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Background: Organizational-level interventions (i.e., Baby-Friendly Hospital Initiative) that support breastfeeding and target breastfeeding initiation are critical to reducing breastfeeding disparities and promoting breastfeeding equity. Research Aim: To determine the association between delivery in a Baby-Friendly accredited hospital and breastfeeding initiation among United States recipients of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Washington DC, the majority of whom report their race as Black. Method: We conducted a secondary analysis of de-identified program data collected as part of routine WIC visits from the Washington DC WIC program, 2017–2020. Women who delivered a firstborn, singleton infant were included (N = 8,225). Multivariable logistic regression models accounted for social determinants of health and other factors. One set of models included a binary exposure variable (Baby-Friendly accredited vs. non-accredited hospitals), and another set included a categorical exposure variable for hospitals (1) Baby-Friendly accredited, (2) Baby-Friendly activities but not accredited, and (3) neither Baby-Friendly activities nor accredited. Results: Breastfeeding initiation was 57.4% (n = 1988) for women delivering in accredited hospitals versus 55.4% (n = 2540) in non-accredited hospitals and multivariable model results were non-significant (OR = 0.95, 95% CI [0.86, 1.05]). However, more women initiated breastfeeding who delivered in either accredited hospitals (57.4%, n = 1988) or hospitals with Baby-Friendly activities but not accredited (55.9%, n = 2430) compared to those delivering in hospitals with neither (45.3%, n = 110), and multivariable models results concurred (Baby-Friendly accredited hospitals OR = 1.44, 95% CI [1.07, 1.94]; Baby-Friendly activities but not accredited, (OR = 1.55, 95% CI [1.16, 2.09]). Conclusion: Organizational-level interventions that create hospital environments supportive of breastfeeding initiation are important to promote equity in breastfeeding, but underlying social determinants of breastfeeding outcomes must be addressed. [ABSTRACT FROM AUTHOR]

Breastfeeding offers significant health benefits for both mothers and infants, particularly preterm infants, where it serves as a therapeutic strategy to reduce mortality and morbidities. However, breastfeeding practices are threatened globally by societal norms and systemic barriers at both micro and macro levels. This paper explores the complex interplay of these barriers and facilitators, focusing on the Neonatal Intensive Care Unit (NICU) setting. Preterm infants face specific feeding challenges due to immature physiological functions, yet evidence supports that strategies like cue-based feeding and individualized care can enhance feeding success and health outcomes. For mothers, initiating and maintaining lactation after preterm birth is critical but challenging, with early lactation support and achieving sufficient milk volume being key predictors of success. Partner support significantly influences lactation outcomes, although more inclusive research is needed for diverse family structures. In the NICU, a multidisciplinary approach to lactation care is vital, emphasizing the need for experienced staff and family-centered practices. NICU design, policies promoting parental presence, and adherence to Baby-friendly Hospital Initiative guidelines further support breastfeeding. This paper aims to provide directives for local breastfeeding policies through an integrated approach, considering societal attitudes and healthcare practices. The findings advocate for improved lactation support in NICUs, inclusive language and policies, and further research into diverse familial and gender roles in breastfeeding. [ABSTRACT FROM AUTHOR]

