The Baby Friendly Hospital Initiative (BFHI), also known as Baby Friendly Initiative (BFI), is a worldwide programme of the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF), launched in 1992 in India [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 Breast-milk Substitutes.
[4] UNICEF, WHO, 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.
[5][6][7][8] Adults who were breastfed as babies may be less likely to develop risk factors for heart disease such as obesity and high blood pressure.
Comply fully with the International Code of Marketing of Breast-milk Substitutes and relevant World Health Assembly resolutions.
However, only Queen Elizabeth Hospital has advanced past the Award of Level 2 Participation stage and is well on its way to receiving BFHI accreditation.
[24] 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".
The Baby Friendly Initiative accredits health-care facilities that adopt internationally recognised best practice standards for breastfeeding.
[30] In 2013 the success of the initiative in Scotland showed that 90% of Scottish mothers gave birth in a UNICEF-accredited Baby Friendly hospital.
It questioned whether full compliance with the ten steps of the initiative might inadvertently lead to the promotion of potentially hazardous practices and/or counterproductive outcomes.
Specific concerns described in this paper included increased risk of sudden unexpected postnatal collapse, rigidly-enforced rooming-in practices leading to exhausted or heavily medicated mothers caring for newborns, and an unnecessary ban on pacifier use.
[40] A 2016 systematic review examined the impact of BFHI implementation on breastfeeding and child health outcomes worldwide and in the United States.
The authors suggested that following the BFHI Ten Steps had a positive impact on short, medium, and long-term breastfeeding outcomes.
Looking at 58 studies, the review found that community support was the key to long-term sustainability of breastfeeding that was initiated in the BFHI hospital setting.
The authors said that their findings dispelled the suggestion that hospital-based breastfeeding initiatives might increase infant death from asphyxiation.
The authors did not discuss the other potential harms to mother and baby that critics have raised, such as increased incidence of neonate hospital admission due to dehydration and poor maternal mental health outcomes.
[44] A 2021 article outlines the harms caused by insufficient milk intake in neonates, and discusses accidental neonatal starvation alongside current scientific evidence while offering a historical and policy perspective on the rise of the Baby Friendly initiative in part as a response to inappropriate advertising of formula in Africa, which led to poor outcomes among children who traditionally would have been breastfed.
Further high quality studies were recommended to evaluate both long-term breastfeeding outcomes and other aspects of maternal health.