Baby (Not So) Friendly: Implementation of the Baby-Friendly Hospital Initiative in Serbia

The WHO and UNICEF launched The Baby-Friendly Hospital Initiative (BFHI) in 1991 with the goal of promoting breastfeeding. Four years later, this initiative was adopted in Serbia (then Yugoslavia). Although Serbia has officially been a part of the BFHI for over 26 years, less than 13% of children are currently exclusively breastfed for the first 6 months of life. Drawing on interviews, observations and document review, this chapter offers ethnographic insight into why the BFHI in Serbia has met with little success. I argue that the principles and practices of the initiative to promote breastfeeding have been both thinly learned and thinly applied by healthcare workers and therefore have had little positive impact on women’s empowerment to breastfeed or the rates of breastfeeding in the country. I show how the global Baby-Friendly Hospital Initiative implemented in Serbia in the early 1990s and the national level policies which renewed it in 2018 were severely constrained by social, political and economic conditions that hindered the uptake of the program by frontline health workers – namely the devastating effects of the civil war and international sanctions in the 1990s, and the deleterious effects of IMF policies on the Serbian healthcare system since the 2000s. The pressure of time due to high workloads, and understaffed hospitals, in combination with unsustainable national funds for implementation may contribute to the reality of the thin implementation of BFHI.

Trends and Determinants in Breastfeeding among Korean Women: A Nationwide Population-Based Study

Many efforts have been launched to promote breastfeeding in Korea. However, breastfeeding trends and associated factors with breastfeeding in Korea remain unknown. This study aimed to examine trends and determinants in breastfeeding using the Korea National Health and Nutrition Examination Survey (KNHANES) (2010–2018). We analyzed data from the KNHANES V (2010–2012), VI (2013–2015), and VII (2016–2018). A total of 9232 women aged 19–49 years were included in this study. We performed multivariable logistic regression analyses to investigate breastfeeding prevalence trends and associated factors with breastfeeding. Compared to 2010–2012, the odds ratio associated with breastfeeding during 2013–2015 and 2016–2018 increased to 1.30 (95% confidence interval (CI): 1.11–1.51) and 1.40 (95% CI: 1.21–1.63), respectively. The breastfeeding rate was associated with 40–49 years (OR, 95% CI: 0.47, 0.34–0.64 compared to 19–29 years), richer and poorer income (1.20, 1.03–1.39 in richer group and 1.24, 1.05–1.46 in poorer group compared to richest group), education level (0.74, 0.65–0.86 in ≤12 years of education compared to ≥13 years of education), smoking status (1.77, 1.38–2.28 in non-smoking compared to smoking), and self-rated health (1.40, 1.14–1.70 in good and 1.20, 1.00–1.44 in average compared to bad). Education programs and policies such as the Baby-Friendly Hospital Initiative (BFHI) and mother-friendly workplaces are necessary to increase the rates of breastfeeding in these groups.

Healthcare Professionals’ Breastfeeding Attitudes and Hospital Practices During Delivery and in Neonatal Intensive Care Units: Pre and Post Implementing the Baby-Friendly Hospital Initiative

Background: The Baby-Friendly Hospital Initiative represents a global effort to support breastfeeding. Commitment to this program has been associated with the longer duration and exclusivity of breastfeeding and improvements in hospital practices. Further, healthcare professionals’ breastfeeding attitudes have been associated with the ability to provide professional support for breastfeeding. Research Aims: To determine healthcare professionals’ breastfeeding attitudes and hospital practices before and after the implementation of the Baby-Friendly Hospital Initiative. Methods: Using a quasi-experimental pretest–posttest study design, healthcare professionals ( N = 131) from the single hospital labor and delivery, maternity care, and neonatal intensive care were recruited before and after the Baby-Friendly Hospital Initiative intervention during 2017 and 2019. Breastfeeding attitudes with the validated Breastfeeding Attitude Questionnaire, breastfeeding-related hospital practices, and background characteristics were collected. Results: The healthcare professionals’ breastfeeding attitude scores increased significantly after the implementation of the Baby-Friendly Hospital Initiative, difference = 0.16, (95% CI [0.13, 0.19]) and became breastfeeding favorable among all professional groups in each study unit. Positive changes in breastfeeding-supportive hospital practices were achieved. The infants had significantly more frequent immediate and uninterrupted skin-to-skin contact with their mothers. The rate of early breastfeeding, as well as the number of exclusively breastfed infants, increased. Conclusions: After the Baby-Friendly Hospital Initiative and Baby-Friendly Hospital Initiative for neonatal wards (Neo-BFHI) interventions were concluded, we found significant improvements in the breastfeeding attitudes of healthcare professionals and in breastfeeding-related care practices. This RCT was registered (0307-0041) with ClinicalTrials.gov on 03/03/2017.

