BABY FRIENDLY

HOSPITAL INITIATIVES
Historical Back Ground
• History suggests, during 20thcentury, significant increase
of women's involvement in workplace outside the home
setting had made breastfeeding less popular and a
burden.
• With the rapid growth of industries and their competition in
the twentieth century, industrial food products were
developed along with the production of breast milk
substitutes.
• This situation received the worldwide attention and to
address the issue, Baby Friendly Hospital Initiative (BFHI)
was initiated by WHO and UNICEF in 1991.
Importance of Breast Feeding
• It has been estimated that the deaths of 823,000
children each year could be averted by increasing
breastfeeding rates to universal levels
• Nearly half of all diarrhoea episodes and one-
third of respiratory infections would be prevented
with breastfeeding in low and middle-income
countries.
• It reduces the risk of non-communicable diseases
and decreases the prevalence of overweight
and/or obesity later in life.
Importance of breast feeding
• Longer breastfeeding durations are associated
with higher scores on intelligence tests
• Breastfeeding also brings benefits to women, with
reductions in ovarian cancer, breast cancer, and
diabetes.
• Despite the obvious health and economic
benefits, worldwide, only 43 percent of children
under six months of age are exclusively breastfed
• The majority of newborns (55%) do not initiate
breastfeeding in the first hour of life, as
recommended by WHO.
Baby Friendly Hospital Initiatives
• The Baby Friendly Hospital Initiatives launched in
1991, is an effort by UNICEF and WHO to ensure
that all maternities , whether free standing or in a
hospital, become center of breastfeeding support
• more than 20,000 hospitals in 156 countries in
the world have adopted it over the last 15 years
Summary of the different international codes in
Breast Feeding

• No advertising of breast milk substitute and

other products to the public

• No donation of breast milk substitute and

supplies to maternity hospital

• No free samples to mother

• No promotion in the health services

Porgress
• Of the 117 countries responding to the BFHI (14%)
reported that they had never implemented the initiative
and 101 (86%) had implemented it (either currently or
previously)
• Roughly 90% of the countries in Africa, Europe, and
Southeast Asia had implemented BFHI,
• 80% of the countries in the Americas, Eastern
Mediterranean, and Western Pacific regions.
• The greatest number of countries introduced BFHI in the
early 1990s, soon after it was launched globally.
• While introduction of BFHI clearly diminished over time.
Source :
http://apps.who.int/iris/bitstream/10665/255197/1/978924
1512381-eng.pdf?ua=1
Figure 1. Number of countries implementing the Baby-
friendly Hospital Initiative by year of initiation

Source :
http://apps.who.int/iris/bitstream/10665/255197/1/978924
1512381-eng.pdf?ua=1
Conclusion
• The BFHI has the potential to significantly improve the
health of mothers and babies by protecting, promoting,
and supporting breastfeeding at the beginning of life.
• The vast majority of countries have recognized this
potential and have created national programmes and
adhere to the International Code of Marketing of Breast-
milk Substitutes.
• However, attention to the initiative has waned over time.
• Many programmes have become inactive and facilities
that were once designated as Baby-friendly have reverted
to practices that are less supportive of breastfeeding.
• The initiative needs to be revitalized and reformed
National Scenario
• In Nepal BFHI activities were started in 1994 with the training of
health workers from 22 hospitals all over the country till 1996.
• After training, these hospitals were assessed by external and
internal assessors in 1997-98 through Nepal Pediatric Society
and seven of the hospitals were certified as Baby Friendly
Hospitals.
• These seven hospitals were:
• TUTH,Maharajgunj
• Maternity Hospital,
• Patan Hospital,
• Bhaktapur,
• Hetauda Hospital,
• BP Koirala Institute of Health Science, and
• Koshi Zonal Hospital.
Nepal Scenario
• Practice of initiation of breastfeeding within one hour of
birth was only 35% and exclusive breastfeeding for six
months was 53% in 2006,but there has been some
increment in both the indicators in 2011.
• Early initiation of breastfeeding rose to 45% and exclusive
breastfeeding to 70%.
• Although there is a need of continuous monitoring and
supervision of BFHI activities to ensure proper
implementation, it was about 13 years that no any
monitoring and assessment activities were carried out in
Nepal.
Assessment of BFHI
• In 2011, an assessment was carried out in all of the 7
BFHI hospitals initiated by Child Health Division
• All the hospitals certified as BFHI were found not fulfilling
all the 10 steps of BFHI activities.
• There was no display of policy on BFHI in the hospitals,
• health workers were very limited or were not trained,
• demand feeding was not strictly followed
• and mother support group or mother friendly care did not
exist in any of these hospitals
• but these hospitals had good practice of rooming-in and
pacifier and teats were not provided to newborns.
Assessment of BFHI
• lack of monitoring and
supervision activities since
a long time, from the time
the hospitals were
certified.
• Transfer of almost all the
trained staffs and
discontinued training
• Strategy for Infant and
Young Child Fedding, 2014
• Programs are not sufficient
as is limited to
breastfeeding week
(August 1-7) only.
Goals of the BFHI
1.To transform hospitals and maternity
facilities through implementation of the “ten
steps”

