The present study aimed to assess the current state of breast-feeding promotion in hospitals and the prevalence of breast-feeding during the first year of life in Germany and to compare the results with a study 20 years earlier.

In the studies on ‘breast-feeding and infant nutrition in Germany’ named ‘SuSe’, a cross-sectional survey in hospitals was combined with a subsequent prospective survey of breast-feeding and infant nutrition during the first year of life (0·5, 2, 4, 6 and 12 months after birth) in mother–infant pairs who were recruited in the hospitals. Written questionnaires and phone calls were used in SuSe I and web-based questionnaires in SuSe II. Breast-feeding promotion and prevalence were evaluated using recommendations from the WHO and the UNICEF.

Two nationwide surveys SuSe I (1997–1998) and SuSe II (2017–2019).

In SuSe I, 177 hospitals and 1717 mother–infant pairs and in SuSe II 109 hospitals and 962 mother–infant pairs were included.

In SuSe II, hospitals implemented seven of the WHO ‘Ten Steps to Successful Breastfeeding’ to a greater extent than the hospitals in SuSe I. More mothers exclusively breastfed for 4 months (57 % v. 33 %) and continued breast-feeding until 6 (78 % v. 48 %) and 12 months (41 % v. 13 %). In both studies, exclusive breast-feeding decreased between 4 and 6 months of age due to the introduction of complementary feeding.

In Germany, breast-feeding habits have come closer to the recommendations over the last 20 years.

To estimate breast-feeding prevalence in Greece in 2007 and 2017, compare breast-feeding indicators and maternity hospital practices between these years, and investigate breast-feeding determinants.

Two national cross-sectional studies (2007 and 2017) using systematic cluster sampling of babies with the same sampling design, data collection and analysis methodology.

Telephone interview with babies’ mothers or fathers.

Representative sample of infants who participated in the national neonatal screening programme (n 549 in 2017, n 586 in 2007).

We found that breast-feeding indicators were higher in 2017 compared with 10 years before. In 2017, 94 % of mothers initiated breast-feeding. Breast-feeding rates were 80, 56 and 45 % by the end of the 1st, 4th and 6th completed month of age, respectively. At the same ages, 40, 25 and <1 % of babies, respectively, were exclusively breast-feeding. We also found early introduction of solid foods (after the 4th month of age). Maternity hospital practices favouring breast-feeding were more prevalent in 2017, but still suboptimal (63 % experienced rooming-in; 51 % experienced skin-to-skin contact in the first hour after birth; 19 % received free sample of infant formula on discharge).

We observed an increasing trend in all breast-feeding indicators in the past decade in Greece, but breast-feeding rates – particularly rates of exclusive breast-feeding – remain low. Systematic public health initiatives targeted to health professionals and mothers are needed in order to change the prevailing baby feeding ‘culture’ and successfully implement the WHO recommendations for exclusive breast-feeding during the first 6 months of life.

To evaluate the impact of the Baby-Friendly Hospital Initiative (BFHI) on breast-feeding initiation and duration overall and according to maternal education.

Quasi-experimental study using data from five states (Alaska, Maine, Nebraska, Ohio, Washington) that participated in the Pregnancy Risk Assessment Monitoring System from 1999 to 2009. Using differences-in-differences models that included year and hospital fixed effects, we compared rates of breast-feeding initiation and duration (any and exclusive breast-feeding for ≥4 weeks) before and after BFHI accreditation between mothers who gave birth in hospitals that were accredited or became accredited and mothers from matched non-BFHI facilities. We stratified analyses into lower and higher education groups.

Thirteen BFHI hospitals and nineteen matched non-BFHI facilities across five states in the USA.

Mothers (n 11 723) who gave birth in BFHI hospitals and mothers (n 13 604) from nineteen matched non-BFHI facilities.

Although we did not find overall differences in breast-feeding initiation between birth facilities that received BFHI accreditation compared with non-Baby-Friendly facilities (adjusted coefficient = 0·024; 95 % CI −0·00, 0·51), breast-feeding initiation increased by 3·8 percentage points among mothers with lower education who delivered in Baby-Friendly facilities (P = 0·05), but not among mothers with higher education (adjusted coefficient = 0·002; 95 % CI −0·04, 0·05). BFHI accreditation also increased exclusive breast-feeding for ≥4 weeks by 4·5 percentage points (P = 0·02) among mothers with lower education who delivered in BFHI facilities.

By increasing breast-feeding initiation and duration among mothers with lower education, the BFHI may reduce socio-economic disparities in breast-feeding.

To assess breast-feeding promotion in maternity hospitals and breast-feeding prevalences during the first year of life in mother–infant pairs in Germany.

Cross-sectional assessment of breast-feeding practices in a random sample of German maternity hospitals by use of a postal questionnaire. Follow-up of mother–infant pairs recruited in the participating hospitals to assess breast-feeding prevalences and infant feeding practices by use of a telephone interview 14 days after birth and food-frequency questionnaires mailed at the end of the 2nd, 4th, 6th, 9th and 12th month of life. Use of indicators for breast-feeding proposed by the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF).

Nation-wide survey.

One hundred and seventy-seven maternity hospitals, 1717 mother–infant pairs.

There were wide variations in breast-feeding promotion in hospitals as evaluated by the practice of the '10 Steps to Successful Breastfeeding' given by WHO and UNICEF for certification as a ‘Babyfriendly Hospital’. Some steps (3, 4, 8) were practised in about 90% of the hospitals, others (steps 7, 9) in only 10%. Prevalences for exclusive (total) breast-feeding as defined by WHO were: 73% (86%) at discharge, 60% (85%) at 14 days, 42% (70%) at 2 months, 33% (59%) at 4 months, 10% (48%) at 6 months, <1% (26%) at 9 months and 0 (13%) at 12 months.

By use of indicators proposed by WHO and UNICEF, a differentiated insight into the breast-feeding situation in Germany has become possible. Moderate levels of breast-feeding promotion in hospitals resulted in almost satisfactory early breast-feeding prevalences but were not effective for long-term breast-feeding success in most mothers.