After the births of her first two children, Charmaine Sharkey's neighborhood hospital gave her cans of baby formula and sent her on her way.
But Sharkey tried something different when her youngest, Dynasty, was born six months ago. The 28-year-old mother from Englewood breast-fed the 6-pound baby, a change she credits to guidance and programs offered by Stroger Hospital of Cook County.
"With breast-feeding, you really have to stay at it. A lot of moms give up; they'd rather get some formula," Sharkey said. But the hospital staff "just encouraged me to keep on."
Stroger is among 33 hospitals in Illinois, including 15 maternity centers in Chicago, that are promoting breast-feeding like never before, a key component for earning the "baby-friendly" designation offered by the World Health Organization and UNICEF. Three hospitals in Illinois have already gotten the title.
The Baby-Friendly Hospital Initiative was launched in 1991, but more hospitals have applied for the title in recent years, said Trish MacEnroe, executive director of Baby-Friendly USA, the nonprofit that administers the program.
That might be because hospitals appear to be less wary of the chief requirement — that they not accept free formula from makers — than they have been in past years, and because the designation might not be as costly as once thought. Experts also say hospitals are catching up to research that shows breast-feeding has major benefits for mothers and newborns.
The American Academy of Pediatrics says infants who receive formula run a higher risk of getting childhood diseases, diabetes and childhood obesity. The organization says breast-feeding helps women reduce their chance of breast and ovarian cancer, hypertension, diabetes and heart disease.
The "baby-friendly" designation shows the facility's commitment to breast-feeding and "gives more credibility," said Suzet McKinney, deputy commissioner of the Chicago Department of Public Health.
To get the "baby-friendly" label, hospitals must implement 10 steps that include informing all pregnant women about nursing, no longer providing pacifiers and better educating and training staff on the benefits of breast-feeding.
Researchers from medical disciplines across the world have conducted studies on each of the "baby-friendly" steps that later were examined and approved by WHO.
Most difficult of all for some hospitals, they must stop accepting free or discounted formula or supplies from pharmaceutical or other companies, a practice that dates back to at least the 1950s, experts said. That means they must buy formula at fair-market price, and also cannot give out baby milk in gift bags. (They can give formula to mothers who have medical requirements.)
"For a lot of hospitals, that's a big hurdle, to have to pay for that when you've never had to before," said Samantha Schoenfelder, a health and early childhood coordinator for Healthy Places, a wellness initiative pushing breast-feeding that is funded through the federal Affordable Care Act's Prevention and Public Health Fund.
Data seem to agree. In a national survey published by the American Academy of Pediatrics in 2006, researchers found that paying for formula was one of the top three barriers preventing hospitals from achieving the baby-friendly status. Hospitals apparently worried that if they declined to accept free formula, their costs for formula supplies would skyrocket.
But advocates contend that breast-feeding rates increase and formula costs eventually wane after the designation goes into effect. They also point to a 2011 study published in the academy's journal that found "baby-friendly" hospitals have minimal increased costs.
"Once they implement steps and start rolling with the new practices, they require less formula and it's not a big cost at the end," said Sadie Wych, a project coordinator with HealthConnect One, a Chicago-based organization that works with hospitals to increase breast-feeding rates.
Some of the requirements in the "baby-friendly" initiative, like placing newborns onto their mother's skin to nurse within an hour after arrival, have been in place at medical institutions for years. Some hospitals may also already keep the mother and baby in the same room, but that would be required to attain the designation.
Still in the early stages of the process, Norwegian American Hospital, in the city's Humboldt Park neighborhood, is busy sending nurses to outside education classes and encouraging them to become certified lactation counselors.
The hospital stocks a variety of about 70 cases of baby milk each month, and officials there aren't too worried about budgeting for formula in the future.
"Any change that will have a financial impact is something we need to consider, but we feel overall we're doing what's best for our patients," said Tim Egan, executive director of the hospital's foundation board.
Similarly, Advocate Condell Medical Center in Libertyville is applying for the "baby-friendly" standing. It already has stopped handing out formula in its discharge packs, a change that most patients don't seem to mind, said Lisa Plucinski, coordinator of lactation services.
At St. John's Hospital in Springfield, the first hospital in Illinois to win the designation, in 1998, breast-feeding rates have risen from 42 percent in 1993, when the hospital started implementing the steps, to 80 percent last year.
Janet Tolley, the hospital's lactation and doula program facilitator, didn't have specific numbers but said formula costs went down when the initiative was implemented because more women started breast-feeding.
Although there was concern among staff about doing away with formula, the biggest push-back came from pharmaceutical companies that continued sending free supplies and gift bags even when the hospital told them to stop, Tolley said.
Eventually, St. John's started sending the items back and charged the companies for the shipping costs.
"It only took a couple of months of their shipments, and they finally figured it out," Tolley said.
The International Formula Council, which represents infant formula manufacturers and marketers, agrees that breast-feeding is best for infants but doesn't support all the steps in the Baby-Friendly Hospital Initiative.
"Allowing mothers full access to all available information on infant feeding options and practices, as well as unrestricted access to infant formula and samples where and when the mother and/or the infant's health care provider find appropriate, is a right all mothers should have," Mardi Mountford, the council's executive vice president, said in a statement.
In Illinois, the exclusive breast-feeding rate is slowly growing but still slightly below the national average, according to the federal Centers for Disease Control and Prevention.
The number of mothers who continued to only nurse their infants at three months last year hit 35.7 percent, but the number dropped to 13.6 percent at six months, data from the CDC show.
Though the "baby-friendly" title has been around for more than 20 years, advocates say national attention on breast-feeding over the past few years may have pushed more hospitals to pursue the designation.
For example, in 2011, the surgeon general shone a light on nursing and first lady Michelle Obama urged hospitals to support breast-feeding in her "Let's Move" campaign.
The CDC is also funding wellness organizations to work with hospitals making the change, said Baby-Friendly USA's MacEnroe, who estimated it could be another year or so before the next hospital in Illinois obtains the designation.
At St. John's in Springfield, the hospital put the designation on its website and keeps posters around the facility advertising it. Staffers also bring it up with expectant mothers, Tolley said.
The second hospital in Illinois to earn the designation was Pekin Hospital, in 2004.
Knowing she wanted to breast-feed but unsure where to turn for help, Jillian Janusz, 29, researched hospitals before giving birth to her first child. She immediately liked Little Company of Mary in Evergreen Park, which received the designation last month.
Even today, Janusz calls the hospital's lactation nurses for advice and guidance when breast-feeding 3-month-old Sophia.