estimations than the GISD. Higher breastfeeding rates at discharge as estimated by the maternity ward staff were favored by a higher BPI and a higher regional socioeconomic status. These data suggest that hospitals may be able to assess their need for intensified breastfeeding promotion and support strategies by identifying the predominant socioeconomic status of their catchment areas. The results also point to the “disproportionate care law” which may still apply in the well‐established German healthcare system.

Head physicians of maternity hospitals are able to accurately estimate the socioeconomic structure of their hospitals' catchment areas, which can serve as a measure for the necessity of intensified breastfeeding promotion activities. Breastfeeding at discharge is more likely in hospitals with a socially advantaged catchment area.