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Abstract

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.

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Impact of the Baby-friendly Hospital Initiative on breastfeeding and child health outcomes: a systematic review.

Rafael Pérez-Escamilla, Josefa L Martinez, Sofia Segura-Pérez (2016)

The Baby-friendly Hospital Initiative (BFHI) is a key component of the World Health Organization/United Nations Children's Fund Global Strategy for Infant and Young Child Feeding. The primary aim of this narrative systematic review was to examine the impact of BFHI implementation on breastfeeding and child health outcomes worldwide and in the United States. Experimental, quasi-experimental and observational studies were considered eligible for this review if they assessed breastfeeding outcomes and/or infant health outcomes for healthy, term infants born in a hospital or birthing center with full or partial implementation of BFHI steps. Of the 58 reports included in the systematic review, nine of them were published based on three randomized controlled trials, 19 followed quasi-experimental designs, 11 were prospective and 19 were cross-sectional or retrospective. Studies were conducted in 19 different countries located in South America, North America, Western Europe, Eastern Europe, South Asia, Eurasia and Sub-Saharan Africa. Adherence to the BFHI Ten Steps has a positive impact on short-term, medium-term and long-term breastfeeding (BF) outcomes. There is a dose-response relationship between the number of BFHI steps women are exposed to and the likelihood of improved BF outcomes (early BF initiation, exclusive breastfeeding (EBF) at hospital discharge, any BF and EBF duration). Community support (step 10) appears to be essential for sustaining breastfeeding impacts of BFHI in the longer term.

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Breastfeeding practices and policies in WHO European Region Member States

Ayse Tulay Bagci Bosi, Kamilla Gehrt Eriksen, Tanja Sobko … (2015)

Objective To provide an update on current practices and policy development status concerning breastfeeding in the WHO European Region. Design National surveys and studies conducted by national health institutions were prioritized. Sub-national data were included where no national data or studies existed. Information on national breastfeeding policies was collected mainly from the WHO Seventh Meeting of Baby-Friendly Hospital Initiative Coordinators and European Union projects. Owing to the different data sources and methods, any comparisons between countries must be made with caution. Setting WHO European Member States. Results Data from fifty-three WHO European Member States were investigated; however, a large proportion had not reported any data. Rates of early initiation of breastfeeding, exclusive breastfeeding and continued breastfeeding to 1 year all varied considerably within the WHO European Region. Exclusive breastfeeding rates declined considerably after 4 months, and were low in infants under 6 months and at 6 months of age. The majority of the countries with existing data reported having a national infant and young child feeding policy and the establishment of a national committee on breastfeeding or infant and young child feeding. The majority of the countries with existing data reported having baby-friendly hospitals, although the proportion of baby-friendly hospitals to the total number of national hospitals with maternity units was low in most countries. Conclusions Breastfeeding practices within the WHO European Region, especially exclusive breastfeeding rates, are far from complying with the WHO recommendations. There are marked differences between countries in breastfeeding practices, infant and young child feeding policy adoption and proportion of baby-friendly hospitals.