The Baby Friendly Hospital Initiative (BFHI), also known as “Baby Friendly Initiative” (BFI), is a worldwide programme of the World Health Organization and UNICEF, launched in 1991[1][2] following the adoption of the Innocenti Declaration on breastfeeding promotion in 1990[3]. The initiative is a global effort for improving the role of maternity services to enable mothers to breastfeed babies for the best start in life. It aims at improving the care of pregnant women, mothers and newborns at health facilities that provide maternity services for protecting, promoting and supporting breastfeeding, in accordance with the International Code of Marketing of Breastmilk Substitutes.
UNICEF, the World Health Organization and many national government health agencies recommend that babies are breastfed exclusively for their first six months of life. Studies have shown that breastfed babies are less likely to suffer from serious illnesses, including gastroenteritis, asthma, eczema, and respiratory and ear infections.[4][5][6][7] Adults who were breastfed as babies are less likely to develop risk factors for heart disease such as obesity and high blood pressure. There are benefits for mothers too: women who breastfeed have a lower risk of developing breast cancer, ovarian cancer and hip fractures in later life.[8][9][10] The BFHI aims to increase the numbers of babies who are exclusively breastfed worldwide, a goal which the WHO estimates could contribute to avoiding over a million child deaths each year.[11]
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The criteria for a hospital's Baby Friendly accreditation include:
The program also restricts use by the hospital of free formula or other infant care aids provided by formula companies.
Since the program's inception, approximately 15,000 facilities in more than 152 countries have been inspected and accredited as "Baby-Friendly."[1][2]
In Canada, the provinces of Quebec and New Brunswick have mandated the implementation of the BFHI. Other provinces and territories are implementing strategies at regional and local levels.[12] As of 2008, 18 health care facilities (9 hospitals & birthing centres and 9 community health services) had been designated “Baby-Friendly” across the country.[13]
In Cuba, 49 of the country's 56 hospitals and maternity facilities have been designated as "baby-friendly". In the six years following the initiation of the BFHI program, the rate of exclusive breastfeeding at four months almost tripled - from 25 per cent in 1990 to 72 per cent in 1996.[1]
Sweden is considered the global leader in terms of BFHI implementation: four years after the programme was introduced in 1993, all of the then 65 maternity centres in the country had been designated “baby-friendly”.[14]
The UNICEF UK Baby Friendly Initiative was launched in the United Kingdom in 1994.[15] The Initiative works with the National Health Service (NHS) to ensure a high standard of care for pregnant women and breastfeeding mothers and babies in hospitals and community health settings. The Baby Friendly Initiative accredits health-care facilities that adopt internationally recognised best practice standards for breastfeeding. During each stage of accreditation, the Initiative provides support as facilities implement standards relating to policies and procedures, staff education, effective auditing, educating pregnant women and mothers, and other relevant areas.
In 1998, its principles were extended to cover the work of community health-care services with the Seven Point Plan for the Promotion, Protection and Support of Breastfeeding in Community Health Care Settings.[15] In 2005, it introduced an accreditation programme for university departments responsible for midwifery, health visitor and public health nurse education. This ensures that newly qualified midwives and health visitors are equipped with the basic knowledge and skills they need to support breastfeeding effectively. The program's emphasis on applying the standards in post-natal and education settings makes it unique amongst the various Baby Friendly programmes in other countries.
There are now 52 Baby Friendly-accredited maternity hospitals in the UK and ten accredited community health-care providers. It has been estimated that if all babies were breastfed, over £35m would be saved by the NHS in England and Wales each year in treating gastroenteritis alone.[16] Despite this, breastfeeding rates in the UK are amongst the lowest in Europe: 78 per cent of babies born in the UK are breastfed at birth, falling to 63 per cent at one week. Only one in five babies still receives breastmilk at six months.[17] In 2009, the Department of Health awarded a total of £4 million to 40 Primary Care Trusts in areas with low rates of breastfeeding to support them in seeking Baby Friendly accreditation.
In New York City, the Harlem Hospital Center was the first hospital to receive the "Baby Friendly" certification granted by Baby-Friendly USA.