Breastfeeding Supportive Services in Baby-Friendly Hospitals Positively Influenced Exclusive Breastfeeding Practice at Hospitalization Discharge and Six Months Postpartum

Background: Studies have shown that implementing the Ten Steps to Successful Breastfeeding of the Baby-Friendly Hospital Initiative can protect, promote, and support breastfeeding. However, few studies have valuated the quality of breastfeeding supportive services provided by Baby-Friendly Hospitals from the perspective of service users. Methods: This was a hospital-based prospective study, conducted at eight Baby-Friendly Hospitals with a total of 707 pregnant women in Shanghai, China between October 2016 and September 2021. Breastfeeding supportive services during hospitalization were assessed at childbirth discharge using a 12-question questionnaire based on the Chinese “Baby-Friendly Hospital Evaluation Standards”. Women were followed up on six months postpartum. The impact of breastfeeding supportive services during hospitalization on the exclusive breastfeeding at discharge and six months postpartum were assessed. Results: Of the 707 mothers who completed the survey at discharge, 526 were followed up on six months after delivery. The overall exclusive breastfeeding rate among participants was 34.4% at discharge and 52.1% at six months postpartum. Mothers who received better breastfeeding supportive services during hospitalization were more likely to practice exclusive breastfeeding at hospitalization discharge compared with mothers who received poorer services (aOR: 3.00; 95% CI: 2.08, 4.35; p < 0.001). Furthermore, they were also more likely to exclusively breastfeed at six months postpartum (aOR: 1.50; 95% CI: 1.03, 2.22; p = 0.033). Conclusion: Better breastfeeding supportive services during hospitalization were significantly associated with higher rate of exclusive breastfeeding at discharge and six months postpartum. More effective measures should be adopted to improve the implementation of the breastfeeding supportive services in Baby-Friendly Hospitals to promote exclusive breastfeeding and better maternal and child health.

Breastfeeding assessment tools for at-risk and malnourished infants aged under 6 months old: a systematic review

Background: Many small and malnourished infants under 6 months of age have problems with breastfeeding and restoring effective exclusive breastfeeding is a common treatment goal. Assessment is a critical first step of case management, but most malnutrition guidelines do not specify how best to do this. We aimed to identify breastfeeding assessment tools for use in assessing at-risk and malnourished infants in resource-poor settings. Methods: We systematically searched: Medline and Embase; Web of Knowledge; Cochrane Reviews; Eldis and Google Scholar databases. Also the World Health Organization (WHO), United Nations International Children’s Emergency Fund (UNICEF), CAse REport guidelines, Emergency Nutrition Network, and Field Exchange websites. Assessment tool content was analysed using a framework describing breastfeeding ‘domains’ (baby’s behaviour; mother’s behaviour; position; latching; effective feeding; breast health; baby’s health; mother’s view of feed; number, timing and length of feeds). Results: We identified 29 breastfeeding assessment tools and 45 validation studies. Eight tools had not been validated. Evidence underpinning most tools was low quality and mainly from high-income countries and hospital settings. The most comprehensive tools were the Breastfeeding, Evaluation and Education Tool, UNICEF Baby-Friendly Hospital Initiative tools and CARE training package. The tool with the strongest evidence was the WHO/UNICEF B-R-E-A-S-T-Feed Observation Form. Conclusions: Despite many possible tools, there is currently no one gold standard. For assessing malnourished infants in resource-poor settings, UNICEF Baby-Friendly Hospital Initiative tools, Module IFE and the WHO/UNICEF B-R-E-A-S-T-Feed Observation Form are the best available tools but could be improved by adding questions from other tools. Allowing for context, one tool for rapid community-based assessment plus a more detailed one for clinic/hospital assessment might help optimally identify breastfeeding problems and the support required. Further research is important to refine existing tools and develop new ones. Rigorous testing, especially against outcomes such as breastfeeding status and growth, is key.

