Abstract
The Baby‐Friendly Hospital (BFH) Initiative has led to an increase in breastfeeding rates and duration worldwide. But little is known about whether the beneficial effects persist beyond a facility's designation as a BFH. To investigate the association of BFH designation (current, former, and never) and compliance with Baby‐Friendly (BF) practices on breastfeeding in Switzerland, this study combined nationwide survey data on breastfeeding with BFH monitoring data. In this cross‐sectional study, 1,326 children were born in 34 current (N = 508), 28 former (N = 425), and 34 never designated BFHs (N = 393). We compared exclusive and any breastfeeding according to BFH designation over the first year of life, using Kaplan‐Meyer Survival curves. Logistic regression models were applied to analyse breastfeeding prevalence, and Cox‐regression models were used for exclusive (0–6 months) and continued (6–12 months) breastfeeding duration. Average duration of exclusive breastfeeding (13.1 weeks, 95% confidence interval [12.0, 17.4]) and any breastfeeding (32.7 weeks, 95% confidence interval [30.5, 39.2]) were the longest for babies born in currently accredited BFHs. Exclusive breastfeeding was associated with high compliance with monitored BF practices in current BFHs and with the number of BF practices experienced in all hospitals. Continued breastfeeding was significantly longer when babies were born in current BFHs (cessation hazard ratio 0.60, 95% confidence interval [0.42, 0.84]) or in former BFHs (cessation hazard ratio 0.68, 95% confidence interval [0.48, 0.97]). Overall, the results support continued investment into BFHs, because babies born in current BFHs are breastfed the most and the longest, whereas a former BFH designation shows a sustained effect on continued breastfeeding.
Highlights
The Baby‐Friendly Hospital Initiative (BFHI) launched by WHO/ UNICEF has proven to be a powerful tool for raising breastfeeding rates
This study showed that outcomes for exclusive breastfeeding and continued breastfeeding were different
BF practices had a positive impact on exclusive breastfeeding, Baby‐Friendly Hospital” (BFH) designation had a positive effect on continued breastfeeding
Summary
The Baby‐Friendly Hospital Initiative (BFHI) launched by WHO/ UNICEF has proven to be a powerful tool for raising breastfeeding rates. Breastfeeding is a protective factor for health (Victora et al, 2016); breastfeeding promotion continues to be an important measure to improve child and maternal health in both developed and developing countries. According to recent meta‐analyses, the BFHI was the most effective intervention for improving breastfeeding rates at health system level (Sinha et al, 2015) and adherence to the BFHI Ten Steps to support successful breastfeeding had a positive impact on breastfeeding outcomes (Perez‐Escamilla, Martinez, & Segura‐ Perez, 2016). 9% of facilities have been designated as a “Baby‐Friendly Hospital” (BFH) at least once. This rate is low, but there are large variations in the proportion of BFHs across industrialised countries (Labbok, 2012). In Sweden and The Netherlands, most hospitals have been designated as a BFH
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