Baby-friendly hospitals in Turkey: evaluation of adherence to the Ten Steps to Successful Breastfeeding.

Abstract

The Baby-Friendly Hospital Initiative (BFHI) is a World Health Organization and United Nations Children's Fund joint global programme to protect, promote and support breastfeeding. Sustainability of the BFHI standards is important for health facilities and country-level implementation. To analyse the 2018-2019 external reassessment results of baby-friendly hospitals (BFHs) in Turkey. We included 414 BFHs. The Ten Steps to Successful Breastfeeding were divided into 2 groups: critical management procedures (Steps 1 and 2) and key clinical practices (Steps 3-10). All 10 steps were fulfilled by 60.1% of the hospitals. Steps 3 and 2 had the lowest compliance rates (81.6% and 85.7%), and Steps 7 and 8 had the highest rates (97.1% and 98.1%). Caesarean section rates in the fourth quartile were associated with significantly lower adherence to Steps 3 and 10. The presence of another external reassessment within 5 years was associated with a significantly higher adherence rate to Step 3, and a significantly higher full implementation rate for the clinical practices. Hospitals that fully implemented management procedures had a significantly higher fulfilment percentage for all clinical practices. The western region had higher adherence rates for all the clinical practices than other regions. Reassessments seem useful for sustainability. Full compliance with Steps 1 and 2 is important for higher adherence to the clinical steps. Regional variations should be taken into account in the implementation of the programme.