Objectives: To examine US in-hospital exclusive breastfeeding (EBF) and the associations with Baby-Friendly designation and neighborhood sociodemographic factors. Methods: Hospital data from the 2018 Maternity Practices in Infant Nutrition and Care survey were linked to hospital zip code tabulation area (ZCTA) sociodemographic data from the 2014–2018 American Community Survey (n = 2,024). The percentages of residents in the hospital ZCTA were dichotomized based on the relative mean percentage of the hospital's metropolitan area, which were exposure variables (high/low Black hospitals, high/low poverty hospitals, high/low educational attainment hospitals) along with Baby-Friendly designation. Using linear regression, we examined the associations and effect measure modification between Baby-Friendly designation and hospital sociodemographic factors with in-hospital EBF prevalence. Results: US mean in-hospital EBF prevalence was 55.1%. Baby-Friendly designation was associated with 9.1% points higher in-hospital EBF prevalence compared to non-designated hospitals [95% confidence interval (CI): 7.0, 11.2]. High Black hospitals and high poverty hospitals were associated with lower EBF prevalence (difference= -3.3; 95% CI: -5.1, -1.4 and − 3.8; 95% CI: -5.7, -1.8). High educational attainment hospitals were associated with higher EBF prevalence (difference = 6.7; 95% CI: 4.1, 9.4). Baby-Friendly designation was associated with significant effect measure modification of the in-hospital EBF disparity attributed to neighborhood level poverty (4.0% points higher in high poverty/Baby-Friendly designated hospitals than high poverty/non-Baby-Friendly designated hospitals). Significance: What is already known on this subject?: Few infants exclusively breastfeed (EBF) for the recommended 6 months. There are known sociodemographic disparities in EBF prevalence, yet little is known about neighborhood sociodemographic factors and the relationship with in-hospital EBF. What this study adds?: Hospitals in neighborhoods with high relative percentage of Black residents and poverty were associated with lower in-hospital EBF prevalence. Baby-Friendly designation may reduce EBF disparities among hospitals located in high poverty neighborhoods. [ABSTRACT FROM AUTHOR]

The World Health Organization recommends assessing compliance with key clinical practices of the Baby-Friendly Hospital Initiative (BFHI; Steps 3–9) using birthing women's self-reports. Globally, compliance is mainly assessed using health staff reports, and the use of women's self-reports in selected countries has deviated from the Global Standards for the BFHI. Therefore, we aimed to provide insight into the appropriate method of incorporating women's self-reports in assessing compliance with Steps 3–9 of the BFHI. We developed questions and coding algorithms for assessing compliance with Steps 3–9 based on Global Standards for BFHI compliance, and implemented them via a cross-sectional survey of 302 women who gave birth to a live baby in Sri Lankan hospitals. Compliance with specific practices within each of Steps 3–9 and overall compliance with each step were described as percentages. Compliance with specific practices and each BFHI Step ranged from 15.9%–100% and 7.0%–100%, respectively. Our findings particularly emphasize the potentially enhanced usefulness and robustness of assessing all specific practices within BFHI key clinical steps and not focusing only on one practice within a step, to derive more useful health service guidance globally for capturing BFHI compliance and its impact on breastfeeding outcomes. This method could be translated across multiple settings globally. It would enable more specific identification of care advancements required by health services to improve the effectiveness of breastfeeding support and address the prevailing undervaluing and under-use of women's experiential data to evaluate and guide health service improvement. [ABSTRACT FROM AUTHOR]

