BFHI Promotes Optimal Infant Feeding Practices Globally
WHO and UNICEF launched the Baby-Friendly
Hospital Initiative (BFHI) in response to the declining breastfeeding
rates in many parts of the world reflected in high infant mortality
and morbidity rates largely due to malnutrition, infections of
the respiratory tract and diarrhoeal disease.
BFHI promotes optimal infant feeding practices in hospitals
throughout the world by providing comprehensive guidelines to
make hospitals centres of support for breastfeeding. It also
establishes the necessary political and technical support for
breastfeeding promotion activities, draws on the experience of
breastfeeding mothers for mother-to-mother support groups and
the skills of health professionals and research to challenge
prevailing medical practice.
Central to the BFHI is the International Code of Marketing
of Breastmilk Substitutes adopted in 1981 by the World Health
Assembly and subsequent WHA resolutions, which call upon breastmilk
substitute manufacturers and distributors not to provide free
or low-cost supplies to any part of the health care system.
Hospitals must meet the BFHI Global Criteria for each of
the Ten Steps to Successful Breast-Feeding to achieve
accreditation as a Baby- Friendly Hospital. The appraisal
is a rigorous process carried out by a team of trained assessors
from outside the facility, who report the results of the assessment
to a national authority that decides the issue of designation
and certification.
Since the launching of BFHI in 1991, 14,584 maternity facilities
in 128 countries have been designated Baby-Friendly and the effects
of the initiative are being measured by the rate and duration
of exclusive breastfeeding, by the changes in practise and policy
of the health care system, and ultimately by lowered infant mortality
and morbidity rates and maternal health, as well as health care
costs.
According to the WHO and UNICEF for example, a year after
the Baby-Friendly Hospital Initiative (BFHI) was launched in
Chile in 1991, 25% of infants were exclusively breastfed
for the first six months of their lives as opposed to the original
4%. By 1996 it had risen to 45%.
In Cuba, six years after the introduction of BFHI an
estimated 98 % of newborns were exclusively breastfed when they
left the maternity ward - an increase of 35%, and about 72% of
these infants were exclusively breastfed through four months
of age, an increase of 47%. All 44 hospitals handling over 1,000
deliveries a year and 42 per cent of smaller hospitals in the
country are Baby-Friendly.
In Mongolia the percentage of mothers breastfeeding
their babies at four months has risen from 48% in 1992 to 93%
in 1998. All 27 major health facilities in the country have achieved
BFHI status.
In France, SESAM (Société Européenne
pour le Soutien a l'Allaitement Maternal) and other health professionals
close to IBFAN are using the BFHI Self-Evaluation of Hospitals
as a starting point for all training courses and have found this
a successful tool. It is estimated that training courses have
been performed in more than 50 hospitals and although it is clear
that several hospitals are now ready for BFHI Assessment, the
absence of a designating authority due to lack of participation
by the Ministry for Health is a major obstacle.
Another key factor is the financial pressure exerted by infant
formula manufacturers on hospitals via the "Tours De Lait"
(each of the 4 main brands of infant formula being distributed
quarterly in their turn and manufacturers paying large sums of
money to the hospital proportionate to the number of deliveries
per year) which makes full implementation of BFHI impossible
at present.
The BFHI in Sweden
The Baby-Friendly Hospital Initiative was first implemented in
hospital maternity wards, resulting in almost all of a total
of 66 hospitals being designated "breastfeeding-friendly".
Recently a new task force was formed under the auspices of
the National Board of Public Health (Folkhälsoinstitutet)
and a re-evaluation of hospitals is under way. Breastfeeding-friendly
policies are also being introduced in primary care facilities.
The BFHI in the Netherlands coordinated by the Care
for Breastfeeding Foundation, have recently researched the level
of BFHI awareness throughout hospitals and home care organizations.
Results showed that 46 facilities plan to become Baby-Friendly
between 1999 - 2001. This is encouraging as the country has one
of the lowest breastfeeding rates in Europe.
The UK Baby-Friendly Initiative (BFI) was launched
in 1994 and in 1995 the first UK hospital achieved Baby-Friendly
status. Since then `baby-friendly fever' has gripped the UK,
with more and more hospitals (and communities) working towards
improving their practice to increase breastfeeding rates. To
date, 15 maternity units have received UK Baby-Friendly accreditation
and another 46 units have been awarded certificates of commitment.
Baby Milk Action Update 24, February
1999.
In North America, the United States have 20 accredited
Baby-Friendly Hospitals to date and Canada recently joined the
ranks with its first Baby-Friendly Hospital in Quebec.
In Africa
In Eritrea and Namibia 100% of health facilities are Baby-Friendly.
In Ghana, the BFHI has increased exclusive breastfeeding rates
at four months of age from 2% in 1992 to 19% in 1995. Swaziland
has mother support groups in 75% of its communities and Zambia
has increased its extensive community support to include working
environments. This has improved exclusive breastfeeding rates
to 26% at three months from less than 10% before the advent of
BFHI.
For more information contact INFACT
Canada at 416 595-9819.
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