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9.2 The Baby Friendly Initiative

Innocenti Declaration

Some 10 years after the WHO Code was first signed a group of high-level policy-makers convened; the outcome was the release of the Innocenti Declaration. The Innocenti Declaration was endorsed by the World Health Assembly in 1991, giving it world-wide status and acceptance. It is the most concise international statement on breastfeeding and covers all three facets of protection, promotion and support.

The Innocenti Declaration set 4 targets for all governments:

  1. To appoint a national breastfeeding coordinator and a multi-sectoral national breastfeeding promotion committee. This target put accountability directly in the hands of each nations' government.
  2. That governments would have taken action to implement the International Code of Marketing of Breastmilk Substitutes.
  3. That maternity facilities should practice the recently published Ten Steps to Successful Breastfeeding. This came at just the right time historically. The launching of the Baby Friendly Hospital Initiative has been the most important and powerful step ever taken on behalf of breastfeeding. It has put breastfeeding on the health policy map in almost every country in the world.
  4. To enact imaginative legislation to protect the breastfeeding rights of working women.

Reaching the targets

In 2005, 15 years after setting the original goals, a celebration was held to evaluate progress and re-affirm commitment to the targets.
The targets were ambitious and although they were not fully achieved by the projected date, great progress was made:
  • 80 countries formed national breastfeeding authorities
  • 19,000 hospitals became designated Baby-Friendly
  • 80 countries had laws implementing the WHO Code on Marketing of Breastmilk Substitutes
  • declining breastfeeding rates were reversed and exclusive breastfeeding rates increase 15% worldwide.

The Baby Friendly Initiative

You may be working in an accredited Baby Friendly facility already or your hospital/institution may be working towards that now.

Baby Friendly hospitals

The Baby Friendly Hospital Initiative (BFHI) was launched by WHO and UNICEF in June 1991 at a meeting of the International Pediatric Association. The goal is to promote the adoption of the Ten Steps to Successful Breastfeeding in hospitals worldwide by the designation of a Baby-Friendly Hospital Initiative award. It is designed to remove hospital barriers to breastfeeding by creating a supportive environment with trained and knowledgeable health workers.
A proud hospital!

A proud hospital!


Ten Steps to Successful Breastfeeding

Every facility providing maternity services and care for newborn infants should:

  1. Have a written breastfeeding policy that is routinely communicated to all health care staff.
  2. Train all health care staff in skills necessary to implement this policy.
  3. Inform all pregnant women about the benefits and management of breastfeeding.
  4. (Help mothers initiate breastfeeding within a half-hour of birth.) Place babies in skin-to-skin contact with their mothers immediately following birth for at last an hour and encourage mothers to recognize when their babies are ready to breastfeeding, offering help if needed.
  5. Show mothers how to breastfeed, and how to maintain lactation even if they should be separated from their infants.
  6. Give newborn infants no food or drink other than breastmilk unless medically indicated.
  7. Practise rooming-in - allow mothers and infants to remain together - 24 hours a day.
  8. Encourage breastfeeding on demand.
  9. Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants.
  10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic.
Source: 1989 WHO/UNICEF

Baby Friendly communities

To continue the best practices initiated in the hospital situation, and to provide supportive care to the mother, UNICEF/BFI United Kingdom developed best practice standards for the community. The Seven-point Plan for the Protection, Promotion and Support of Breastfeeding in Community Health Services follows the same principles as the Ten Steps to Successful Breastfeeding. The emphasis is to ensure consistency of advice for mothers and continuity of care when care is passed from maternity to community services.
Community facilities who acquire the Seven-Point Plan Award are often referred to a "mother-child friendly" or "breastfeeding-friendly".

Seven-Point Plan

The 7 points in summary are:

1. Have a written breastfeeding policy that is routinely communicated to all health-care staff.
2. Train all staff involved in the care of mothers and babies in the skills necessary to implement the policy.
3. Inform all pregnant women about the benefits and management of breastfeeding.
4. Support mothers to initiate and maintain breastfeeding.
5. Encourage exclusive and continued breastfeeding, with appropriately-timed introduction of complementary foods.
6. Provide a welcoming atmosphere for breastfeeding families.
7. Promote cooperation between health-care staff, breastfeeding support groups and the local community.

Source: 2001 UNICEF/BFI UK

Does Baby Friendly Work?

  • UNICEF, in 1999, reported widespread increases in rates of breastfeeding in urban areas, reductions in respiratory infections and diarrhea in infants, and savings in terms of both costs and staff time when BFHI is implemented.
  • USA - Baby-Friendly designated hospitals have elevated rates of breastfeeding initiation and exclusivity. Elevated rates persist regardless of demographic factors that are traditionally linked with low breastfeeding rates. 1
  • China - after 2 years of implementation of the Ten Steps, exclusive breastfeeding rates doubled in rural areas and improved from 10% to 47% in urban areas.
  • Cuba - exclusive breastfeeding rates increased from 25% in 1990 to 72% in 1996. 2
  • Scotland - babies born in a Baby-Friendly accredited hospital were 28% more likely to be exclusively breastfed at 7 days of postnatal age than those born in other maternity units. 3
  • UK - in a 2 year period of mandatory BFI training of health visitors and nursery nurses resulted in a 1.57 times increased likelihood of an infant being breastfed at 8 weeks. 4
  • New Zealand - Exclusive breastfeeding rates at discharge from hospital increased from 55.6% (2001) to 84.4% (2011). 96.1% of New Zealand hospitals now hold BFHI accreditation.5

Becoming accredited

To receive the Baby Friendly designation a hospital or community health unit will have fully embraced all of the Steps or Points, as well as adhere to the International Code on the Marketing of Breastmilk Substitutes. Achievement of the criteria will be assessed by a team of trained assessors who will make observations, view charts and feeding records and speak with mothers and the unit's staff.

Workbook Activity 9.4

Complete Activity 9.4 in your workbook.

Poster Promotion

Gather a small working group to collect appropriate photos (or obtain permission from mothers to photograph them and their babies) which could be made into a poster for each of the Ten Steps or each of the Seven Points.

Display the posters in strategic areas in your workplace.

What should I remember?

  • The significance of the landmark Innocenti Declaration on the protection, promotion and support of breastfeeding.
  • An understanding of the purpose of the Baby-Friendly Initiative.
  • The application of each of the Ten Steps or Seven Points to my work practice.

Self-test quiz

Match an item from the column on the left with an item from the column on the right. Click on an item in one column, then on its matching response from the other column

Notes

  1. # Merewood A et al. (2005) Breastfeeding Rates in US Baby-Friendly Hospitals: Results of a National Survey
  2. # Philipp BL et al. (2004) The Baby-Friendly way: the best breastfeeding start.
  3. # Broadfoot M (2005) The Baby Friendly Hospital Initiative and breast feeding rates in Scotland
  4. # Ingram J et al. (2011) The effects of baby-friendly iniatiative training on breastfeeding rates and the breastfeeding attitudes, knowledge and self-efficacy of community health care staff.
  5. # Martis R et al. (2013) The New Zealand/aotearoa baby-friendly hospital initiative implementation journey: piki ake te tihi--strive for excellence.