Aim Design Method Results Conclusion Implications for the profession and/or patient care Impact Reporting Method Patient or Public Contribution What Does This Paper Contribute to the Wider Global Clinical Community? Trial and Protocol Registration The aim of the study was to investigate the impact of the use of baby‐friendly community initiative (BFCI) model on various stakeholders in the community.Quasi‐experimental research design.The study was conducted in public premises and online workshops from April 2019 to September 2022. Participants were followed up for a period of 1 month, except for those employed at public premises. The program involved training based on an accredited BFCI framework to cultivate a breastfeeding‐friendly attitude and knowledge. A paired sample t‐test was used to examine breastfeeding attitude and knowledge scores before and after BFCI training among staff employed from public premises. An analysis of variance was conducted to examine the breastfeeding self‐efficacy and attitude scores, measured repeatedly at different timepoints over 1‐month timepoint (T0, T1 and T2) among pregnant and postpartum women.A total of 2340 perinatal women and 1339 staff from public premises were recruited. For staff, there was an increase in the mean score of breastfeeding knowledge and attitude by 5.8 and 6.1, respectively, at T1. Similarly, for perinatal women, there was an increase in the mean score of breastfeeding self‐efficacy and attitude by 6.6 and 3.3, respectively, at T1.In summary, a BFCI model, with active community participation, accreditation and an award system, has been effective in promoting breastfeeding. Adapting the baby‐friendly hospital initiative to local contexts and employing a social theory model can enhance breastfeeding promotion and improve infant health outcomes. Prioritizing culturally sensitive breastfeeding education is crucial for successful BFCI implementation.Healthcare professionals should consider clients' culture and socio‐economic backgrounds when providing breastfeeding education to maximize effectiveness. The target audience for breastfeeding education should be expanded to include various community stakeholders beyond families.What problem did the study address? This study addressed the problem of knowledge gaps among stakeholders in building a breastfeeding‐friendly community, particularly in implementing a baby‐friendly community initiative (BFCI) as part of a baby‐friendly hospital initiative (BFHI). The research filled a service gap by providing effective interventions targeting community stakeholders and assessing the impact of a BFCI program on their knowledge and attitudes towards breastfeeding.What were the main findings? The findings highlighted the effectiveness of a BFCI program in enhancing breastfeeding knowledge and attitudes among frontline staff and increasing breastfeeding confidence among mothers. These findings contribute to the understanding of the program's impact on different stakeholders in the community.Where and on whom will the research have an impact? It impacts on global policymakers by providing insights for developing comprehensive guidelines for future BFCI implementations. It also contributes to the creation of a more baby‐friendly community, benefiting breastfeeding families and their infants by promoting and supporting breastfeeding families.This study has adhered to relevant EQUATOR guidelines using the TREND reporting guideline.No patient or public contribution.This study provides an overview of the establishment of a localized BFCI program. It also opens up a new direction for the community to investigate BFCI strategies for community stakeholders. It also provides evidence to support other countries in following a similar process, as each country approaches becoming breastfeeding‐friendly in its own unique way.No protocol. [ABSTRACT FROM AUTHOR]

Quantify and compare reported breastfeeding support practices in the Baby-Friendly Hospital Initiative (BFHI) and non-BFHI facilities. Cross-sectional survey. Regions across the US. Two hundred and eighty-six facilities (110 BFHI and 176 non-BFHI) selected by a stratified (by hospital size) random sample of 50% BFHI and 50% non-BFHI facilities. Emailed survey Fall 2019 through Spring 2020. Reported adherence to the 10 Steps to Successful Breastfeeding. Wilcoxon rank sum test with continuity correction, Pearson chi-square test of independence, and Fisher's exact test. Baby-Friendly Hospital Initiative facilities were more likely to report adherence to the 10 Steps to Successful Breastfeeding. Only 2 of the reported steps were not significantly different: immediate postnatal care and responsive feeding. This research supports breastfeeding support interventions within hospitals as both BFHI and non-BFHI facilities have room for improvement. Interventions targeting non-BFHI facilities are an opportunity to close the disparity in breastfeeding care. [ABSTRACT FROM AUTHOR]

Background The Baby-Friendly Hospital Initiative (BFHI) is associated with improved breastfeeding outcomes in many high-income countries including the UK and the USA, but its effectiveness has never been evaluated in France. We investigated the impact of the BFHI on breastfeeding rates in French maternity units in 2010, 2016 and 2021 to assess if the BFHI aids to reduce inequalities in breastfeeding. Methods We examined breastfeeding in maternity units (exclusive, mixed and any breastfeeding) in mothers of singleton full-term newborns using the 2010 (n  = 13 075), 2016 (n  = 10 919) and 2021 (n  = 10 209) French National Perinatal Surveys. We used mixed-effect hierarchical multinomial regression models adjusting for neonatal, maternal, maternity unit and French administrative department characteristics, and tested certain interactions. Results The adjusted rate of exclusive breastfeeding was higher by +5.8 (3.4–8.1) points among mothers delivering in BFHI-accredited maternity units compared with those delivering in non-accredited units. When compared with average-weight newborns, this difference was sharper for infants with low birthweight: +14.9 (10.0–19.9) points when their birthweight was 2500 g. Mixed breastfeeding was lower by -1.7 points (-3.2–0) in BFHI-accredited hospitals, with no notable difference according to the neonatal or maternal characteristics. Conclusion Mothers delivering in BFHI-accredited maternity units had higher exclusive breastfeeding rates and lower mixed breastfeeding rates than those delivering in non-accredited maternity units. The positive impact of the BFHI was stronger among low-birthweight neonates, who are less often breastfed, helping reduce the gap for this vulnerable group while favouring mothers with higher education levels. [ABSTRACT FROM AUTHOR]

