Baby friendly hospitals: are we failing mothers who formula feed their babies?

The UNICEF Baby Friendly Hospital Initiative (BFHI) has identified steps to promote breast-feeding in maternity hospitals worldwide. However, in the UK it is customary for women to make informed choices about their method of infant feeding and surveys show that a substantial number choose formula feeding either initially or after a few weeks. While upholding the benefits of breast-feeding, health professionals have a duty of care to ensure that mothers who choose to formula feed are taught to do so safely and appropriately with correct and up-to-date information, e.g. on allergy prevention. Many midwives are under the mistaken impression that the BFHI's "ten steps" to successful breast-feeding forbid discussion with mothers about formulae and the practicalities of formula feeding, including demonstration of sterilisation of equipment and preparation of feeds. In fact the BFHI clearly includes what is required for safe and appropriate formula feeding. Yet it is not easy for midwives to obtain the information they need on formula feeding, especially as many maternity units in the UK appear to have stopped manufacturers' representatives from meeting with managers or clinical midwives to give factual information on infant formula. As a result of these factors, a serious discrepancy has opened up between the stated goals of the BFHI and its interpretation in practice, and some mothers and their babies are being badly served.