The Baby-Friendly Hospital Initiative (BFHI) designation is known to increase breast-feeding rates in the USA. However, less is known about barriers and facilitators to breast-feeding support practices in BFHI hospitals and how they differ from non-BFHI hospitals. We examined what barriers and facilitators are perceived to affect breast-feeding practices among BFHI and non-BFHI hospital administrators and further explored factors that presented challenges to the adoption and continuation of breast-feeding support practices.

Cross-sectional study was conducted. We measured whether hospitals were implementing 12 breast-feeding support practices and identified barriers and facilitators to the practices. The survey questionnaire included both structured and open-ended questions.

This study included hospital administrators from both BFHI and non-BFHI hospitals from all regions of the USA to help elucidate potential differences.

A stratified random sample of 50 % of BFHI and 50 % of non-BFHI hospitals was obtained. The final sample size included 113 BFHI and 177 non-BFHI hospital administrators.

Low interest among mothers was reported as the most significant barrier to providing breast-feeding support among all administrators. Non-BFHI hospital administrators were more likely to report cost, nursing staff and physician resistance and hospital infrastructure as barriers to initiating practices. In-person training was cited as the most important facilitator among both groups.

Strengthening prenatal education for mothers and trainings for administrative and nursing staff and physicians is warranted in BFHI and non-BFHI hospitals. Staff management and hospital infrastructure need to be improved particularly in non-BFHI hospitals to provide adequate breast-feeding support for mothers.