A Multifaceted Approach to Revitalizing the Baby-Friendly Hospital Initiative in Croatia

Abstract

The Baby-Friendly Hospital Initiative (BFHI) was launched in Croatia in 1993. By 1998, 15 of 34 maternity facilities were designated "Baby-Friendly." Introduction of hospital bags, violating the International Code of the Marketing of Breastmilk Substitutes, led to a standstill in the BFHI. The aim of this article is to describe the successful reintroduction of the BFHI in Croatia between 2007 and 2015. After hospital bags were abolished in 2007, UNICEF Croatia undertook an assessment of BFHI implementation. All maternity facilities were invited by UNICEF and the Ministry of Health to join the renewed BFHI. UNICEF materials were translated and training for trainers, assessors, coordinators, and hospital staff held. By June 2015, 30 of 32 (94%) maternity facilities, providing care to 89% of newborns, were Baby-Friendly. Nine maternity hospitals have been renovated and 2 new hospitals have been built. Exclusive breastfeeding rates have risen 16% at 0 to 2 months (from 51% in 2007 to 67% in 2014) and 14% at 3 to 5 months (from 32% in 2007 to 46% in 2014). Fourteen "Breastfeeding-Friendly" primary care practices have been designated, 166 breastfeeding support groups are in operation, criteria for Mother-Friendly care are being piloted in 2 maternity facilities, and "Ten Steps in the Neonatal Intensive Care Unit" are being introduced. The BFHI provides an excellent opportunity for revitalizing breastfeeding protection, promotion, and support in all settings. Recognition and support of the BFHI by the Croatian government was crucial for implementing the BFHI, whereas the marketing practices of the breast milk substitutes industry are an ongoing challenge.

External evaluation and self-monitoring of the Baby-friendly Hospital Initiative’s maternity hospitals in Brazil

“…In the international setting, the BFHI has also been facing numerous challenges for its sustainability and financing [14, 19, 20]. The financing hardships exist both at the government level and internally at maternity hospitals, hampering assessments and the training of employees of Baby-Friendly Hospitals [3].…”

“…Studies conducted in Australia [19], Croatia [20] and some Latin American countries [14] have shown that BFHI’s sustainability depends on several factors. Emphasis is placed on the importance of a robust national breastfeeding policy, with active national and local breastfeeding committees, financial incentive, involvement of hospital managers, articulation between federal and state governments, and the involvement of all sectors of society to support hospitals that wish to be part of this initiative and maintain their title.…”

“…Brazil has a strong national breastfeeding policy, internationally recognized [6]. Periodic self-monitoring and external reassessment of hospitals have been strategic tools for maintaining the quality of Brazilian Baby-Friendly Hospitals [14, 19, 20].…”

Compliance With WHO/UNICEF BFHI Standards in Croatia After Implementation of the BFHI

“…Subsequently, hospital standards fell, and none of the Baby-Friendly designated facilities renewed their status in the subsequent decade. In 2007, the BFHI was revitalized thanks to renewed efforts by UNICEF Croatia and the Ministry of Health (Grgurić, Zakarija-Grković, Pavičić Bošnjak, & Stanojević, 2016), which resulted in all public hospitals becoming Baby-Friendly. In the process, nine maternity facilities were renovated, and two new maternity hospitals were built, including the maternity facility at the University Hospital of Split.…”

Adolescents’ Knowledge of Breastfeeding and Their Intention to Breastfeed in the Future

“…The UNICEF programme, the Baby-Friendly Hospital Initiative, was launched in Croatia in 1993 [1]. Today, all Croatia’s maternity wards are baby-friendly.…”