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Baby-friendly hospitals: only the better, but not the best

European Journal of Clinical Nutrition volume 66, page 1077 (2012)Cite this article

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We read with great interest the article by Samuel et al.1 The authors found that in spite of being delivered in a baby-friendly hospital (BFH) early complementary feeding (CF) was observed at home. Based on their findings, they suggested home- and community-oriented approaches to improve exclusive breast feeding rates. There are few points in the article that need to be commented.

First step (before home- and community-oriented approaches) to ensure is that whether the hospitals designated as BFHs are sufficiently committed to carry out the 10 steps of BFH Initiative successfully. This question is important as a failure of any of the 10 steps would adversely affect both the duration and exclusivity of breast feeding. To be accredited as a BFH, at least 80% adherence to each step of WHO/UNICEF recommendation is required (after allowing for medical concerns, for individual preferences of women and their families and for preferences of health care practitioners).2 A Canadian study based on the mothers reports found that only three steps (3, 5 and 10) would reach the standards expected by the WHO/UNICEF.3 A survey conducted in India4 found that steps that do not need many skills or staff time have been observed to be showing more improvement like step 4, 7 and 8 (address initiation, rooming in and demand feeding). Other steps like 3, 5, 6, 9 and 10 (addressing helping women if they have problem and counseling and support, building confidence need skills and staff time) are seemingly not well implemented. The step 2 (training of health personnel) has not been sufficiently addressed through the current program (only 44% doctors and 30% nurses had training). This survey also found no significant differences between BFH and non-BFH hospitals in maternal plans for exclusive BF, and this was attributed to the lack of adequate counseling during the antenatal, perinatal and postnatal period.

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References

  1. Samuel TM, Thomas T, Bhat S, Kurpad AV . Are infants born in baby-friendly hospitals being exclusively breastfed until 6 months of age? Eur J Clin Nutr 2012; 66: 459–465.

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  3. Chalmers B, Levitt C, Heaman M, O’Brien B, Sauve R, Kaczorowski J . Breastfeeding rates and hospital breastfeeding practices in Canada: a National Survey of Women. Birth 2009; 36: 122–132.

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  4. Breastfeeding Promotion Network of India. Report of All India Study of newborn care, infant feeding practices and implementation of the ‘Infant Milk Substitutes, Infant Foods and Feeding Bottles (Regulation of Production, Distribution and Supply) Act, 1992 in the hospital settings, and infant feeding practices in the catchment area of these hospitals October 2000. Breastfeeding Promotion Network of India: Delhi, India, 2000.

  5. Black PA . A confident start to a new relationship: biological and psychological aspects of breastfeeding. Professional Nurse 1993; 9: 193–197.

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Authors and Affiliations

  1. Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India

    R R Das

  2. Department of Obstetrics and Gynecology, SCB Medical College, Cuttack, India

    S S Naik

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  1. R R Das
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  2. S S Naik
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Correspondence to R R Das.

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Das, R., Naik, S. Baby-friendly hospitals: only the better, but not the best. Eur J Clin Nutr 66, 1077 (2012). https://doi.org/10.1038/ejcn.2012.64

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