Baby (Not So) Friendly: Implementation of the Baby-Friendly Hospital Initiative in Serbia

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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“…This is further highlighted in the guidance for infant feeding in emergencies [ 43 ] in recognition of the fact that breastfeeding is particularly important in situations where there is lack of access to safe conditions for the preparation of formula milk [ 44 ], as can be the case in refugee camps. However, practices on postnatal wards in Serbia are not universally supportive of breastfeeding [ 45 , 46 ]. For example, separating mother and baby during the initial postnatal period is at odds with rooming-in (keeping the mother and baby together to promote breastfeeding), and the common enforcement by health professionals of timed or restrictive breastfeeding, which can hinder a mother’s milk supply, are commonplace on postnatal wards [ 46 ].…”

“…However, practices on postnatal wards in Serbia are not universally supportive of breastfeeding [ 45 , 46 ]. For example, separating mother and baby during the initial postnatal period is at odds with rooming-in (keeping the mother and baby together to promote breastfeeding), and the common enforcement by health professionals of timed or restrictive breastfeeding, which can hinder a mother’s milk supply, are commonplace on postnatal wards [ 46 ].…”