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 279 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 post-partum 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.

Barriers and Facilitators for Early and Exclusive Breastfeeding in the Duhok Governorate in Iraqi Kurdistan

“…We found that explanation of the benefits of breastfeeding by health professionals, the intention to feed, and the practice of feeding in congruence to a mother's intention during pregnancy were associated with exclusive breastfeeding. This is consistent with different Health Problems of Civilization eISSN: 2354-0265, ISSN: 2353-6942 studies that found that breastfeeding counseling to mothers and antenatal education programs were significantly related to exclusive breastfeeding [1,7,11,27,45,46] and that inadequate knowledge about breastfeeding was considered an important barrier to exclusive breastfeeding in studies conducted in Sri Lanka [32], in the state of Qatar [37], and in Saudi Arabia [28].…”

"Fertility-friendly hospitals": A key measure to promote long-term and balanced population development in China

“…In comparison to conventional medical facilities, hospitals that are attuned to fertility concerns tend to adhere more to evidence-based practices that encourage lactation and intimate mother-infant bonding. Empirical research has indicated that the prevalence of exclusive breastfeeding is notably higher in regions where a substantial number of hospitals and maternal health care facilities advocate for fertility-friendly services (12). This correlation contributes significantly to the improvement of neonatal health outcomes.…”

Implementation of the Baby-Friendly Hospital Initiative in Mexico: a systematic literature review using the RE-AIM framework

“…For the postnatal period, it is important to highlight that the tenth Step of the BFHI provides the extension to the Baby-Friendly Community Initiative (BFCI), which focuses on the community-based support needed after discharge. Despite its relevance, there is less evidence about the implementation of BFCI (12).…”

“…Previous studies have documented that countries have encountered difficulties in sustaining the BFHI because of financial and human resources considerations (14). It has also been noted that its successful implementation requires political commitment (12). Additionally, successfully implementing the Ten Steps can be challenging due to the lack of robust internal monitoring and evaluation systems at maternity facilities that can support quality assurance efforts related to the Ten Steps (14), including the training of health personnel (20,21).…”