Analysis of the Outcomes at Baby‐Friendly Hospitals: Appraisal in Taiwan

Abstract

This study examined the effect of the Baby-Friendly Hospital Initiative (BFHI) on the breastfeeding rate in Taiwan and analyzed factors related to BFHI qualification. The assessments included 56 hospitals enlisted for appraisal and 7,563 mothers in the maternity wards of these hospitals. Among the 56 hospitals appraised, 38 (67.9%) passed appraisal. Geographically, 88.5% (23/38) of hospitals are located in northern Taiwan, and only one hospital is situated in eastern Taiwan. All 13 medical centers enlisted for appraisal were qualified as BFHI. Only one private clinic passed the appraisal. We found close correlation between the location of the hospital and passing the appraisal (chi2 = 12.71, p < 0.01), and between the grade of a hospital and BFHI qualification (chi2 = 9.17, p < 0.05). Of the 10 steps to successful breastfeeding practiced in these hospitals, we found that step 10 got the highest scores, with a gain point rate of 94.64%; nonetheless, step 1 had significant power of discrimination regarding appraisal. Statistically, steps 7, 1, and 2 were more significant than any of the other steps. Mothers in qualified baby-friendly hospitals had higher breastfeeding rates than those in non-qualified hospitals, whether they were surveyed while in maternity wards after delivery (88.1% vs 78.1%) or in their first postnatal month (67.6% vs 59.4%). In conclusion, our study indicates that health policy intervention has a significant impact on increasing the breastfeeding rate in Taiwan.

Breastfeeding Programs and Policies, Breastfeeding Uptake, and Maternal Health Outcomes in Developed Countries

“…[37][38][39][40][41][42][43][44][45][46][47][48][49][50] 47 and Scotland. 52 Table B presents key findings and SOE related to the benefit of BFHI interventions.…”

“…48 We planned to consider heterogeneity carefully before calculating a pooled summary estimate in a meta-analysis, we carefully considered the heterogeneity across studies. As described above, in cases where we identified a recent eligible meta-analysis for an eligible outcome, we assessed whether to update the analysis by considering how the results of recently published primary studies would change the conclusions of the meta-analyses using a SOE framework.…”

“…[37][38][39][40][41][42][43][44][45][46][47][48][49][50] Studies were conducted in diverse country settings including the United States (2 studies); 39,40 Taiwan (2 studies); 46,50 and one each in the Republic of Belarus, 37 Hong Kong, 41 Czech Republic, 42 Russia, 51 Brazil, 44 Croatia, 45 Brazil, 49 United Kingdom (multiple regions), 47 and Scotland. 52 Table B presents key findings and SOE related to the benefit of BFHI interventions.…”

“…BF = breastfeeding; BFHI = Baby Friendly Hospital Initiative; ITT = intent-to-treat; KQ = Key Question; NA = not applicable; NLC = nurse-led class; OR = odds ratio; PLC = peer-led class; PRAMS = Pregnancy Risk Assessment Monitoring System. 48 Probably yes NA No information NA Yes Some concerns Co-interventions are not discussed, although the authors note in the discussion that "some hospitals refused to accept onthe-job training and had no intention to improve their services; these hospitals failed the evaluation." This suggests that failing BFHI evaluation may reflect staff resistance to breastfeeding promotion, which in turn may lower BF rates.…”

Barriers, Facilitators, and Recommendations Related to Implementing the Baby-Friendly Initiative (BFI)

“…Initial granting of Baby-Friendly status is only for 2 years, motivating the organization to conduct continuous audit compliance with the Ten Steps and improve practices76 BFI criteria included in hospital accreditation process47,56 Hospitals report breastfeeding rates to the public64 Breastfeeding policies…”