Baby-Friendly Hospital Research Articles

Awareness of Federal and State Breastfeeding Laws and Provision of Breastfeeding Resources on a College Campus (OR30-04-19)

ObjectivesThe objective of the study was to determine the familiarity of breastfeeding laws and provision of resources among college students in a large public university in southeastern United States. MethodsThis was a cross-sectional online survey of undergraduate and graduate students of the University of Georgia. Data was collected through Qualtrics. Results1,117 college students of which over half (53.1%) were undergraduate students participated in the study. 76.1% self-identified as females while 0.6% self-identified as transgender. About two-thirds of the participants were 24 years or younger with significant age difference between undergraduate and graduate students, and majority being Caucasians. Only 16.1% and 4.5% reported to be familiar with federal and state laws and provisions that support maternal leave and successful breastfeeding. Significantly higher percentage of graduate students reported to be familiar with both federal (P < 0.0001) and state (P = 0.008) breastfeeding laws. Less than 8% of the participants were familiar with the Baby Friendly Hospital Initiative concept. About 1 in 4 of the participants reported the institution provides supportive breastfeeding environment with significant difference in the response by undergraduate versus graduate students (P < 0.0001). Majority of undergraduates compared to graduate students “support promotional materials of formula milk, feeding bottles, and pacifiers in hospital” (P < 0.0001). A higher percentage of undergraduate students were of the opinion that “hospitals can provide discharge packs containing free infant formula to new mothers” (P = 0.003). Significantly higher percentage of graduate students compared to undergraduate students were of the opinion that it is appropriate for women to breastfeed at work (P = 0.006) and should be paid for time spent breastfeeding or expressing breastmilk at work (P < 0.0001). ConclusionsThe awareness of both federal and state breastfeeding laws was generally low among college students. Further studies are needed to develop breastfeeding education interventions aimed at improving familiarity and awareness of federal and state breastfeeding laws and provisions on our college campus if we are to achieve breastfeeding objectives set for the year 2020 and beyond. Funding SourcesThe project was supported by the Georgia Agriculture Experimental Station (GEO00820).

Effect of Maternal Exhaustion on Breastfeeding Exclusivity

The current rate of exclusive breastfeeding at Bon Secours St. Francis Hospital is 68.3%, with 910 newborns out of 1,332 eligible newborns being exclusively breastfeed over a 6-month period. The general assumption by staff was that a lactation consultant nurse could improve, during the night shifts, breastfeeding exclusivity until the patient was discharged. Data were gathered over a 6-month period on 1,332 births. The mother–baby unit manager was a key stakeholder who used the eight-step plan–do–check–act (PDCA) methodology to solve this problem. The unit manager selected to investigate the subset of 44 mothers who attempted breastfeeding but failed and identified that exhaustion, pain, or unknown reasons were causes. The unit manager worked with front-line staff to develop a root cause analysis using the categories of man, method, material, machine. and environment and identified five important causes of the exhaustion that new mothers experienced:•Care providers were operating on their own schedules, which resulted in 31 planned encounters with the mother during the first 24-hr postbirth.•The hospital did not have mandatory quiet hours or a process to limit visitors.•The patient rooms are side by side with no sound protection.•Staff lacked the awareness of their noise level and how it related to the mother’s exhaustion and lower breastfeeding rates.•Badge swipes for supply, medical, and linen (any locked door) on the unit created loud beeps and mechanical sounds throughout the unit any time a locked door was accessed. Since March 2018, breastfeeding exclusivity rates have remained above 70% and patient satisfaction scores have improved. The hospital also was surveyed for Baby-Friendly hospital designation in August 2018 and is awaiting results. The staff was not familiar with the eight-step PCDA process, and, in the beginning, they believed that the solution was to add lactation support at night. There were additional opportunities that could have been taken advantage of with these improvements by working with internal marketing to promote the initiative and exploring the potential to partner with physician practices to focus on women’s care from prenatal planning to postpartum care.