2.To end the practice of distribution of free

and low cost supplies of breast - milk
substitutes to maternity wards hospitals
10 steps
Have Have a written breast feeding policy that is routinely communicated to all
health care staff

Train Train all health care staff in skill necessary to implement this policy

Inform Inform all pregnant women about the benefits and management of
breastfeeding

Help Help mothers initiate breast feeding within a half hour of birth

Show Show mothers how to breastfed and how to maintain lactation, even if they
should be separated from their infants

Give Give newborn infants no food or drink other than breast milk unless
medically indicate
 Acceptable medical reasons for supplementation
or replacement
• Infant condition
• Infants who cannot be BF but can receive BM include those
who are very weak
• Have sucking difficulties or oral abnormalities or are
separated from their mothers
• Infant who may need other nutrition in addition to BM
include VLBW or pre-term infants are risk of hypoglycemia,
or those who are dehydrated or malnourished, when BM
alone is not enough
• Infants with galactosemia should not receive BM or the
usual BMS. They will need a galactose free formula
• Infants with PKU may be BF and receive some
phenylalanine free formula
 Acceptable medical reasons for supplementation
or replacement
• Maternal condition
• Should stop during therapy, if mother is taking anti- metabolites,
radioactive iodine, or thyroid medication
• Some medications may cause drowsiness or other side effects in
infants and should be substituted during BF
• BF remains the feeding choices for the majority of infants even with
tobacco, alcohol and drug use. If the mother is an intravenous drug user
BF is not indicated
• Avoidance of all BF by HIV + mothers is recommended when
replacement feeding is acceptable, feasible, affordable, sustainable and
safe.
• Otherwise EBF is recommended during the 1st months, with BF
discontinued when condition are met. Mixed feeding is not
recommended
Acceptable medical reasons for supplementation
or replacement
• If a mother is weak, she may be assisted to position her
baby so she can BF
• BF is not recommended when a mother has a breast
abscess, but BM should be expressed and BF resumed
once the breast is drained and antibodies have
commenced
• Mothers with herpes lesion on their breasts should refrain
from BF until active have been resolved
• BF is not encouraged for mothers with Human T-cell
Leukemia Virus, if safe and feasible options are available
• BF can be continued when mothers have hepatitis B, TB
and Mastitis, with appropriate treatment undertaken
10 Steps
7. Practice rooming in- allows mothers and
newborn to remain together 24 hours a
day Rooming –in A hospital arrangement
where a mother/ baby pair stay in the
same room day and night, allowing
unlimited contact between mother and
infant
8. Encourage breastfeeding on demand
Breast Feeding on Demand
• Earlier passage of meconium

• Lower maximal weight loss

• Breast milk flow established sooner

• Larger volume of milk intake on day 3

• Less incidence of jaundice

10 Steps

Give no artificial teats or pacifiers ( also

Give called dummies and soothers) to
breastfeeding infants

Foster the establishment of breast feeding

Foster support group and refer mothers to them on
discharge from hospital or clinic
Supports can include
• Early postnatal or clinic checkup
• Home visits
• Telephone calls
• Community services
• Mother support group
• community support group
Assingment
• Causes of Child Mortality: Parash Pokhrel
Thank you