Impact of the Baby-friendly Hospital Initiative on Breastfeeding and Child Health Outcomes

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Infant and young child feeding practices play a crucial role in the nutritional status, overall health, and mortality rate of children under the age of 2. The World Health Organization (WHO) strongly advocates for breastfeeding, recommending that it be initiated within the first hour after birth, exclusively practiced for the first 6 months of life, followed by the introduction of safe and nutritious complementary foods, and continued until the child is at least 2 years old (WHO, 2002).

There is a wealth of evidence supporting the benefits of optimal breastfeeding behaviors. Studies have shown that breastfeeding is strongly associated with a lower incidence of gastrointestinal and respiratory tract infections, as well as improved child survival rates (Sankar et al., 2015). Additionally, breastfeeding has been linked to a reduced risk of otitis media, malocclusions, dental caries, obesity, type 2 diabetes, and improved cognitive development (Bowatte et al., 2015; Peres et al., 2015; Tham et al., 2015; Horta et al., 2015a, 2015b). Mothers who breastfeed also experience benefits such as prolonged lactational amenorrhea and a reduced risk of post-partum hemorrhage, ovarian and breast cancer, and type 2 diabetes (Chowdhury et al., 2015).

Given the multitude of advantages, the WHO Global Strategy on Infant and Young Child Nutrition emphasizes the importance of strong government commitment to protecting, promoting, and supporting breastfeeding (WHO/UNICEF, 2003).

The Baby-friendly Hospital Initiative (BFHI)

The Baby-friendly Hospital Initiative (BFHI), launched in 1991, is a vital component of the WHO/UNICEF Global Strategy for Infant and Young Child Feeding (de Oliveira et al., 2003; UNICEF, 1990; WHO/UNICEF, 2003). The initiative focuses on adherence to the Ten Steps to Successful Breastfeeding (Ten Steps) and the 1981 WHO Code for Marketing of Breast Milk Substitutes (Kyenkya-Isabirye, 1992; Naylor, 2001; UNICEF/WHO, 2009) and promotes the integration of facility-level and community-level services (UNICEF/WHO, 2009).

The Ten Steps can be seen as a quality assessment and improvement system, involving specific actions in five breastfeeding domains:

  1. Policy: This includes the establishment of written breastfeeding policies endorsing the Ten Steps and the 1981 WHO Code, as well as the avoidance of free or reduced-cost infant formula and the prohibition of direct or indirect marketing of infant formula to mothers.
  2. Development of human resources: This involves breastfeeding training for maternity ward staff.
  3. Promotion and support: This includes prenatal breastfeeding education, in-hospital support such as early breastfeeding initiation and on-demand breastfeeding, and community support through referrals and in-house support groups.
  4. Protection: This encompasses the discouragement of infant formula use and the avoidance of teats or pacifiers.
  5. Structural changes to maternity ward workflow: This includes the practice of rooming-in throughout the hospital stay (UNICEF/WHO, 2009; WHO, 1989).

As of 2010, it is estimated that there were 21,328 maternity hospitals or birthing centers worldwide that had received the Baby-friendly Hospital (BFH) designation at some point (Labbok, 2012; UNICEF/WHO, 2009; Baby Friendly USA, 2010). BFHs are present in 160 countries, with approximately 31% of maternity facilities in developing countries and 8.5% in developed countries having received the BFH certification (Labbok, 2012). In the United States, there are currently 166 hospitals and birthing centers with the baby-friendly designation, accounting for 7% of annual births nationwide (Baby Friendly USA, 2012).

Rating of the hospital's support for pregnant women and their newborns

FAQs

Q: What are the benefits of breastfeeding?
A: Breastfeeding provides numerous benefits to both infants and mothers. Infants who are breastfed have a lower risk of gastrointestinal and respiratory tract infections, otitis media, malocclusions, dental caries, obesity, type 2 diabetes, and improved cognitive development. Mothers who breastfeed experience a reduced risk of postpartum hemorrhage, ovarian and breast cancer, and type 2 diabetes (Sankar et al., 2015; Bowatte et al., 2015; Peres et al., 2015; Tham et al., 2015; Horta et al., 2015a, 2015b; Chowdhury et al., 2015).

Q: What is the Baby-friendly Hospital Initiative (BFHI)?
A: The Baby-friendly Hospital Initiative is a program launched in 1991 as part of the WHO/UNICEF Global Strategy for Infant and Young Child Feeding. It promotes the Ten Steps to Successful Breastfeeding and the 1981 WHO Code for Marketing of Breast Milk Substitutes, with the aim of protecting, promoting, and supporting breastfeeding. BFHI recognizes hospitals and birthing centers that adhere to these guidelines and provide comprehensive breastfeeding support (de Oliveira et al., 2003; UNICEF, 1990; WHO/UNICEF, 2003).

Conclusion

The impact of the Baby-friendly Hospital Initiative on breastfeeding and child health outcomes is undeniable. The initiative, with its focus on implementing the Ten Steps to Successful Breastfeeding, has contributed to increased rates of breastfeeding initiation, exclusivity, and duration. By supporting and promoting breastfeeding, BFHI has been instrumental in improving child health outcomes, reducing the incidence of infections and diseases, and providing numerous benefits to both infants and mothers.

Breastfeeding is not only a natural and optimal way to nourish infants but also a key factor in their long-term health and development. The implementation of BFHI in hospitals and birthing centers worldwide plays a crucial role in ensuring that breastfeeding is supported and encouraged from the very beginning of a child’s life.

By adhering to the Ten Steps and creating a supportive environment for breastfeeding, hospitals and birthing centers can make a significant impact on the well-being of both mother and child. Supporting breastfeeding is a collective effort that requires commitment from healthcare providers, communities, and governments. With continued efforts and investment in breastfeeding support, we can strive towards better health outcomes for children around the world.

Sources:

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  • Bowatte, G., Tham, R., Allen, K. J., Tan, D. J., Vander Leek, T. K., Luu, L. A., … & Dharmage, S. C. (2015). Breastfeeding and childhood acute otitis media: a systematic review and meta-analysis. Acta Paediatrica, 104(S467), 85-95.
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