A Cross Sectional Study on Assessing the Relationship Between Prenatal Complications and Delay in Breast Feeding in New Born Babies

The Baby friendly hospital initiative was launched in the year 1991 -1992, by World Health Organization and UNICEF, in around 156 countries throughout the world with a goal to ensure initiation of breast feeding in all infant before their discharge from the hospital. The hospitals which implemented Ten recommendations for successful breast feeding were designed as Baby Friendly Hospitals. By strengthening of this as initiative in the community, a better child survival can be achieved. A revised and expanded version of baby friendly hospital initiative was implemented by WHO and UNICEF in the year 2009. This study is carried out to estimate the prevalence of early initiation of breast feeding, the reasons for its delay in hospitals in and around Chennai. The age distribution among the study population was ranged between 18 to 40 years. The mean age was 24.6 years. Out of 450 mothers 84.2% of mothers were between 21 – 30 years, 11.1% of mothers were less than 20 years and 4.7% of mothers were more than 30 years. This study shows that there is a significant association between mode of delivery and initiation of breast feeding. The prevalence of early initiation of breast feeding among normal deliveries and caesarean deliveries was 71.3% and 41.5% respectively. This study was supported by the study done by Ashmika Motee et al (2013) which reveals that 42.6% of normally delivered mothers and 23.9% of caesarean delivered mothers had initiated breast feeding within one hour. For caesarean delivered mothers, management of pain along with support of family members and health care providers, helps in early initiation of breast feeding.

Baby Friendly Hospital Initiative Breastfeeding Outcomes in Mothers with COVID-19 Infection During the First Weeks of the Pandemic in Spain

Background: Adherence to the Ten Steps of the Baby-Friendly Hospital Initiative has been shown to have a protective role for the initiation and maintenance of breastfeeding. Research Aims: (1) To determine the breastfeeding rate during the first 6 months of life in children of mothers diagnosed with COVID-19 infection at the time of birth; and (2) to assess the possible influence of being born in a center with Baby-Friendly Hospital Initiative accreditation. Methods: This was a two-group comparative longitudinal observational study of infants born to mothers with COVID-19 at the time of birth, between March 13–May 31, 2020 (the first wave of the pandemic) in Spain. Fourteen Spanish hospitals participated, five (35.7%) were Baby-Friendly Hospital Initiative accredited. Type of feeding was assessed prospectively at discharge, 1, 3, and 6 months of age. A total of 248 newborns were included in the study. Results: A total of 117 (47.3%) newborns were born in Baby-Friendly Hospital Initiative (BFHI) accredited centers. These centers applied skin-to-skin contact with greater probability ( OR = 1.9; 95% CI [1.18, 3.29]) and separated the newborns from their mothers less frequently ( OR = 0.46; 95% CI [0.26, 0.81]) than non-accredited centers. No differences were observed in relation to the presence of a companion at the time of birth. At discharge, 49.1% ( n = 57) of newborns born in BFHI-accredited centers received exclusive breastfeeding versus 35.3% ( n = 46) in non-accredited centers ( p = .03). No differences were observed in breastfeeding rates throughout follow-up. Conclusions: The exclusive breastfeeding rate at discharge in children of mothers with COVID-19 infection at birth was higher in Baby-Friendly Hospital Initiative accredited centers, which most frequently applied skin-to-skin contact at birth as well as rooming-in.