What is the WHO/UNICEF Baby-Friendly Hospital Initiative and why do we need it?
More than one million infants worldwide die every year because they are not breastfed or are given other foods too early. Millions more live in poor health, contract preventable diseases, and battle malnutrition.
Although the magnitude of this death and disease is far greater in the developing world, thousand of infants in the United States suffer the ill effects of an infant formula-feeding culture. A decreased risk of diarrhea, respiratory and ear infections, and allergic skin disorders are among the many benefits of breastfeeding to infants in the industrialized world. In the United States these benefits could translate into millions of dollars of savings to our health care system through decreased hospitalizations and pediatric clinic visits. For diarrhea alone, approximately 200,000 U.S. children, most of who mare young infants, are hospitalized each year at a cost of more than half a billion dollars. Many of these cases of diarrhea could have been prevented with breastfeeding. It is the rare exception when a woman cannot breastfeed her baby for physical or medical reasons. Yet a woman’s ability to feel self confident and secure with her decision to breastfeed is challenged by her family and friends, the media, and health care providers. Much has been done in the past few years to strengthen the sources of support for women to breastfeed. However, no comprehensive national program has existed that focused on the efforts of hospitals.
Although the hospital is not and should not be the only place a mother receives support for breastfeeding, hospitals provide a unique and critical link between the breastfeeding support provided prior to and after delivery.
The Baby-Friendly Hospital Initiative (BFHI), launched in 1992, is a global program sponsored by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) to encourage and recognize hospitals and birthing centers that offer an optimal level of care for lactation. The BFHI assists hospitals in giving breastfeeding mothers the information, confidence, and skills needed to successfully initiate and continue breastfeeding their babies and gives special recognition to hospitals that have done so.
The Ten Steps to Successful Breastfeeding
The Ten Steps to Successful Breastfeeding, as outlined by the WHO and UNICEF, states that every facility providing maternity services and infant care should:
1. Have a written breastfeeding policy that is routinely communicated to all health care staff.
2. Train all health care staff in skills necessary to implement this policy.
3. Inform all pregnant women about the benefits and management of breastfeeding.
4. Help mothers initiate breastfeeding within one hour of birth.
5. Show mothers how to breastfeed and maintain lactation, even if they should be separated from their infants.
6. Give newborn infants no food or drink other than breastmilk, unless medically indicated.
7. Practice rooming in – that is, allow mothers and infants to remain together 24 hours a day.
8. Encourage breastfeeding on demand.
9. Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants.
10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic.
11. A Baby-Friendly Hospital has agreed to implement the Ten Steps to Successful Breastfeeding, and agreed not to accept free or low-cost breast milk substitutes, feeding bottles or teats.
How Can Hospitals and Birthing Centers Apply for a Certificate of Intent?
To apply for this Certificate of Intent, a hospital must submit the following to the U.S. Committee for UNICEF:
1. A complete copy of the “Self Appraisal Tool”. This questionnaire is designed as a self evaluation and education tool that assists interested hospital staff in identifying strategies for optimal care for breastfeeding mothers.
2. A “Letter of Intent” signed by the CEO of the hospital or other appropriate hospital administrator that includes the following items:
• A brief description of activities and any existing supporting documentation (e.g., a copy of policy) to demonstrate which of the Ten Steps (as defined globally) the hospital has accomplished
• A brief description of actions planned (e.g., convene in-house task force, implement policy, provide training) and problems foreseen in accomplishing the global Ten Steps;
• A general timetable for breastfeeding promotion and support activities to accomplish the global Ten Steps;
• Any other information you would like to include that could be shared with other hospitals.
The following should also be submitted with the Letter of Intent or within six months after receiving the Certificate of Intent:
• A copy of the hospital’s written breastfeeding policy;
• Documentation of breastfeeding training currently given to hospital personnel or a plan for establishing a training program;
• Documentation of the breastfeeding rates at the hospital and the methodology used to collect these data or a plan to document rates.