Objectives: Our aim was to explore postpartum individuals' experiences and perceptions of breastfeeding and International Board Certified Lactation Consultants' (IBCLC) knowledge and perceptions of maternity care practices and perceived barriers to breastfeeding among their patient populations in Appalachia. Methods: Semistructured interviewswere conductedwith seven IBCLCs and seven postpartum individuals. Interviews were recorded and transcribed. Thematic analysis was conducted to determine emergent themes and subthemes related to knowledge/perceptions, experiences, and barriers to breastfeeding among postpartum individuals, aswell as emergent themes associated with the knowledge and perceptions of maternity care practices, easy-/difficult-to-implement Baby-Friendly Hospital Initiative maternity care practices, and perceived barriers to breastfeeding among IBCLCs. Results: Postpartum individuals recruited from an Appalachian obstetrics/gynecology clinicwere aware of the benefits of breastfeeding, but their infant feeding journeys were more stressful than they expected, and they had limited access to lactation support and breastfeeding education/information. IBCLCs identified the benefits of the Baby-Friendlymaternity care practices but mentioned some risks, especially when there is a lack of communication and coordination among providers. Environmental and informational barriers were identified by both postpartum individuals and IBCLCs as breastfeeding challenges potentially amenable to change. Conclusions: To support postpartum mothers in the Appalachian region, environmental barriers (eg, lack of lactation support) and informational barriers (eg, lack of prenatal education) need to be addressed. [ABSTRACT FROM AUTHOR]

Despite the care provided, some newborns, who are perfectly healthy, show functional alterations that impair a good breast attack in the first few days. This situation often leads to the early failure of lactation. We conducted a randomized single-blind controlled trial to evaluate whether four weeks of osteopathic treatment can normalize the sucking score in a group of neonates with impaired lactation ability. Forty-two healthy full-term neonates were enrolled in this study. On the basis of the sucking score and the assessment of the infant's breastfeeding skills, infants who had intrinsic breastfeeding difficulties were selected. The inclusion criteria were healthy infants born > 37 weeks, a suction score ≤ 6, and any breast milk at enrolment. At the end of the study, the sucking score was significantly greater in the osteopathic group than in the untreated group; the median sucking score in the treated group was in the normal range, while it remained lower in the untreated group. At the end of the follow-up, the percentage of exclusively breastfeeding infants in the treatment group increased by +25%. This pilot study demonstrates the efficacy of early osteopathic intervention to relieve breastfeeding difficulties in newborns in the first few weeks of life. [ABSTRACT FROM AUTHOR]

