Improving breastfeeding support through the implementation of the Baby-Friendly Hospital and Community Initiatives: a scoping review

Abstract

Background Improved breastfeeding practices have the potential to save the lives of over 823,000 children under 5 years old globally every year. The Baby-Friendly Hospital Initiative (BFHI) is a global campaign by the World Health Organization and the United Nations Children’s Fund, which promotes best practice to support breastfeeding in maternity services. The Baby-Friendly Community Initiative (BFCI) grew out of step 10, with a focus on community-based implementation. The aim of this scoping review is to map and examine the evidence relating to the implementation of BFHI and BFCI globally. Methods This scoping review was conducted according to the Joanna Briggs Institute methodology for scoping reviews. Inclusion criteria followed the Population, Concepts, Contexts approach. All articles were screened by two reviewers, using Covidence software. Data were charted according to: country, study design, setting, study population, BFHI steps, study aim and objectives, description of intervention, summary of results, barriers and enablers to implementation, evidence gaps, and recommendations. Qualitative and quantitative descriptive analyses were undertaken. Results A total of 278 articles were included in the review. Patterns identified were: i) national policy and health systems: effective and visible national leadership is needed, demonstrated with legislation, funding and policy; ii) hospital policy is crucial, especially in becoming breastfeeding friendly and neonatal care settings iii) implementation of specific steps; iv) the BFCI is implemented in only a few countries and government resources are needed to scale it; v) health worker breastfeeding knowledge and training needs strengthening to ensure long term changes in practice; vi) educational programmes for pregnant and postpartum women are essential for sustained exclusive breastfeeding. Evidence gaps include study design issues and need to improve the quality of breastfeeding data and to perform prevalence and longitudinal studies. Conclusion At a national level, political support for BFHI implementation supports expansion of Baby-Friendly Hospitals. Ongoing quality assurance is essential, as is systematic (re)assessment of BFHI designated hospitals. Baby Friendly Hospitals should provide breastfeeding support that favours long-term healthcare relationships across the perinatal period. These results can help to support and further enable the effective implementation of BFHI and BFCI globally.

Mediating role of birth at a baby-friendly hospital in the association between parental socioeconomic status and infant exclusive breastfeeding at six months old

“…We found that compared with the pre-pregnancy underweight mothers, the normal weight and overweight/obese mothers were more inclined to EBF at six months of age, which was not previously reported. Moreover, excessive gestational weight gain, older maternal childbearing age and cesarean birth were risk factors for EBF at six months of age, which were in accordance with a previous Japanese study [ 51 ]. Nonetheless, further research is warranted to validate the findings of our study.…”

“…In summary, to enhance EBF rates, our results underscore the significant impact of SES and the importance of ensuring access to BFHs, especially for those with low SES and in rural areas. Recognizing the pivotal role of birth at a BFH in promoting EBF, BFHI promotion programs targeting low socioeconomic and rural populations could yield substantial public health benefits [ 51 ]. Additionally, there is a need to formulate policies to ensure the effective implementation of EBF, such as making policies encouraging primary hospitals and health centers to achieve BFHI certification and expanding BFH to a larger segment of the population.…”

Breastfeeding interventions and programmes conducted in Portuguese‐speaking sovereign states: A scoping review

“…Such interventions may have great application potential because many areas have community health workers available to provide such counselling. However, while several review articles are available to assess the impact of the Baby Friendly Hospital initiative, few assessed or compared timing, optimal number of visits, or other specifics of peer counsellors and breastfeeding 58,59 …”

Breastfeeding duration and associations with prevention of accelerated growth among infants from low-income, racially and ethnically diverse backgrounds

“…In the recent past, exclusive breastfeeding rates have increased nationally ( 24 ) . National programmes, including the baby-friendly hospital initiative ( 37 ) and the WIC programme, which serves half of the infants in the U.S. ( 37 ) , have been critical in not only increasing breastfeeding initiation rates but also advancing policies and programmes to support continued and coordinated breastfeeding services ( 37 ) . WIC breastfeeding support services and interventions, including text messaging, group education sessions and economic incentives have been effective in improving continuation and intensity of breastfeeding among mothers with limited resources ( 38 ) .…”