The Baby Friendly Hospital Initiative (BFHI), also known as Baby Friendly Initiative (BFI), is a worldwide programme of the World Health Organization and UNICEF, launched in 1991 following the adoption of the Innocenti Declaration on breastfeeding promotion in 1990. The initiative is a global effort for improving the role of maternity services to enable mothers to breastfeed babies for the best start in life. It aims at improving the care of pregnant women, mothers and newborns at health facilities that provide maternity services for protecting, promoting and supporting breastfeeding, in accordance with the International Code of Marketing of Breastmilk Substitutes.
UNICEF, the World Health Organization, and many national government health agencies recommend that babies are breastfed exclusively for their first six months of life. Studies have shown that breastfed babies are less likely to suffer from serious illnesses, including gastroenteritis, asthma, eczema, and respiratory and ear infections. Adults who were breastfed as babies may be less likely to develop risk factors for heart disease such as obesity and high blood pressure. There are benefits for mothers too: women who don't breastfeed have increased risk of developing heart disease, hypertension, diabetes, high cholesterol, breast cancer, ovarian cancer and hip fractures in later life. The BFHI aims to increase the numbers of babies who are exclusively breastfed worldwide, a goal which the WHO estimates could contribute to avoiding over a million child deaths each year, and potentially many premature maternal deaths as well.
UNICEF, the World Health Organization, and many national government health agencies recommend that babies are breastfed exclusively for their first six months of life. Studies have shown that breastfed babies are less likely to suffer from serious illnesses, including gastroenteritis, asthma, eczema, and respiratory and ear infections. Adults who were breastfed as babies may be less likely to develop risk factors for heart disease such as obesity and high blood pressure. There are benefits for mothers too: women who don't breastfeed have increased risk of developing heart disease, hypertension, diabetes, high cholesterol, breast cancer, ovarian cancer and hip fractures in later life. The BFHI aims to increase the numbers of babies who are exclusively breastfed worldwide, a goal which the WHO estimates could contribute to avoiding over a million child deaths each year, and potentially many premature maternal deaths as well.
Criteria
The criteria for a hospital's Baby Friendly accreditation (2018) include:
Critical management procedures
1a. Comply fully with the International Code of Marketing of
Breast-milk Substitutes and relevant World Health Assembly resolutions.
1b. Have a written infant feeding policy that is routinely communicated to staff and parents.
1c. Establish ongoing monitoring and data-management systems.
2. Ensure that staff have sufficient knowledge, competence and skills to support breastfeeding.
Key clinical practices
3. Discuss the importance and management of breastfeeding with pregnant women and their families.
4. Facilitate immediate and uninterrupted skin-to-skin contact
and support mothers to initiate breastfeeding as soon as possible after
birth.
5. Support mothers to initiate and maintain breastfeeding and manage common difficulties.
6. Do not provide breastfed newborns any food or fluids other than breast milk, unless medically indicated.
7. Enable mothers and their infants to remain together and to practise rooming-in 24 hours a day.
8. Support mothers to recognize and respond to their infants’ cues for feeding.
9. Counsel mothers on the use and risks of feeding bottles, teats and pacifiers.
10. Coordinate discharge so that parents and their infants have timely access to ongoing support and care.
The program also restricts use by the hospital of free formula
or other infant care aids provided by formula companies and recommends
that when formula is medically needed, it should be given in a small cup
or spoon, rather than a bottle and should only be used to supplement
breastfeeding.
Since the program's inception, approximately 15,000 facilities in
more than 152 countries have been inspected and accredited as
"Baby-Friendly."
Recommended alternatives
The
World Health Organization recommends that if a mother is unable to
breastfeed, chooses not to breastfeed, or if her baby (often premature)
shows signs that it isn't getting enough breast-milk, a healthy wet nurse or milk from a donor is a healthy alternative to formula.
A special formula is manufactured for premature babies, although the
World Health Organization recommends it only if breast-milk is medically
not an option such as if a premature baby has to be fed formula through
a tube to maintain a healthy weight.
The World Health Organization advocates the importance of a baby being
close to its mother whenever possible even if the mother does not
breastfeed.
Regional schemes
Canada
In Canada, the provinces of Quebec and New Brunswick
have mandated the implementation of the BFHI. All public health units
in Ontario have been required to work towards having BFI designation
since 2011.
In 2012, the Ministry of Health and Long Term Care in Ontario added BFI
status to their progress indicators for Public Health Units thus
requiring all Public Health Units in Ontario to begin implementation of
BFI. Other provinces and territories are implementing strategies at regional and local levels.
As of 2008, 18 health care facilities (9 hospitals & birthing
centres and 9 community health services) had been designated
"Baby-Friendly" across the country.
The B.C. Women's Hospital and Health Centre has been recognized as a
breast-feeding and “baby-friendly” hospital by the World Health
Organization (WHO) and UNICEF since 2008. It is the largest hospital in
Canada to receive the designation.
China
China, now
has more than 6,000 Baby-Friendly Hospitals, exclusive breastfeeding in
rural areas rose from 29 per cent in 1992 to 68 per cent in 1994; in
urban areas, the increase was from 10 per cent to 48 per cent.
Cuba
In Cuba, 49
of the country's 56 hospitals and maternity facilities have been
designated as "baby-friendly". In the six years following the initiation
of the BFHI program, the rate of exclusive breastfeeding at four months
almost tripled - from 25 per cent in 1990 to 72 per cent in 1996.