• The exclusive breastfeeding rate after hospital discharge was high (81%) • Adequate in-hospital breastfeeding support is important for successful breastfeeding. • First-time mothers need enhanced support for breastfeeding. • Timely access to face-to-face breastfeeding support should be ensured for mothers. Global breastfeeding rates are not optimal, and the early postpartum period represents a critical time for breastfeeding initiation. The Baby-Friendly Hospital Initiative endeavours to provide mothers with evidence-based breastfeeding support in birth hospitals. This study examined factors associated with breastfeeding exclusivity and breastfeeding difficulties in the first days after being discharged from Baby-Friendly designated hospital. The adequacy of breastfeeding support and maternal preferences for optimal support were also reported. A non-experimental correlational study was conducted between May 2021 and October 2022. A total of n = 80 breastfeeding mothers completed a semi-structured questionnaire within two weeks of discharge from Baby-Friendly hospital in Finland. The questionnaire included demographic and obstetric background information and six questions on breastfeeding exclusivity, breastfeeding difficulties, and breastfeeding support. Descriptive statistical analysis and multivariate binary logistic regression analysis were performed. The mean age of the mothers was 30.6 years (SD 5.4), and half of the mothers were primiparas (49 %). Most mothers gave birth vaginally (85 %) to a full-term infant (84 %). Most (85 %) had made some prenatal plans for breastfeeding, and the median planned duration of breastfeeding was 12 months. Half of the infants (53 %) received supplemental milk while in the hospital. Most mothers (81 %) were exclusively breastfeeding after hospital discharge. Mothers whose infants received supplemental milk in the hospital had an increased odds of non-exclusive breastfeeding (aOR 16.5 [CI 95 % 1.7–156.7], p 0.015). Approximately one-third of the mothers (39 %) experienced breastfeeding difficulties. Primiparous mothers had increased odds of experiencing breastfeeding difficulties (aOR 3.41 [CI 95 % 1.2–9.8], p 0.023). Mothers who received adequate postnatal breastfeeding support in birth hospital had decreased odds of experiencing breastfeeding difficulties (aOR 0.16 [CI 95 % 0.03–0.8], p 0.026). Mothers were mainly satisfied with breastfeeding support, although timelier access to support was preferred after hospital discharge. Adequate in-hospital postnatal breastfeeding support, including avoidance of non-medical supplementation, contributes to successful breastfeeding after hospital discharge in terms of more exclusive breastfeeding and fewer breastfeeding difficulties. Primiparous mothers need emphasized support to mitigate breastfeeding difficulties. Timelier access to breastfeeding support after discharge is needed. [ABSTRACT FROM AUTHOR]

BackgroundBreastfeeding (BF) provides optimal nutrition during the first 6 mo of life and is associated with reduced infant mortality and several health benefits for children and mothers. However, not all infants in the United States are breastfed, and sociodemographic disparities exist in BF rates. Experiencing more BF-friendly maternity care practices at the hospital is associated with better BF outcomes, but limited research has examined this association among mothers enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), a population at risk of low BF rates.ObjectivesWe assessed the association between BF-related hospital practices (rooming-in, support from hospital staff, and provision of a pro-formula gift pack) and the odds of any or exclusive BF through 5 mo among infants and mothers enrolled in WIC.MethodsWe analyzed data from the WIC Infant and Toddler Feeding Practices Study II, a nationally representative cohort of children and caregivers enrolled in WIC. Exposures included maternal experience of hospital practices reported at 1 mo postpartum, and BF outcomes were surveyed at 1, 3, and 5 mo. ORs and 95% CIs were obtained using survey-weighted logistic regression, adjusting for covariates.ResultsRooming-in and strong hospital staff support were associated with higher odds of any BF at 1, 3, and 5 mo postpartum. Provision of a pro-formula gift pack was negatively associated with any BF at all time points and with exclusive BF at 1 mo. Each additional BF-friendly hospital practice experienced was associated with 47% to 85% higher odds of any BF over the first 5 mo and 31% to 36% higher odds of exclusive BF over the first 3 mo.ConclusionsExposure to BF-friendly hospital practices was associated with BF beyond the hospital stay. Expanding BF-friendly policies at the hospital could increase BF rates in the United States WIC-served population.

Aim: Implementing the Baby‐Friendly Hospital Initiative (BFHI) programme has been fraught with challenges globally. The study aimed to assess the implementation of the BFHI and breastfeeding practices in healthcare facilities in Ogun State, Nigeria. Methods: It was a questionnaire‐based cross‐sectional study carried out between August and October 2019 among 100 healthcare workers and 110 mothers from health facilities in Ijebu‐Ode Local Government Area of Ogun State, Nigeria. Results: Nearly two‐thirds (61.0%) of the healthcare workers were community health workers while the others were nurses. Less than a quarter (23.8%) of the healthcare workers had ever attended breastfeeding educational programmes since they started working. About half of the healthcare workers had good knowledge, attitude and practice of BFHI. Nurses had a significantly better practice of BFHI than community health workers. Understaffing was a major limitation to the implementation of BFHI. The mothers had an exclusive breastfeeding rate of 47%. Conclusion: The knowledge, attitude, and practice of BFHI were suboptimal and the exclusive breastfeeding rate among the mothers was low. There is a need to improve staff strength, training and re‐training of staff, as well as regular monitoring and evaluation of healthcare facilities on the implementation of BFHI. [ABSTRACT FROM AUTHOR]