Pacifier Use and Education With Exclusive Breastfeeding

Hospitals throughout the country are moving toward a Baby-Friendly designation, focusing on exclusive breastfeeding through a set of 10 steps. These steps include encouraging rooming-in during the hospital stay, education of the staff about exclusive breastfeeding, skin-to-skin contact and breastfeeding within the first hour of life, and limited to no use of a pacifier in breastfeeding infants. The average exclusive breastfeeding rate is 60%, whereas the requirement for Baby-Friendly hospital designation is 80%. This program involved intensive education of the staff, proceeded by education of the patients. The goal of this program was to educate patients about pacifier use with exclusive breastfeeding and to decrease supplementation. This education program involved comforting newborns, cautious pacifier use, and a proactive approach to exclusive breastfeeding. The program started in June 2017 and ended in November 2017. The project was divided into seven phases, including a foundation or review phase, data collection and analysis phases, creating and then disseminating the educational program phases, and post–data-collection and analysis phases. During the pre–data-collection phase, it was found that before the implementation of this educational program, 46% of mothers who were exclusively breastfeeding were using a pacifier with their newborn, whereas only 50% were educated on this topic. Thirty percent of all mothers who had stated before birth their intent to exclusively breastfeed had used formula for supplementation as well. The same data-collection tool and breastfeeding dashboard were used and analyzed. It was found that after our educational program started, the number of patients using pacifiers with their newborns decreased to 40%, whereas the number of patients educated on the topic increased to 90%. Patients who supplemented with formula decreased to 27%. According to the data presented, the project was a success. The number of mothers who were using a pacifier while exclusively breastfeeding decreased, whereas the number of those patients who were educated drastically increased. The amount of formula supplementation with those women who wanted to exclusively breastfeed also decreased. With these being our end goals, the project was successful. With this, we will continue our educational program with our postpartum patients.

Understanding evidence-informed decision-making: a rural interorganizational breastfeeding network

BackgroundNetworks are a vehicle for mobilizing knowledge, but there is little research about evidence-informed decision-making in community settings. Breastfeeding is a powerful intervention for population health; combined system and community interventions can increase exclusive breastfeeding rates by 2.5 times. This study examined evidence-informed decision-making within an interorganizational network, including the facilitators and barriers to achieving network goals.MethodsA mixed method case study design was used. The primary sources of data were focus group discussion and questionnaire administration. Data were analyzed concurrently using framework analysis and social network analysis.ResultsKey findings were at the interorganizational and external levels: 1) Relationships and trust are connected to knowledge exchange 2) Need for multiple levels of leadership.ConclusionsThe findings of this study have potential implications for enhancing the use of evidence-informed decision-making as other networks work toward Baby Friendly Initiative (BFI) designation and also highlights the potential for network maps to be used as a knowledge mobilization tool.

Improving the Health of Alaska Native People Through Use of a Policy Change Model and Capacity Building.

Public health training often includes program and education development but not policy, systems, and environmental (PSE) strategies. The Alaska Native Tribal Health Consortium’s Good Health and Wellness in Indian Country program works to build tribal PSE change capacity. Trainings included community health assessment, facilitation and leadership engagement, policy and systems, and digital storytelling. From 2014 to 2017, 30 PSE changes were made: 3 tobacco-free healthcare organization policies; 2 tobacco-free tribal resolutions; 1 tobacco-free school district policy; 3 healthy food policies and environmental changes; 4 improvements in patient-provider communication; 13 prediabetes, obesity, and/or tobacco screening and referral policies; 3 improvements to health care facility signage; and 1 Baby-friendly Hospital application, protecting the health of 46,000 tribal community members. Targeted training and technical assistance moved tribal staff from a focus on direct services to population-based improvements. This increased self-efficacy may increase the sustainability of chronic disease public health efforts and improve tribal health.

Compliance of a Baby-Friendly Designated Hospital in Ghana With the WHO/UNICEF Baby and Mother-Friendly Care Practices.

Although the Baby-Friendly Hospital Initiative has improved breastfeeding rates globally, weak monitoring still affects hospital-level implementation. To reassess compliance of a Baby-Friendly Hospital with the Ten Steps to Successful Breastfeeding, International Code of Marketing of Breast-milk Substitutes, HIV and Infant Feeding, and Mother-Friendly Care following the WHO/UNICEF global criteria. In this cross-sectional, prospective, mixed-methods study (N = 180), clinical staff (n = 60), pregnant women (n = 40), postpartum mothers (n = 60), and mothers of babies in intensive care (n = 20) were randomly selected from one urban secondary-level public hospital in Ghana designated as Baby-Friendly in 2004 but never reassessed. Data were collected through interviews, document reviews, and observations using the revised WHO/UNICEF external reassessment tool and analyzed quantitatively using the Baby-Friendly Hospital Initiative computer tool. Scores higher than 80% signified a pass (high compliance). Scores rated as low (< 50%) and moderate (50-80%) signified noncompliance. The facility passed the criteria for full compliance with the International Code (86%) but failed other components. Compliance with the Ten Steps was moderate (55%). Step 7 about rooming-in (84%) and Step 9 about human milk substitutes (100%) were passed, whereas Step 1 about written breastfeeding policies (0%), Step 2 about staff training (7%), and Step 4 about early breastfeeding initiation (31%) were met the least. Compliance with Mother-Friendly Care (34%) and HIV and Infant Feeding (47%) were low. Main implementation gaps were unavailability of policies and staff's inadequate knowledge about Baby-Friendly practices. Improving staff training and maternal counseling, routinely reassessing designated facilities, and providing technical support in problematic areas might sustain implementation.

