The impact of the UK Baby Friendly Initiative on maternal and infant health outcomes: A mixed‐methods systematic review

Abstract

Global evidence demonstrates that adherence to the Baby Friendly Initiative (BFI) has a positive impact on multiple child health outcomes, including breastfeeding initiation and duration up to 1 year post-partum. However, it is currently unclear whether these findings extend to specific countries with resource-rich environments. This mixedmethods systematic review aims to (a) examine the impact of BFI implementation (hospital and community) on maternal and infant health outcomes in the United Kingdom (UK) and (b) explore the experiences and views of women receiving BFI-compliant care in the UK. Two authors independently extracted data including study design, participants, and results. There is no UK data available relating to wider maternal or infant health outcomes. Two quantitative studies indicate that Baby Friendly Hospital Initiative implementation has a positive impact on breastfeeding outcomes up to 1 week post-partum but this is not sustained. There was also some evidence for the positive impact of individual steps of Baby Friendly Community Initiative (n = 3) on breastfeeding up to 8 weeks post-partum. Future work is needed to confirm whether BFI (hospital and community) is effective in supporting longer term breastfeeding and wider maternal and infant health outcomes in the UK. A meta-synthesis of five qualitative studies found that support from health professionals is highly influential to women's experiences of BFI-compliant care, but current delivery of BFI may promote unrealistic expectations of breastfeeding, not meet women's individual needs, and foster negative emotional experiences. These findings reinforce conclusions that the current approach to BFI needs to be situationally modified in resource-rich settings.

Perspectives about the baby friendly hospital/health initiative in Australia: an online survey

“…Consideration of a new mother's values and needs (micro-level) was seen as very important, aligning with recent literature suggesting culturally tailored services are significant [51]. A mixed-method analysis of five qualitative studies found that BFHI may not address women's needs and cause negative emotional experiences [49]. These negative experiences were due to poor communication and attitudes by staff which included the use of judgemental language, criticism of feeding attempts, unrealistic expectations, and using discourse which may cause feelings of guilt in breastfeeding women.…”

“…Similarly, continuity of midwifery care is known to be associated with improved maternal and neonatal outcomes [46,47] including increased breastfeeding initiation [48]. Models of midwifery care facilitating relationship building between mother and midwife as well as mother and infant [48], which are practical, consistent, and family-centred, are encouraged as such models have a positive impact on breastfeeding outcomes [49]. The importance of establishing quality communication and interaction skills and its potential impact on the dissemination of information at organisational and individual levels was also highlighted.…”

“…This study found that disseminating the message of the public health impacts of the BFHI to organisations (leadership) and individuals (staff and managers) would motivate uptake and implementation of the BFHI. To successfully share such messages with mothers, there is a need for establishing quality communication between healthcare staff and mothers, which is based on trust [49,50]. These studies identified that women need to feel that staff spend sufficient time with them so they feel listened to, while lack of time by staff has been identified as a major barrier [49,50].…”

“…To successfully share such messages with mothers, there is a need for establishing quality communication between healthcare staff and mothers, which is based on trust [49,50]. These studies identified that women need to feel that staff spend sufficient time with them so they feel listened to, while lack of time by staff has been identified as a major barrier [49,50]. An Australian study also identified that communication is vital in supporting a mother to feel confident in her knowledge about her and her infant's needs [48].…”

Achieving Baby-Friendly Designation at a Large Metropolitan Center

“…Implementation of the BFHI has continued to have a positive effect on breastfeeding and maternity practices worldwide. 10 At our academic institution, we embarked upon our Baby-Friendly journey as a large medical center providing maternity care on two campuses in two distinct, underserved areas of the Bronx in New York City (NYC).…”