We assessed the prevalence of the "Ten Steps to Successful Breastfeeding" in Hungary and identified possible associations of the steps with breastfeeding. Our quantitative, cross-sectional research was conducted anonymously online in Hungary with a self-administered questionnaire in 2021. Targeted sampling was used, with biological motherhood and having at least one child no older than 60 months as inclusion criteria (n = 2008). The implementation of the "Ten Steps to Successful Breastfeeding" was analyzed separately for breastfeeding and non-breastfeeding mothers. A breastfeeding mother was defined as breastfeeding for at least six months. Descriptive statistics, χ2 test, and t-test were calculated with SPSSv25 (p < 0.05). No significant differences were found between breastfeeding and non-breastfeeding mothers in terms of supplementary feeding at the advice of a health professional (p = 0.624) and in terms of assistance with breastfeeding or suggested breastfeeding positions during hospitalization (p = 0.413). Significant differences were found for receiving breastfeeding-friendly recommendations by staff (p = 0.006), valuing breastfeeding (p < 0.001), skin-to-skin contact within 1 h (p = 0.002), receiving supplementary feeding (p < 0.001), rooming-in (p < 0.001), responsive feeding, recognizing hunger signs (p < 0.001), pacifier/bottle use (p < 0.001), and availability of breastfeeding support (p = 0.005). Significant differences were observed between breastfeeding and non-breastfeeding subsamples regarding the implementation of baby-friendly steps (p < 0.001). Breastfeeding mothers experienced the implementation of more baby-friendly steps and a higher rate of breastfeeding, while there was no significant difference in the duration of exclusive (p = 0.795) and partial breastfeeding (p = 0.250) based on the results. We concluded that exposure to the Baby-Friendly Hospital Initiative may be associated with increased 6-month breastfeeding but may not influence longer durations. [ABSTRACT FROM AUTHOR]

Background: The aim of this study is to identify factors associated with successful breastfeeding in late preterm infants (LPIs) and explore the initiation of complementary feeding; Methods: Prospective cohort study was conducted of infants born at 34+0 to 36+6 weeks gestational age in the Hospital of the Lithuanian University of Health Sciences Kaunas Clinics during 2020–2021. Families were followed up until the infants reached 12 months of age. Average breastfeeding initial time, average breastfeeding duration time, prevalence of exclusive breastfeeding and average solid-food feeding initiation time were examined. The correlations among factors that might affect breastfeeding rates were calculated using the chi-square test (p < 0.05); Results: In our study with 222 eligible participants, we observed a statistically significant delay in breastfeeding initiation only in the 34+0+6 gestational age group (p < 0.001). At discharge, the 36+0+6 group exhibited a significantly higher exclusive breastfeeding rate (p < 0.001). Over the first year, breastfeeding rates varied, with no correlation found between duration of exclusive breastfeeding and gestational age. Initial solid-food feeding times were similar across groups, and all infants were introduced to vegetables first; Conclusions: Vaginal delivery, skin-to-skin contact after birth, early rooming-in, and breastfeeding within 2 h after birth statistically significantly causes earlier breastfeeding initiation and longer duration of breastfeeding in LPIs. All infants began solid-food feeding at an average age of 5 months, with vegetables being the primary food choice. [ABSTRACT FROM AUTHOR]

The study aimed to examine the trends and associated factors of bottle-feeding among children aged 0–35 months. Data covering 11,205 mother-child pairs, from six recent Turkey Demographic and Health Surveys (TDHSs) were analyzed by using complex sample crosstabs and logistic regression. Bottle-feeding was on an upward trend from 33.0% to 51.5% from 1993 to 2013 and fell slightly 47.9% in 2018. Increasing trends of bottle-feeding were found in children aged 6–35 months, the East region, lower wealth index, maternal education under 5 years, Kurdish mothers, and the low antenatal care attendance. Multivariate analysis using data from TDHS-2018 showed that young maternal age, low birth weight and being 6–23 months of age were associated with higher rates of bottle-feeding. The prolonged bottle-feeding became widespread, and the bottle-feeding was common even in 35-month-old children. Interventions by the Government and stakeholders to minimize low rates of bottle-feeding should focus on high-risk groups. [ABSTRACT FROM AUTHOR]