Breastfeeding Outcomes Among WIC-Participating Infants and Their Relationships to Baby-Friendly Hospital Practices.

Background: Breastfeeding rates among low-income children participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) lag behind national rates. In Los Angeles County (LAC), recent efforts have been made to increase the number of Baby-Friendly designated hospitals. This study examines changes in Baby-Friendly hospital practices, breastfeeding outcomes, and their relationships with Baby-Friendly hospital status among WIC-enrolled children in LAC. Methods: Cross-sectional data from the triennial LAC WIC Survey (2008 through 2017) were analyzed (n = 6,449) to examine changes in Baby-Friendly hospital practices over time, and differences in breastfeeding outcomes by specific Baby-Friendly hospital practices. Multivariate logistic regression was used to evaluate the relationship between the number of Baby-Friendly hospital practices that mothers met and any and exclusive breastfeeding outcomes. Results: In 2017, mothers surveyed were more likely to engage in Baby-Friendly hospital practices compared with 2008. Any and exclusive breastfeeding outcomes at 1 and 3 months significantly increased since 2014, and breastfed infants were more likely to have mothers who participated in Baby-Friendly hospital practices. The more Baby-Friendly hospital practices mothers met, the better the breastfeeding outcomes. However, there is room for improvement in the uptake of Baby-Friendly hospital practices in Baby-Friendly hospitals. Conclusion: Effort is needed to ensure Baby-Friendly hospitals have support to continuously comply with all steps to maintain Baby-Friendly designation, and non-Baby-Friendly hospitals have support to incorporate these practices into hospital protocols.

Effect of Peanut Ball and Position Changes in Women Laboring With an Epidural

ObjectiveTo examine the effect of a nurse-driven intervention using a peanut ball (PB) with position changes on length of labor and incidence of cesarean birth among women who receive epidural anesthesia. DesignQuasiexperimental comparison group design. Setting/Local ProblemA 407-bed, nonprofit, Magnet-designated, Baby-Friendly Hospital Initiative–designated hospital with 8 labor and delivery suites and an average of 100 births per month. ParticipantsA total of 343 participants were included, with 164 women in the PB group. Intervention/MeasurementsThe PB was placed after epidural administration; women were repositioned a minimum of every 1 to 2 hours, and the PB was removed at second stage of labor; duration was recorded. ResultsOverall, women in the PB group were 50% less likely to have cesarean birth. For women with cervical dilation of 4 cm or less, rates of vaginal birth were 61% with use of the peanut ball. A multivariate analysis of outcomes was used. A multiple linear regression model showed, after adjusting for other variables, that PB placement alone did not shorten labor length (p = .4684). However, a stratified analysis indicated that for women with cervical dilation of 4 cm or less, length of the first stage of labor was affected by parity (p = .0042) and frequency of position change (p < .001). For women with cervical dilation greater than 4 cm, length of the first stage of labor was influenced by frequency of position changes (p = .0130) and effacement (p = .0050). Length of the second state of labor was affected by the frequency of position change (p = .0416). ConclusionThe PB may be an effective intervention to reduce the incidence of cesarean birth. Changing position frequently was associated with reduced length of first and second stages of labor.

Social Support and Baby-Friendly Hospital Care: Improving Breastfeeding Rates Among African American Mothers [15N

