Successful application of the baby-friendly hospital initiative contains lessons that must be applied to the control of formula feeding in hospitals in industrialized countries.

Abstract

* Abbreviations: BMC = : Boston Medical Center • BFHI = : Baby-Friendly Hospital Initiative • WHO = : World Health Organization • UNICEF = : United Nations Children's Fund The health risks of artificial feeding of infants in the industrialized world are now well-established—breastfed infants receive protection against illnesses including gastroenteritis, respiratory infections, and otitis media, and have a lower risk of atopic disease and insulin-dependent diabetes in childhood, while women who breastfeed may have less risk of some cancers and hip fractures in later life.1 ,2 In addition to the health benefits, there are also significant cost implications—the US Department of Agriculture has estimated that a minimum of $3.6 billion per year would be saved if breastfeeding rates were increased from current levels to those recommended by the US Surgeon General.3 What is less clear is how society as a whole and the health services in particular should go about reversing the decline in breastfeeding. The evaluation by Philipp and colleagues in this issue of Pediatrics ,4 which found that breastfeeding rates at the Boston Medical Center (BMC) rose by 28.5% over 4 years, during which the maternity unit achieved accreditation by the Baby-Friendly Hospital Initiative (BFHI) is therefore interesting for a number of reasons. Although breastfeeding can also be promoted by improving facilities in the public environment, addressing workplace issues, and providing education in schools—and indeed efforts have been made in this direction5 ,6—it is in maternity hospitals and subsequently in … Address correspondence to David P. Southall, OBE, MD, FRCPCH, Child Advocacy International, 79 Springfield Rd, Stoke on Trent ST4 7RY United Kingdom. E-mail: davids{at}doctors.org.uk andcai_uk{at}compuserve.com