Quality improvement is paramount in the nursing profession today, and there is increased awareness and focus on implementing evidence-based practices into nursing care. The Baby-Friendly Hospital Initiative (BFHI) is an evidence-based program that promotes and protects exclusive breastfeeding by encouraging breast milk feeds to infants from the time of birth. This article will discuss the history and current state of breastfeeding in the United States as well as an evidence-based change model that can be used to implement the BFHI to change the status quo and future of breastfeeding in the United States. Physical benefits to the infant and mother as well as financial benefits to the mother, hospital, and global economy will also be addressed. [ABSTRACT FROM AUTHOR]

Background: Mothers having difficulty breastfeeding their infants may use alternative supportive feeding methods. Although a supplemental feeding tube device is commonly used, efficacy for supporting sustained breastfeeding remains unknown. Purpose: To describe supplemental feeding tube device use by breastfeeding mothers as an alternative feeding method through exploration of associations between supplemental feeding tube device use and continued breastfeeding at 4 weeks of infant's age. Method: Forty mothers participated. They were interviewed during the birth hospitalization and at 4 weeks postpartum. Questions addressed use of supplemental feeding tube devices, breastfeeding issues, and continued breastfeeding relationships. We examined the relationship between LATCH scores at 2 to 3 days of life. Results: Breastfeeding mothers who chose to supplement with bottle-feeding instead of use of a supplemental feeding tube device were 30% less likely to continue breastfeeding at a medium/high/exclusive level. Conclusion: Use of the supplemental feeding tube device may help avoid the potentially detrimental effect of bottle-feeding on continued breastfeeding. [ABSTRACT FROM AUTHOR]

Abstract Background In 2009, the World Health Organization and the United Nations Children’s Fund issued a revised Baby-friendly Hospital Initiative (BFHI) package to encourage all healthcare facilities to promote the advice of exclusive breastfeeding. The scope of the BFHI was expanded to include neonatal units by the Nordic and Quebec Working Group. Aim To determine the level of compliance with the recommendations outlined in the “Baby-friendly Hospital Initiative for neonatal wards” (Neo-BFHI) in the South African neonatal wards. Method In this cross-sectional survey, the sample included neonatal wards (N = 33) from public and private hospital facilities. Using EasyTrial software, the Neo-BFHI self-assessment questionnaire was utilized to collect the data. The data was transferred to MS Excel (version 15.0.5127.1000) and analysed with the Statistical Package for Social Sciences version 24. Results The South African median score for Neo-BFHI compliance was 77. Neonatal wards in public hospitals scored higher (85) than those in private hospitals (73). Neonatal wards in hospitals that were accredited Baby-friendly had higher compliance scores than those without accreditation. The country had the highest compliance scores (100, 90) on Guiding Principle 1 (respect towards mothers) and step 5 (breastfeeding support), respectively. However, it scored low (71, 58) on steps 4 (enhancing kangaroo mother care) and 7 (maternal infant “togetherness”), respectively. Level 1 and 2 care facilities scored significantly higher than level 3. Conclusion Although South Africa successfully implemented the Neo-BFHI recommendations, private hospitals had a smaller number of BFHI-accredited facilities and lower compliance than public hospitals. Strategies should be developed to strengthen and improve BFHI accreditation and compliance, particularly in private hospitals.