INTRODUCTION: Women of high education and income status are more likely to breastfeed adequately in comparison with their less educated peers. African-American mothers continue to record the lowest breastfeeding rates compared to White and Hispanic mothers. METHODS: We recorded demographic information from 257 pregnant African-American women aged between 15 and 42 years recruited by flyers and word-of-mouth in a breastfeeding promotion intervention, and collected their infant feeding action at birth and at 3 months and 6 months postpartum. We computed their Baby-Friendly knowledge and exposure score using a 16-item survey, recorded their Supplemental Nutrition Assistance Program (SNAP) and Women, Infant, and Children (WIC) status. Rate comparisons was by Chi-Square test using Statistical Package for Social Sciences, SPSS Version 25.0. RESULTS: 98 (38.1%) were nulliparous, 114 (44.4%) had one or two children, and 45 (17.5%) had &gt;2 children. Of 164 interviewed within a week of delivery, 104 (63.4%) breastfed exclusively, 38 (23.2%) mix fed, and 22 (13.4%) did not breastfeed (NBF). Exclusive breastfeeding (EBF) rates at 3-months and 6-months were 32.8% and 17.1%, with NBF rates 30.5% and 44.4% respectively. Breastfeeding rates were higher for educated, older, and married mothers, but similar across work status. NBF rates at 3 months for mothers on SNAP, SNAP &amp; WIC, WIC only, and Neither, were 47.1%, 50.0%, 16.0% and 15.2% respectively, P&lt;.004. The rate for exclusive breastfeeding for WIC mothers with high vs low Baby-Friendly exposure score were 38.0% vs 0.0%, P&lt;.006. CONCLUSION: Policies that combine Baby-Friendly principles and nutritional assistance for all mothers, particularly low-income working mothers, will improve breastfeeding rates dramatically.

Perceptions and Practices of Infant Feeding among African American Women

ABSTRACTA large urban hospital in Florida implemented changes to achieve the Baby-Friendly Hospital Initiative (BFHI) designation in 2015 resulting in an increase of exclusive breastfeeding rates at hospital discharge; however, African American women continue to have the lowest rates overall. Qualitative interviews were conducted with 20 African American women who received prenatal care at a low-income women’s clinic and gave birth at an affiliated BFHI hospital. Using a medical anthropology analytical framework to examine predisposing, enabling, and service-related factors that affect breastfeeding, this study investigated interpersonal, sociocultural, and institutional barriers to breastfeeding. Common challenges experienced by participants included lack of maternity leave from work, lack of access to electric pumps, social pressures to initiate formula supplementation, fears that breastfeeding renders infants overly dependent on their mother’s care, and a lack of breastfeeding role models and/or support networks to normalize longer-term breastfeeding. We conclude that efforts to increase breastfeeding rates for African American women and promote culturally sensitive interventions must address underlying socioeconomic and structural barriers, women’s perceptions of breastfeeding benefits and difficulties, and the need for improvements in postnatal lactation and doula support to foster a more inclusive culture of breastfeeding.

The effect of rooming-in on duration of breastfeeding: A systematic review of randomised and non-randomised prospective controlled studies.

BackgroundThe benefits of six months exclusive breastfeeding are well established for both mother and infant. One of the 10 steps of the Baby Friendly Hospital Initiative is rooming-in (mother and baby together in the same room throughout hospitalisation). A Cochrane review found only one randomised controlled trial (RCT) examining the effects of continuous rooming-in versus nursery care on breastfeeding duration, and concluded there was insufficient evidence to support or refute either practice. We aimed to examine the effect of continuous or intermittent rooming-in on breastfeeding duration.Methods and findingsWe included all prospective controlled studies (randomised and non-randomised) comparing rooming-in to nursery care that reported full or partial breastfeeding up to six months. We used the 2016 search results of the Cochrane review and updated the search to August 2018 using OVID MEDLINE. Duplicate data extraction and assessment of risk of bias were performed. Meta-analyses were performed using REVMAN 5. The GRADE approach was used to assess quality of evidence.Seven studies were included, five had 24-hour-per-day, one daytime only and one 8-hours-per-day rooming-in. Four studies had at least one additional co-intervention: Differences in delivery room management, and educational packages.All studies contributing to meta-analyses had 24-hour rooming-in. There was no difference in the proportion of infants on full breastfeeding at 3 months (RR 1.14; 95% CI 0.84 to 1.54; very-low-quality evidence), 4 months (RR 0.99; 95% CI 0.73 to 1.33; very-low-quality evidence) and 6 months (RR 0.95; 95% CI 0.57 to 1.58; low-quality evidence). The proportion of infants on partial breastfeeding at 3–4 months was higher with rooming-in (RR 1.31; 95% CI 1.06 to 1.61; very-low-quality evidence).ConclusionThe addition of non-randomised prospective controlled studies to existing evidence did not add further information on the effects of rooming-in on breastfeeding duration but resulted in lower quality of evidence. Uncertainty about the effects of rooming-in on breastfeeding duration remains.

