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Compliance with the "Baby-friendly Hospital Initiative for Neonatal Wards" in 36 countries
Ragnhild Maastrup1, Laura N Haiek2,3,4,
1Department of Neonatology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
Insights
Global compliance with Baby-friendly Hospital Initiative for Neonatal Wards (Neo-BFHI) recommendations for breastfeeding support in neonatal wards is partial. While some areas show high scores, others need improvement, indicating readiness for wider implementation.
Area of Science:
- Neonatal care
- Public health
- Infant nutrition
Background:
- The Baby-friendly Hospital Initiative for Neonatal Wards (Neo-BFHI) was established in 2012 to enhance breastfeeding support for vulnerable infants.
- Global implementation of Neo-BFHI standards in neonatal settings is crucial for improving infant health outcomes.
Purpose of the Study:
- To assess the global compliance of neonatal wards with the Neo-BFHI's expanded Ten Steps and Guiding Principles.
- To identify areas of high and low compliance across different income levels and hospital designations.
Main Methods:
- A cross-sectional survey conducted in 2017 using the Neo-BFHI Self-Assessment questionnaire in 15 languages.
- Data collected from 917 neonatal wards across 36 countries, representing all income levels and continents.
- Compliance scores calculated at ward, country, and international levels.
Main Results:
- The international median compliance score was 77%, with country scores ranging from 52% to 91%.
- Highest compliance was observed for Guiding Principle 1 (respect for mothers), Step 5 (breastfeeding initiation), and Step 6 (human milk use).
- Lowest compliance was found for Step 3 (antenatal information) and Step 7 (rooming-in). High-income countries and Baby-friendly designated hospitals showed higher scores.
Conclusions:
- Neo-BFHI recommendations are currently only partly implemented globally in neonatal wards.
- There is significant international readiness to adopt and expand Baby-friendly standards in neonatal care.
- Increased efforts from hospitals and governments are needed to fully support breastfeeding for preterm and ill infants.
Abstract:
In 2012, the Baby-friendly Hospital Initiative for Neonatal Wards (Neo-BFHI) began providing recommendations to improve breastfeeding support for preterm and ill infants. This cross-sectional survey aimed to measure compliance on a global level with the Neo-BFHI's expanded Ten Steps to successful breastfeeding and three Guiding Principles in neonatal wards. In 2017, the Neo-BFHI Self-Assessment questionnaire was used in 15 languages to collect data from neonatal wards of all levels of care. Answers were summarized into compliance scores ranging from 0 to 100 at the ward, country, and international levels. A total of 917 neonatal wards from 36 low-, middle-, and high-income countries from all continents participated. The median international overall score was 77, and median country overall scores ranged from 52 to 91. Guiding Principle 1 (respect for mothers), Step 5 (breastfeeding initiation and support), and Step 6 (human milk use) had the highest scores, 100, 88, and 88, respectively. Step 3 (antenatal information) and Step 7 (rooming-in) had the lowest scores, 63 and 67, respectively. High-income countries had significantly higher scores for Guiding Principles 2 (family-centered care), Step 4 (skin-to-skin contact), and Step 5. Neonatal wards in hospitals ever-designated Baby-friendly had significantly higher scores than those never designated. Sixty percent of managers stated they would like to obtain Neo-BFHI designation. Currently, Neo-BFHI recommendations are partly implemented in many countries. The high number of participating wards indicates international readiness to expand Baby-friendly standards to neonatal settings. Hospitals and governments should increase their efforts to better support breastfeeding in neonatal wards.