{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T17:45:28Z","timestamp":1791913528996,"version":"4.3.4"},"reference-count":29,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T00:00:00Z","timestamp":1791676800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Breastfeeding Medicine"],"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Breastfeeding improves maternal and infant health, reducing risks of cancer, diabetes, cardiovascular disease, and infant mortality. Despite national gains in breastfeeding initiation, disparities persist in exclusivity and duration across social determinants of health (SDOH). The Baby-Friendly Hospital Initiative (BFHI) promotes evidence-based maternity care practices to support breastfeeding, yet its effectiveness across diverse populations remains unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>This study examined whether BFHI designation is associated with breastfeeding outcomes including initiation, exclusive breastfeeding at 8 weeks, and any breastfeeding at 8 weeks among Oklahoma mothers who delivered between 2016 and 2018, and whether these associations differ across SDOH including race, ethnicity, household income, educational attainment, marital status, maternal age, parity, and geographic location.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      A retrospective secondary analysis of linked Oklahoma Pregnancy Risk Assessment Monitoring System and birth certificate data (2016\u20132018;\n                      <jats:italic toggle=\"yes\">N<\/jats:italic>\n                      = 4,234) was conducted. Weighted logistic regression estimated associations between BFHI designation and breastfeeding outcomes, stratified by SDOH, and adjusted for demographic and socioeconomic factors.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>BFHI designation at birth facility was associated with higher odds of initiation among primiparous mothers (adjusted odds ratio [aOR] = 1.89, 95% confidence interval [CI]: [0.98\u20133.64]), Native American mothers (aOR = 1.43, 95% CI: [0.95\u20132.15]), and unmarried mothers (aOR = 1.34, 95% CI: [0.89\u20132.03]). Among mothers with moderate household income ($24,001\u2013$48,000), BFHI designation was associated with significantly greater odds of exclusive breastfeeding at 8 weeks (aOR = 1.85, 95% CI: [1.19\u20132.89]); a similar, nonsignificant pattern was observed for any breastfeeding at 8 weeks (aOR = 1.63, 95% CI: [0.99\u20132.70]).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>BFHI demonstrates differential effects across SDOH, benefiting first-time and moderate-income mothers but not Black mothers. Culturally responsive nursing care and tailored interventions are needed to achieve breastfeeding equity.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/15568253261496653","type":"journal-article","created":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T05:04:28Z","timestamp":1791781468000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Baby-Friendly Hospital Initiative and Breastfeeding Outcomes Across Social Determinants of Health in Oklahoma, USA: A Secondary Data Analysis"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3500-7686","authenticated-orcid":false,"given":"Ingrid R.","family":"Wilhelm","sequence":"first","affiliation":[{"name":"Fran and Earl Ziegler College of Nursing, University of Oklahoma Health Campus, Oklahoma City, Oklahoma, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily J.","family":"Jones","sequence":"additional","affiliation":[{"name":"Fran and Earl Ziegler College of Nursing, University of Oklahoma Health Campus, Oklahoma City, Oklahoma, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark J.","family":"Fisher","sequence":"additional","affiliation":[{"name":"Fran and Earl Ziegler College of Nursing, University of Oklahoma Health Campus, Oklahoma City, Oklahoma, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie A.","family":"Gordon","sequence":"additional","affiliation":[{"name":"Fran and Earl Ziegler College of Nursing, University of Oklahoma Health Campus, Oklahoma City, Oklahoma, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anitra C.","family":"Frederick","sequence":"additional","affiliation":[{"name":"Cizik School of Nursing, The University of Texas Health Science Center at Houston, Houston, Texas, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer D.","family":"Peck","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Campus, Oklahoma City, Oklahoma, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,10,11]]},"reference":[{"key":"e_1_3_4_2_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2022-057988"},{"key":"e_1_3_4_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/heapol\/czae069"},{"key":"e_1_3_4_4_1","unstructured":"3.Centers for Disease Control and Prevention. Breastfeeding report card: United States 2022. CDC: Atlanta GA; 2022. Available from: https:\/\/www.cdc.gov\/breastfeeding\/data\/reportcard.htm"},{"key":"e_1_3_4_5_1","unstructured":"4.Office