Baby-friendly hospital is a designation awarded by the
World Health Organization and the
United Nations Children's Fund to
hospitals worldwide that foster evidence based strategies
concerning infant feeding. These strategies have as an outcome
an increased likelihood of informed decision making regarding
infant feeding and greater skills for mothers to initiate and
sustain breastfeeding. It is termed baby friendly because it is
a global strategy inclusive of and beneficial to all mothers
regardless of how they decide to feed their infants. The
designation is awarded according to stringent criteria. The
award recognizes facilities that offer mothers the information,
confidence and skills needed to successfully initiate and
continue breastfeeding their babies.
The initiative was
launched in 1991 as part of an effort to promote nursing over
formula feeding. In developing countries, formula feeding is
associated with higher
infant mortality and higher social and economic costs. Even
in developed countries, breastfeeding offers nutritional,
developmental, immunologic, and psychological advantages.
The criteria
for designation as Baby-Friendly include:
-
Have a written
breastfeeding policy that is routinely communicated to all
health care staff.
-
Train all health
care staff in skills necessary to implement this policy.
-
Inform all
pregnant women about the benefits and management of
breastfeeding.
-
Help mothers
initiate breastfeeding within one half-hour of birth.
-
Show mothers how
to breastfeed and maintain lactation, even if they should be
separated from their infants.
-
Give newborn
infants no food or drink other than breastmilk, not even sips
of water, unless medically indicated.
-
Practice rooming
in - that is, allow mothers and infants to remain together 24
hours a day.
-
Encourage
breastfeeding on demand.
-
Give no
artificial teats or pacifiers (also called dummies or
soothers) to breastfeeding infants.
-
Foster the
establishment of breastfeeding support groups and refer
mothers to them on discharge from the hospital or clinic
The program
also restricts use by the hospital of free formula or other
infant care aids provided by formula companies.
Between 1991
and 2005, approximately 15,000 facilities worldwide have been
inspected and accredited as "Baby-Friendly."
The concept of
"rooming in" is rapidly being converted to the concept of
bedding in, where the neonate is transferred to the mother
within 30 minutes after a normal vaginal delivery and maximum of
4 hours following a caesarean section.
The
Baby-Friendly Hospital Initiative
Hospitals and
maternity units set a powerful example for new mothers. The
Baby-Friendly Hospital Initiative ( BFHI ), launched in 1991, is
an effort by UNICEF and the World Health Organization to ensure
that all maternities,whether free standing or in a hospital,
become centers of breastfeeding support.
A maternity
facility can be designated 'baby-friendly' when it does not
accept free or low-cost breastmilk substitutes, feeding bottles
or teats, and has implemented
10 specific steps to support successful breastfeeding.
The process is
currently controlled by national breastfeeding authorities,
using Global Criteria that can be applied to maternity care in
every country. Implementation guides for the BFHI have been
developed by UNICEF and WHO.
FHI Part II
provides the Global Criteria and outlines how to transform
hospital practices. Part IV and Part VI help to verify the
ending of free and low-cost supplies of breastmilk substitutes.
Additional BFHI Parts, including questionnaires used by external
teams to assess facilities before Baby-Friendly designation, may
be requested when appropriate from the breastfeeding authority
of each country.
Please see the
following list of
Baby Friendly Hospitals on a country by country basis. In
areas where hospitals have achieved baby-friendly status, more
mothers are breastfeeding their infants, and child health
improves as a consequence.
Since the BFHI
began, more than 15,000 facilities in 134 countries have been
awarded Baby-Friendly status. In many areas where hospitals have
been designated Baby-Friendly, more mothers are breastfeeding
their infants, and child health has improved. News of the BFHI
accomplishments and articles about effective breastfeeding
programmes have been published for ten years in UNICEF's BFHI
News.
New knowledge
about breastfeeding and its management has been provided through
publication of four training courses, and through recommendation
of selected Breastfeeding Papers of the Month .
Success Stories
In Cuba, where
49 of the country's 56 hospitals and maternity facilities are
baby-friendly, the rate of exclusive breastfeeding at four
mounths almost tripled in six years - from 25 per cent in 1990
to 72 per cent in 1996.
In the first
two years of BFHI implementation at the Central Hospital of
Libreville in Gabon, cases of neonatal diarrhoea fell by 15 per
cent, diarrhoeal dehydration declined by 14 per cent and
mortality fell by 8 per cent.
In China, which
now has more than 6,000 Baby-Friendly Hospitals, exclusive
breastfeeding in rural areas rose from 29 per cent in 1992 to 68
per cent in 1994; in urban areas, the increase was from 10 per
cent to 48 per cent.
The Catholic
University of Chile, Santiago, initiated one of the first
baby-friendly hospitals. As a result, initiation of
breastfeeding within the first two hours increased. With a
strong Step 10, a monthly clinic, exclusive breastfeeding at 6
months increased from approximately 20% to over 60%.
The
internationally defined term 'Baby-Friendly' may be used only by
maternity services that have passed external assessment
according to the Global Criteria for the BFHI. The term
"Baby-Friendly" is not appropriately applied to other medical
services, community activities, workplaces or commercial
products. Descriptions such as 'breastfeeding-friendly',
'mother-child friendly' or 'pro-breastfeeding' may be used for
such other complementary efforts to help mothers to breastfeed.
Ten steps
to successful breastfeeding
-
Have a written
breastfeeding policy that is routinely communicated to all
health care staff.
-
Train all health
care staff in skills necessary to implement this policy.
-
Inform all
pregnant women about the benefits and management of
breastfeeding.
-
Help mothers
initiate breastfeeding within one half-hour of birth.
-
Show mothers how
to breastfeed and maintain lactation,even if they should be
separated from their infants.
-
Give newborn
infants no food or drink other than breastmilk, unless
medically indicated.
-
Practice rooming
in - that is, allow mothers and infants to remain together 24
hours a day.
-
Encourage
breastfeeding on demand.
-
Give no
artificial teats or pacifiers (also called dummies or
soothers) to breastfeeding infants.
-
Foster the
establishment of breastfeeding support groups and refer
mothers to them on discharge from the hospital or clinic.
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