The Baby-Friendly Initiative:

A Global View

Michelle LeDrew, RN, MN, CHE

Breastfeeding Committee for Canada

Baby-Friendly Hospital Initiative Congress,

World Health Organization & UNICEF,

Geneva 2016

2016 BFHI Congress objectives:

• Celebrate achievements

• Current status of BFHI

• New Guidance document

• Strengthen regional networks

WHO BFHI Congress Attendees, 2016

Breastfeeding foundational documents:

Baby-Friendly Hospital Initiative

2016 WHO BFHI Congress

highlights:

• 20,000 maternity facilities have been designated Baby-Friendly

• This is approximately 10% of births world wide

• Need to scale up to full coverage for all maternity facilities

• BFHI should not be voluntary or a stand alone program

• Need national standards based on the Ten Steps

• Integrate BFHI into health care improvement and quality initiatives

• Internal and external monitoring needed

• BFHI designation process is cumbersome

Key messages:

• Breastfeeding must be treated as the norm in all countries

• BFI should be mainstreamed as much as possible into other programs, initiative, polices

• Advocacy for BFHI must be increased at the global and national levels

• BFHI should cover both healthy and preterm/LBW newborns

• BFHI should cover public and private facilities

• The Code should remain a strong part of BFHI

Global policy impacting breastfeeding:

Nutrition:

• WHO six global nutrition target

• Sustainable Development Goals

• Second International Conference on

Nutrition’s Framework for Action

• United Nations: Decade of Action on

Nutrition 2016-2025

• The International Code of Marketing

Breastmilk Substitutes still relevant o

BFHI

Photo from Pink with permission,

Halifax, NS, Canada

The Lancet Breastfeeding Series

• Over 823,000 deaths each year can be averted by increasing breastfeeding rates to universal levels

• Benefits short & long term for low, mid & high income countries:

• Infections, diarrhea

• Obesity, type 2 diabetes, NEC, SIDS & promising for leukemia

• Higher IQ & Cellular level effects

• Reduce breast & ovarian cancer, birth spacing

• Environmental impacts

• Economic country success

Used with permission from the BCC and

www.health.gov.sk.ca/, 2016

The Lancet Breastfeeding Series, 2016

Breastfeeding prevalence at 1 year(The Lancet Breastfeeding Series, 2016)

Breastfeeding within first hour

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

Baby Friendly Hospital Network Industrialized Nations (2016)

Exclusive Breastfeeding at 6 months

0%

10%

20%

30%

40%

50%

60%

70%

Baby Friendly Hospital Network Industrialized Nations (2016)

• Only 43% of children under 6

months exclusively breastfed

(Canadian rates much lower at <

26%)

• Dose response rate: greater number

of Ten Steps implemented

increased breastfeeding outcomes(From left) Mothers from Namibia's Himba tribe; from Amber, India; and from

Washington state. Jose Luis Trisan/Getty; Hadynyah/Getty; Sarah Wolfe

Photography/Getty hide caption

toggle caption

Jose Luis Trisan/Getty; Hadynyah/Getty; Sarah Wolfe Photography/Getty

National Implementation

of the BFHI, 2017

• Analysis of the current status of the BFHI in countries around the world

• 168 countries (Canadian data not included)

• Majority of countries have implemented BFHI

• Only 1 in 5 have more than half their facilities designated

• Overall coverage of the BFHI is estimated at 10% as of 2016

• 35% in European region but less than 5% in Africa and Southeast Asia

• BFHI needs to become integrated into national polices and standards of quality of care (credentialing/accreditation processes)

• Need for BFHI to be revitalized and reformed

WHO (2017), National Implementation of the Baby-Friendly Initiative

Number of countries implementing the BFHI by year of initiation

WHO (2017), National Implementation of the Baby-Friendly Initiative

WHO (2017), National Implementation of the Baby-Friendly Initiative

Number of countries reporting having incorporated the Ten Steps

into national quality standards and national polices, strategies or plans

Future global investment:

• Need investment in policy and programs

• Societal responsibility

• Marketing of formula continuing to grow and undermine breastfeeding (44.8 billion in 2014 to 70.6 billion in 2019)

• Evidence informed about breastfeeding

• Need concurrent interventions in more than one setting

• Health Systems (BFHI) tied to quality improvement/accreditation

• Home and families

• Antenatal and postnatal

• Community based interventions

• Maternity leaves and child care

• Need to monitor population breastfeeding trends

http://hc-sc.gc.ca/fn-an/surveill/nutrition/commun/prenatal/initiation-eng.php#a1 2009-

2010

Initiation

Breastfeeding Rates:Exclusive at 6 months

Hospitals 16

Birthing Centres* 7

Community Health

Services/CLSC

107

Native Health Center 1

Total 131

BFI Designated Facilities & Services

Hospital

Community Health Service

Birthing Centres

* Of the 233 hospitals/birth centres in Canada less than 7% are designated BFI

Canadian strategic direction:

• BCC Strategic Plan in development

• Focus on Quality and Accreditation processes

• Need investment in policy, programs and funding

• Need national data collection system

• Leverage societal responsibility and economic opportunities

References:• Baby Friendly Hospital Initiative Industrial Nations (2016) Excerpts from the presentation of industrialized countries’ survey by Elise Chapin

(Italy), on behalf of the BFHI Network, October 2016 at WHO BFHI Congress.

• Breastfeeding Committee for Canada (2017). The Baby-Friendly Initiative in Canada Status Report 2017

• National Implementation of the Baby-Friendly Hospital Initiative 2017, World Health Organization, 2017

• Victora, C.G. et al (The Lancet Breastfeeding Series Group, 2016) Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect.

P 475-490, Vol 387.

• Rollins, et al (The Lancet Breastfeeding Series Group, 2016) Why invest, and what it will take to improve breastfeeding practices?. p 491-

504, Vol 387.

• Statistics Canada , (2009-2010) retrieved from; http://hc-sc.gc.ca/fn-an/surveill/nutrition/commun/prenatal/initiation-eng.php#a1 2009-2010

• World Health Organization, (1981). International Code of Marketing Breastmilk Substitutes, Geneva.

• World Health Organization & UNICEF, (1989). Protecting, Promoting and Supporting Breastfeeding; The Special Role of Maternity Services.

• World Health Organization/UNICEF, (1990). Innocenti Declaration: On the Protection, Promotion and Support of Breastfeeding, Florence, Italy

• World Health Organization/UNICEF (2016) Baby-Friendly Hospital Initiative Congress October 24-26, WHO Headquarters Geneva, Switzerland

• UNICEF & WHO (2017), Global Breastfeeding Scorecard, 2017. Retrieved from

http://www.who.int/nutrition/publications/infantfeeding/global-bf-scorecard-2017.pdf?ua=1 August 15, 2017