Breastfeeding Experiences of Taiwanese Mothers of Infants with Breastfeeding or Breast Milk Jaundice in Certified Baby-Friendly Hospitals

PurposeThe purpose was to explore the breastfeeding experiences of mothers of infants with breastfeeding or breast milk jaundice. MethodsIn-depth qualitative interviews and content analysis were conducted with nine mothers of newborns with breastfeeding and/or breast milk jaundice who breastfed their babies during the first year postpartum. ResultsMothers' experiences can be described in four phases and six themes. (1) Prenatal stage: build breastfeeding belief, i.e., breastfeeding is best and a natural behavior, without awareness of neonatal jaundice; (2) stage after neonatal jaundice started to appear: include two themes, questioning beliefs in breastfeeding and happiness in being a mother. Mothers lacked knowledge and ignored the threat of neonatal jaundice, mainly focused on their physical discomforts and worried about insufficient breast milk; they also felt an intimate mother–infant bond through breastfeeding; (3) stage when newborns had confirmed diagnosis of breastfeeding or breast milk jaundice that required medical attention: include two themes, diagnosis of breastfeeding or breast milk jaundice and phototherapy caused negative emotions and regaining original beliefs about breastfeeding. They struggled through emotional swings and inconsistent advices about whether phototherapy and formula supplementation are needed. Then, they decided breastfeeding or breast milk jaundice is only temporary and retrieved initial beliefs of breastfeeding. (4) Stage after neonatal jaundice faded and mothers continued breastfeeding: insisting and adapting. ConclusionBreastfeeding mothers were unaware of neonatal jaundice until medical attention was required; they experienced physical and mental distress and gradually learned to manage jaundice while insisting on breastfeeding through their breastfeeding beliefs and happiness in being mothers.

International Board Certified Lactation Consultants' Practices Regarding Supplemental Feeding Methods for Breastfed Infants.

According to the Baby Friendly Hospital Initiative, when supplementary feeding occurs, mothers should be counseled on the use and risks of feeding bottles and teats. To help support this initiative it is important to understand the supplementation practices of Internationally Board Certified Lactation Consultants (IBCLC)®. To determine (1) if the location of an IBCLC's practice has any impact on supplemental feeding methods; (2) the preferred methods of and the main reasons for supplementation; (3) the level of an IBCLC's confidence with supplemental feeding methods; (4) who is making supplemental feeding decisions; and (5) if there are geographical differences among supplementation choices and reasons for supplementation. An exploratory, descriptive, cross sectional survey of IBCLCs was conducted to generate data about their use of supplemental feeding methods. The survey was sent via email invitation through the International Board of Lactation Consultant's Board of Examiners, with a response rate of 11.5% (N = 2,308). There was no standard method of supplementation among participants. Participants indicated that they were confident advising mothers on alternative feeding methods. Only 17.6% (n = 406) of participants reported that the IBCLC was the caregiver who recommended the method of supplementation used. The majority of participants believed the Supplemental Feeding Tube Device SFTD) best preserves the breastfeeding relationship, and this was their preferred method of supplementation. However, the bottle was ranked as the number one method used in the United States, Australia, and Canada. The use of alternative feeding methods may be overwhelming to the mother. Supplementation by alternative feeding methods might help preserve the breastfeeding relationship and help reach the World Health Organization's goal of increasing exclusive breastfeeding rates.

Pacifiers: Counseling instead of prohibiting. The new Baby-friendly Hospital Initiative.

Pacifiers: Counseling instead of prohibiting. The new Baby-friendly Hospital Initiative.

Breastfeeding: Investing in the Future.

Breastfeeding: Investing in the Future.

Dowling, S.,Pontin, D. and Boyer, K. (eds). Social Experiences of Breastfeeding: Building bridges between research, policy and practice. Bristol: Policy Press. 2018. 280pp. £60.00 (hbk) ISBN: 978‐1447338499.

Dowling, S.,Pontin, D. and Boyer, K. (eds). Social Experiences of Breastfeeding: Building bridges between research, policy and practice. Bristol: Policy Press. 2018. 280pp. £60.00 (hbk) ISBN: 978‐1447338499.