Hong Kong
In Hong Kong several hospitals have shown interest in being designated Baby Friendly. However, only Queen Elizabeth Hospital has advanced past the Award of Level 2 Participation stage and is well on its way to receiving BFHI accreditation.
Ireland
The
BFHI started in Ireland in 1998 under the auspices of the Irish Health
Promoting Hospitals Network (a WHO programme). The BFHI in Ireland
became an independent registered charity in mid-2016 and changed their
name to Baby Friendly Health Initiative. They offer two levels - a
participation or membership level in which maternity facilities are
encouraged to implement the standards and network with other maternity
facilities but with no external assessment process, and the designation
level where there is external assessment and on-going monitoring to
ensure the standards are met and sustained.
Sweden
Sweden is
considered the global leader in terms of BFHI implementation: four
years after the programme was introduced in 1993, all of the then 65
maternity centres in the country had been designated "baby-friendly".
Taiwan
In 2014
78.60% of babies were born in BFHI hospitals. Between 2001 and 2013, the
increase in certified hospitals was from 38 to 176.
United Kingdom
The UNICEF UK Baby Friendly Initiative was launched in the United Kingdom in 1995. The Initiative works with the National Health Service (NHS) to ensure a high standard of care for pregnant women and breastfeeding mothers and babies in hospitals
and community health settings. The Baby Friendly Initiative accredits
health-care facilities that adopt internationally recognised best
practice standards for breastfeeding.
During each stage of accreditation, the Initiative provides support as
facilities implement standards relating to policies and procedures,
staff education, effective auditing, educating pregnant women and
mothers, and other relevant areas.
In 1998, its principles were extended to cover the work of community health-care services with the Seven Point Plan for the Promotion, Protection and Support of Breastfeeding in Community Health Care Settings. In 2005, it introduced an accreditation programme for university departments responsible for midwifery, health visitor and public health nurse
education. This ensures that newly qualified midwives and health
visitors are equipped with the basic knowledge and skills they need to
support breastfeeding effectively. The program's emphasis on applying
the standards in post-natal and education settings makes it unique
amongst the various Baby Friendly programmes in other countries.
There are now 52 Baby Friendly-accredited maternity hospitals in the UK and ten accredited community health-care providers.[citation needed]
It has been estimated that if all babies were breastfed, over £35m
would be saved by the NHS in England and Wales each year in treating
gastroenteritis alone.
Despite this, breastfeeding rates in the UK are amongst the lowest in
Europe: 78 per cent of babies born in the UK are breastfed at birth,
falling to 63 per cent at one week. Only one in five babies still
receives breastmilk at six months. In 2009, the Department of Health awarded a total of £4 million to 40 Primary Care Trusts in areas with low rates of breastfeeding to support them in seeking Baby Friendly accreditation.
By the end of 2013 the success of the initiative in Scotland
meant that 90% of Scottish mothers now give birth in a UNICEF-accredited
Baby Friendly hospital. This compares with 30% of mothers in England,
58% for Wales and 57% in Northern Ireland.
United States
The
first hospitals verified as Baby-Friendly in the USA were on the
Pacific Coast. The first US hospital to receive this designation was Evergreen Hospital Medical Center, in Kirkland, Washington, which was certified in September 1996. All of these early adopters were able to achieve 100% breastfeeding initiation rates. In New York City, the Harlem Hospital Center was the first hospital to receive the "Baby Friendly" certification granted by Baby-Friendly USA for the city in 2008.
In 2011, New York University Langone Medical Center became the second
hospital to receive the Baby-Friendly Hospital designation in New York
City.
As of May 2, 2018, the United States only had 512 hospitals that
hold the Baby-Friendly designation. This translates to 24.57% of annual
births occurring in a Baby-Friendly hospital.
Mothers in the United States face prejudice regarding breastfeeding
their children. The US Surgeon General reported in 2001 that 57% of
U.S. adults believe that a woman should not be allowed to breastfeed in
public places and not all states protect women from being charged with
public indecency for breastfeeding in public.
A study conducted by Bartick and Reinhold, determined that $10.5 billion
US dollars could be saved if 80% of families in the United States were
able to meet current recommendations for exclusive breastfeeding for the
first 6 months of life, that cost-savings jumps to $13 billion saved if
90% of families comply.
Lower income households are often eligible for Medicaid and WIC, by
breastfeeding, these agencies have been estimated to save $478 during
the first six months of the infant's life for each infant.
Studies have also shown a positive correlation of breastfeeding with increased professional education of care providers.
86% of Americans rely on professional healthcare providers like
doctors, midwives, and nurses for medical advice and recommendations.
Classes are then offered in group and individual settings as
"low-intensity intervention" directed by trained medical professionals.
Research conducted at large healthcare institutions in Massachusetts
has demonstrated a statistically significant increase in breastfeeding
rates for mothers who participate in breastfeeding and lactation
training.
Criticism
One
group of authors expressed concerns in a paper published in October
2016. It questioned whether full compliance with the ten steps of the
initiative might inadvertently lead to the promotion of potentially
hazardous practices and/or counterproductive outcomes. Specific concerns
described in this paper included increased risk of Sudden Unexpected
Postnatal Collapse, rigidly-enforced rooming-in practices leading to
exhausted or heavily medicated mothers caring for newborns, and an
unnecessary ban on pacifier use.