of Disease Prevention and Health Promotion. Healthy People 2030. U.S. Department of Health and Human Services: Washington DC; 2020. Available from: https:\/\/health.gov\/healthypeople"},{"key":"e_1_3_4_6_1","doi-asserted-by":"publisher","DOI":"10.21106\/ijma.271"},{"key":"e_1_3_4_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/heapol\/czz050"},{"key":"e_1_3_4_8_1","unstructured":"7.World Health Organization. Protecting promoting and supporting breastfeeding: The special role of maternity services. WHO: Geneva Switzerland; 1991. Available from: https:\/\/apps.who.int\/iris\/handle\/10665\/39679"},{"key":"e_1_3_4_9_1","volume-title":"Guidelines and evaluation criteria for facilities seeking Baby-Friendly designation","author":"Baby-Friendly USA","year":"2023","unstructured":"8.Baby-Friendly USA. Guidelines and evaluation criteria for facilities seeking Baby-Friendly designation. 6th ed. Baby-Friendly USA: Albany, New York; 2023.","edition":"6"},{"key":"e_1_3_4_10_1","doi-asserted-by":"publisher","DOI":"10.1089\/bfm.2015.0135"},{"key":"e_1_3_4_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/mcn.12294"},{"key":"e_1_3_4_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/NMC.0000000000001205"},{"key":"e_1_3_4_13_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12939-021-01432-3"},{"key":"e_1_3_4_14_1","doi-asserted-by":"publisher","DOI":"10.1177\/21650799231167580"},{"key":"e_1_3_4_15_1","doi-asserted-by":"publisher","DOI":"10.1017\/S1368980014000238"},{"key":"e_1_3_4_16_1","unstructured":"15.Centers for Disease Control and Prevention. Breastfeeding report card: United States 2018. CDC: Atlanta GA; 2018. Available from: https:\/\/www.cdc.gov\/breastfeeding\/pdf\/2018breastfeedingreportcard.pdf"},{"key":"e_1_3_4_17_1","unstructured":"16.Oklahoma State Department of Health. Oklahoma maternal mortality report 2016\u20132017. OSDH: Oklahoma City OK; 2019. Available from: https:\/\/oklahoma.gov\/health\/protective-health\/maternal-and-child-health.html"},{"key":"e_1_3_4_18_1","volume-title":"Nowhere to go: maternity care deserts across the US","author":"Stoneburner A","year":"2024","unstructured":"17.Stoneburner A, , Lucas R, , Fontenot J, et al. Nowhere to go: maternity care deserts across the US. March of Dimes: Arlington, VA; 2024."},{"key":"e_1_3_4_19_1","unstructured":"18.Artiga S Hinton E. Beyond health care: The role of social determinants in promoting health and health equity. Kaiser Family Foundation; 2019. Available from: https:\/\/www.kff.org\/racial-equity-and-health-policy\/issue-brief\/beyond-health-care-the-role-of-social-determinants-in-promoting-health-and-health-equity\/"},{"key":"e_1_3_4_20_1","unstructured":"19.Centers for Disease Control and Prevention. Racism and health. CDC: Atlanta GA; 2021. Available from: https:\/\/www.cdc.gov\/healthequity\/racism-disparities\/index.html"},{"key":"e_1_3_4_21_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2018.304563"},{"key":"e_1_3_4_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/jan.16877"},{"key":"e_1_3_4_23_1","doi-asserted-by":"publisher","DOI":"10.1017\/S1368980016000367"},{"key":"e_1_3_4_24_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10995-011-0866-x"},{"key":"e_1_3_4_25_1","unstructured":"24.Centers for Disease Control and Prevention. Pregnancy-related deaths among American Indian or Alaska Native women: Data from maternal mortality review committees. CDC: Atlanta GA; 2024. Available from: https:\/\/www.cdc.gov\/maternal-mortality\/php\/data-research\/mmrc\/aian.html"},{"key":"e_1_3_4_26_1","doi-asserted-by":"publisher","DOI":"10.1089\/bfm.2020.0306"},{"key":"e_1_3_4_27_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2018-1897"},{"key":"e_1_3_4_28_1","doi-asserted-by":"publisher","DOI":"10.1089\/jwh.2020.8882"},{"key":"e_1_3_4_29_1","doi-asserted-by":"publisher","DOI":"10.1177\/0890334417731077"},{"key":"e_1_3_4_30_1","unstructured":"29.Commonwealth Fund. What is PRAMS and why is it at risk ?. Commonwealth Fund: New York NY; 2026. Available from: https:\/\/www.commonwealthfund.org\/publications\/explainer\/2026\/jan\/what-is-prams-and-why-is-it-at-risk"}],"container-title":["Breastfeeding Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/15568253261496653","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/15568253261496653","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/15568253261496653","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T16:49:25Z","timestamp":1791910165000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/15568253261496653"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,11]]},"references-count":29,"alternative-id":["10.1177\/15568253261496653"],"URL":"https:\/\/doi.org\/10.1177\/15568253261496653","relation":{},"ISSN":["1556-8253","1556-8342"],"issn-type":[{"value":"1556-8253","type":"print"},{"value":"1556-8342","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,11]]},"article-number":"15568253261496653"}}