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The benefits of breast-feeding for health and development pre-term and full-term infants changed the attitude towards nutrition of twins and higher-order multiples. Mothers of twins are often at risk of unsuccessful initiation of lactation while in hospital. The possibilities to provide appropriate intervention and support when a mother breastfeeds twins are presented.

Objectives: To study the effects of newborn status and hospital practices on exclusive breast-feeding in a maternity ward., Design: National survey conducted in January 1995 in 427 hospitals., Materials and Methods: Data on 11,422 newborns obtained from hospital staff. Statistical analysis was performed using odds ratios (OR), population attributable risks (PAR%) and logistic regression method., Results: The most important factors for supplementation were: caesarean section (OR = 5.3; PAR = 19.0%), first breastfeeding later than 2 h after birth (OR = 5.2; PAR = 41.3%), mother and newborn separation longer than 1 h/24 h (OR = 3.4; PAR = 44.9%). Logistic regression analysis showed that first feeding in 2 hours is the main prognostic factor for exclusive breastfeeding in a maternity ward., Conclusions: Changes in hospital practices increase the proportion of exclusively breastfeeding infants during stay in the maternity ward.

Extensive research, especially in the recent years documents the divers advantages of breastfeeding not only for infants but also for breastfeeding women and their reproductive health. The paper presents the results of epidemiological studies concerning protective effects of breastfeeding against large number of acute and chronic diseases of childhood and possible health benefits for mothers like fertility regulation, stimulation of parenting abilities and protection against breast and ovarian cancer, bone loss, nutritional depletion. The recommendations of hospital postpartum care supportive to physiological initiation of breastfeeding, based on the experience of Baby Friendly Hospital Initiative implementation in Poland is also presented.

The data on 11,750 newborns collected in 427 hospitals during the survey of maternity words practices in 1995 were used to analyse the factors related to breastfeeding initiation while in hospital. The statistical analyses were done using percentage of newborn breastfed as well as odds ratio (OR) and population attributable risk in percent (PAR%) of artificial feeding. The identified factors of artificial feeding were: newborn birth weight < 2500 g (OR = 28.2; PAR = 52%), complications in neonatal period (OR = 10.3; PAR = 64%), caesarean section (OR = 4.3; PAR = 32.2%), mother and newborn separation longer than 1h/24h (OR = 13%; PAR = 87.2%), lack of skin-to-skin contact after birth (OR = 8.5; PAR = 60.9%).

On the basis of the experience and data gained during breast-feeding situation assessment process (see Part II) the major activities of the breast-feeding promotion programme were identified as follows: 1. Training of health workers which aims the revision and change of practices in health services responsible for mother and child care. 2. Education of population about advantages of breast milk and breast-feeding management. The detailed project of the implementation of the programme on the national scale was presented.

Assessment of breast-feeding situation in Poland was based on three kinds of nation-wide surveys conducted in 1988: newborn feeding and breast feeding routines in maternity wards epidemiology of breast-feeding and other feeding methods in first six months of infant life KAP study among MCH professionals The major findings of the surveys were: conflicting with lactation maternity wards routines especially: very initiation of breast-feeding, administration of liquids and formulas, rigid feeding schedule, separation of newborns from the mothers too early supplantation of breast-feeding lack of current breast-feeding knowledge among MCH professionals.

A breast-feeding promotion programme for Poland was developed as a part of governmental programme to protect and improve health of the mother, child and family for the years 1986-2000 carried out by Institute of Mother and Child. It was presented as a document consisting of three major components which will go to press successively. Part I covers justification of the proposed programme activities and thirty five consistent paragraphs summarizing principal information on breast-feeding and its promotion.