The Practice of Exclusive Breastfeeding Can Reduce Frequency of Sick Children and Improve the Productivity of Health-Care Provider Mothers: Study in Samarinda, Indonesia

ABSTRACT Sick children can be a reason a mother is absent from work or does not work optimally. This study aims to look at the relationship between exclusive breastfeeding practices and frequency of sick children and the productivity of health-care provider mothers. This quantitative study was done using a sample of 160 health-care provider mothers from hospitals in cities and districts in Samarinda, Indonesia. Data analysis was approached using Chi-square test for categorical variables. There is a significant relationship between the practice of exclusive breastfeeding and the frequency of sick children and the productivity of health-care provider mothers (p = 0.002). The results showed that the scores of OR on the frequency variable of sick children and maternal-productivity variables are 3.22 and 2.99, respectively. The practice of exclusive breastfeeding can reduce the frequency of sick children and the productivity of health-care provider mothers. The health-care provider mothers play a role in promoting exclusive breastfeeding and as role models in providing support for the application of the Baby-Friendly Hospital Initiative with “Ten Steps to Successful Breastfeeding”. There is a need for regulations regarding maternity and breastfeeding leave regardless of employment status.

Risk Factors for Delayed Onset of Lactogenesis II Among Primiparous Mothers from a Brazilian Baby-Friendly Hospital.

Low milk supply is frequently reported as a reason for exclusive breastfeeding cessation. To determine the occurrence of, and the risk factors associated with, delayed onset of lactogenesis II among primiparas seen at a Baby-Friendly Hospital in Brazil. We conducted a prospective longitudinal observational cohort study of 224 primiparas who had a singleton delivery. Data were first collected at the hospital. We assessed the onset of lactogenesis on day four postpartum, based on maternal reports of changes in breast fullness. Breastfeeding practices and Edinburgh Postnatal Depression Scale were evaluated on day seven postpartum. Using Poisson regression, we assessed significant factors associated with delayed onset of lactogenesis II. Delayed lactogenesis II occurred in 18.8% (n = 42) of participants and was significantly associated with alcohol drinking during pregnancy (IRR = 2.710, 95% CI [1.469, 4.996]); Edinburgh Postnatal Depression Scale scores ≥ 10 (IRR = 2.092, 95% CI [1.118, 3.916]), and the age of the mother (IRR: 1.081, 95% CI [1.039, 1.125]). Postpartum depression and alcohol ingestion during pregnancy may be associated with lactogenesis II delay, but more research is needed to elucidate the directionality of these relationships. Older mothers are at risk of delayed lactogenesis II onset. The frequency of delayed lactogenesis in this population is similar to the rates seen in previous Latin America studies and much lower than the ranges seen in North America, possibly because of the low proportion of obesity and severe gestational diabetes in this sample.

BFHI News Brief: News From the Baby-Friendly Hospital Initiative Network.

BFHI News Brief: News From the Baby-Friendly Hospital Initiative Network.

Breastfeeding Promotion and Baby-Friendly Health Facilities in Turkey: A Systematic Approach to Scale up the Program

Objectives: In Turkey, Breastfeeding Promotion and Baby-Friendly Health Facilities Program (BFHF) was launched in 1991 with the collaboration of the Ministry of Health (MoH) and United Nations International Children’s Emergency Fund (UNICEF). Since 2002, the program has been extended from hospitals to the primary health care services and the community level. This paper aims to present the current status of BFHF and development of new strategies to revitalize the program and thus, to contribute to the progress. Materials and Methods: All information about health facilities and provinces was collected from the database of the Child and Adolescent Health Department. Discussions about Initiative with stakeholder institutions and baby-friendly advocates took place in the National Breastfeeding Committee Meeting and in Annual Breastfeeding Symposium. Then a SWOT (strengths, weaknesses, opportunities, threats) analysis of the Program was performed by the working group. Using this analysis results, new strategies and course of action were identified. Results: The current number of baby-friendly hospitals has reached a total of 1051(69.42% of all hospitals). Of those, 46 were maternity hospitals, which were 93.50% approved as baby-friendly at the end of 2017. Between 2008 and 2017, 120 (%11.42) of those pre-certified hospitals were reassessed. Between 2002 and 2013, all 81 provinces have been designated Baby-Friendly Provinces. Since 2008, 61 of the 81 provinces have been designated Golden Baby-Friendly Provinces and 95% of Family Medicine Units have been certified as baby-friendly. According to the SWOT analysis result, the main strength of the program was strong recognition and support of the BFHF by the government. The difficulties in maintaining of baby-friendly standards in health facilities and inadequate reassessment of pre-certified facilities were determined as the main weaknesses of the BFHF by the working group. Conclusion: To protect, promote and support breastfeeding effectively and to reach the national and global breastfeeding goals, interventions should be planned in a combination of settings by concurrently involving health policies, health systems, home, family and the community.