Breastfeeding friendly practices in the hospitals help in establishing and sustaining optimal breastfeeding practices. Following are some studies that lend support to the implementation of the BFHI.
A systemic review conducted in 19 different countries located in South America, North America, Western Europe, Eastern Europe, South Asia, Eurasia and Sub-Saharan Africa has shown that adherence to the BFHI Ten Steps has a positive impact on short-term, medium-term and long-term breastfeeding outcomes. There is a dose–response relationship between the number of BFHI steps women are exposed to and the likelihood of improved breastfeeding outcomes (early BF initiation, exclusive breastfeeding (EBF) at hospital discharge, any BF and EBF duration). Community support (step 10) appears to be essential for sustaining breastfeeding impacts of BFHI in the longer term. (Pérez-Escamilla R, Martinez JL, Segura-Pérez S. Impact of the Baby-friendly Hospital Initiative on breastfeeding and child health outcomes: a systematic review. Matern Child Nutr. 2016 Jul;12(3):402-17. doi: 10.1111/mcn.12294. Epub 2016 Feb 29. PMID: 26924775; PMCID: PMC6860129.)
A study from Croatia concludes that BFHI provides an excellent opportunity for revitalizing breastfeeding protection, promotion, and support in all settings. The study found that BFHI helped in increasing the exclusive breastfeeding rates. (Grguric J., et al. A multifaceted approach to revitalizing the baby-friendly hospital initiative in Croatia.J Human Lact. 2016, 32: 568-73).
The PROBIT study from Belarus concluded that BFHI intervention providing health care worker assistance with initiating and maintaining breastfeeding and lactation and postnatal breastfeeding support results in increased duration and degree (exclusivity) of breastfeeding and decreased risk of gastrointestinal tract infection and atopic eczema in the first year of life. (Kramer MS, Chalmers B, Hodnett ED, et al. Promotion of Breastfeeding Intervention Trial (PROBIT): A Randomized Trial in the Republic of Belarus. JAMA. 2001;285 (4):413–420. doi:10.1001/jama.285.4.413)
A study from Singapore, which looked into effect of a 20-Hour Baby-Friendly Hospital Initiative training program on Nurses' Breastfeeding Knowledge, Attitudes and Confidence, found that after training, there were significant improvements in many items of infant feeding knowledge, including greater awareness of the International Code of Marketing of Breastmilk Substitutes and medical contraindication for breastfeeding. Participants were more confident in assisting mothers on breastfeeding; advising hand expressing breast milk; and advising attachment to the breast. (Fok D, Chang HF, Meng LY, Ng YPM. The Effect of a 20-Hour Baby-Friendly Hospital Initiative Training Program on Nurses' Breastfeeding Knowledge, Attitudes and Confidence, in a Tertiary Hospital in Singapore. Am J Perinatol. 2020 Sep 10. doi: 10.1055/s-0040-1716489. Epub ahead of print. PMID: 32911554.)
A study from Brazil, which looked into the Cost-effectiveness economic assessment from the health system perspective, found that BFHI was highly cost-effective in raisingbreast-feeding during the first hour of life by 32.0 % at lower cost in comparison with non-BFHI. In addition, BFHI was cost-effective in reducing late neonatal mortality rate by 13.0 % from all causes and by 13.1 % of infant mortality rate from infections. (Silva OLO, Rea MF, Sarti FM, Buccini G. Cost-effectiveness analysis of Baby-Friendly Hospital Initiative in promotion of breast-feeding and reduction of late neonatal infant mortality in Brazil. Public Health Nutr. 2020 Jul 20:1-11. doi: 10.1017/S1368980020001871. Epub ahead of print. PMID: 32686631.)
A quasi-experimental, retrospective cohort design study from the United States comparing short-term breastfeeding duration between a pre-BFHI and a post-BFHI cohort found that “implementation of the BFHI and cumulative exposure to the Ten Steps increased short-term duration of any breastfeeding and exclusive breastfeeding at 2-6 weeks postpartum. Exposure to all six of the inpatient Ten Steps increased the odds of any breastfeeding by 34 times and exclusive breastfeeding by 24 times. Exposure to Step 9 ("Give no pacifiers or artificial nipples") uniquely increased the likelihood of any breastfeeding at 2-6 weeks postpartum by 5.7 times, whereas Step 6 ("Give infants no food or drink other than breastmilk") increased the rate of exclusive breastfeeding by 4.4 times at 2-6 weeks postpartum.” (Hawkins SS, Stern AD, Baum CF, Gillman MW. Evaluating the impact of the Baby-Friendly Hospital Initiative on breast-feeding rates: a multi-state analysis. Public Health Nutr. 2015 Feb;18(2):189-97. doi: 10.1017/S1368980014000238. Epub 2014 Mar 14. PMID: 24625787; PMCID: PMC4163534.)
A study from Belgium, which compared exclusive breastfeeding prevalences and breastfeeding practices for mothers giving birth in Baby-friendly Hospital Initiative (BFHI) and non-BFHI maternity facilities, found that at discharge, a larger proportion of children were exclusively breastfed if they were born in a BFHI maternity facility. (Robert E, Michaud-Létourneau I, Dramaix-Wilmet M, Swennen B, Devlieger R. A comparison of exclusive breastfeeding in Belgian maternity facilities with and without Baby-friendly Hospital status. Matern Child Nutr. 2019 Oct;15(4):e12845. doi: 10.1111/mcn.12845. Epub 2019 Jun 11. PMID: 31106522; PMCID: PMC6859970.)
A prospective cohort study from Saudi Arabia which compared experience of mothers about breastfeeding in one BFHI and one non-BFHI hospital revealed that breastfeeding education and encouragement was higher at the BFHI-hospital (93.3%) compared to the non-BFHI-hospital (48.2%). At postpartum discharge, 51% of mothers in the BFHI-hospital were breastfeeding exclusively versus 29.6% at the non-BFHI-hospital. (Mosher C, Sarkar A, Hashem AA, et al. Self-reported breast feeding practices and the Baby Friendly Hospital Initiative in Riyadh, Saudi Arabia: prospective cohort study. BMJ Open. 2016;6(12):e012890. Published 2016 Dec 16. doi:10.1136/bmjopen-2016-012890)
A randomized controlled study that compared the effect of skilled counselling on breastfeeding during pregnancy and first 6 months of life in an urban hospital, showed initiation of breastfeeding within one hour of birth was 73.4% in intervention group as compared to 33.6% in control group (P=0.001). More mothers in the intervention group (88.2%) were able to sustain exclusive breastfeeding rates at 6 months of age in comparison to the control group (50%) (OR 7.44, 95% CI 3.98-13.92). Trained dedicated breastfeeding counsellor during the antenatal and post-natal periods made the difference. (Gupta A, Dadhich JP, Ali SM, Thakur N. Skilled Counseling in Enhancing Early and Exclusive Breastfeeding Rates: An Experimental Study in an Urban Population in India. Indian Pediatr. 2019 Feb 15;56(2):114-118. PMID: 30819989.)