Health professional competency building is one of nine national responsibilities (to achieve universal coverage and sustainability) described in the 2018 World Health Organization/UNICEF implementation guidance for the Baby‐Friendly Hospital Initiative (BFHI). Skilled breastfeeding support as a standard of newborn care is critical to the establishment of lactation and exclusive breastfeeding. This qualitative case study describes the Kyrgyz Republic's experience with health professional competency building related to breastfeeding counselling and support. We interviewed 38 key informants and reviewed national policies and international guidelines related to BFHI. The study found that although the country has a new policy reflecting BFHI global standards and guidance, the policy has not been disseminated nationally. Additionally, the policy lacks guidance on competency monitoring and verification and does not mention preservice training, even though preservice training on breastfeeding support exists. To achieve universal coverage for health professional competencies, the Kyrgyz Republic uses preservice, in‐service and refresher training. However, the main limitations to aligning with the new guidance are a lack of preservice BFHI‐ and breastfeeding‐specific curricula, experienced trainers and sufficient time and funding to dedicate to practical skill development. Conducted during the COVID‐19 pandemic, this study confirmed disruptions to BFHI training and service delivery but also documents the Kyrgyz Republic's resilient strides to mitigate impacts on breastfeeding support through facility‐level individual champions and adjustments to training such as going online. Opportunities exist for strengthening the competencies of service providers through strengthened preservice training, comprehensive and consistent in‐service training, solutions for overworked service providers and clear and sufficiently funded monitoring guidance. Key messages: The Kyrgyz Republic government has proactively enacted policies (Order 1078) reflecting the updated Baby‐Friendly Hospital Initiative (BFHI) guidance and has demonstrated a commitment to institutionalizing BFHI.Insufficient funding and the COVID‐19 pandemic derailed plans for implementing the new policy and guidance beyond the regional levels.There remain gaps in prioritizing, funding, and monitoring breastfeeding counselling and support competency building for both preservice and in‐service.Multi‐sectoral advocacy for BFHI is needed to secure national and local commitment and funding across and beyond the health system. [ABSTRACT FROM AUTHOR]

Abstract Background Improved breastfeeding practices have the potential to save the lives of over 823,000 children under 5 years old globally every year. The Baby-Friendly Hospital Initiative (BFHI) is a global campaign by the World Health Organization and the United Nations Children’s Fund, which promotes best practice to support breastfeeding in maternity services. The Baby-Friendly Community Initiative (BFCI) grew out of step 10, with a focus on community-based implementation. The aim of this scoping review is to map and examine the evidence relating to the implementation of BFHI and BFCI globally. Methods This scoping review was conducted according to the Joanna Briggs Institute methodology for scoping reviews. Inclusion criteria followed the Population, Concepts, Contexts approach. All articles were screened by two reviewers, using Covidence software. Data were charted according to: country, study design, setting, study population, BFHI steps, study aim and objectives, description of intervention, summary of results, barriers and enablers to implementation, evidence gaps, and recommendations. Qualitative and quantitative descriptive analyses were undertaken. Results A total of 278 articles were included in the review. Patterns identified were: i) national policy and health systems: effective and visible national leadership is needed, demonstrated with legislation, funding and policy; ii) hospital policy is crucial, especially in becoming breastfeeding friendly and neonatal care settings iii) implementation of specific steps; iv) the BFCI is implemented in only a few countries and government resources are needed to scale it; v) health worker breastfeeding knowledge and training needs strengthening to ensure long term changes in practice; vi) educational programmes for pregnant and postpartum women are essential for sustained exclusive breastfeeding. Evidence gaps include study design issues and need to improve the quality of breastfeeding data and to perform prevalence and longitudinal studies. Conclusion At a national level, political support for BFHI implementation supports expansion of Baby-Friendly Hospitals. Ongoing quality assurance is essential, as is systematic (re)assessment of BFHI designated hospitals. Baby Friendly Hospitals should provide breastfeeding support that favours long-term healthcare relationships across the perinatal period. These results can help to support and further enable the effective implementation of BFHI and BFCI globally.

Background: In 2009, the World Health Organization and the United Nations Children's Fund issued a revised Baby-friendly Hospital Initiative (BFHI) package to encourage all healthcare facilities to promote the advice of exclusive breastfeeding. The scope of the BFHI was expanded to include neonatal units by the Nordic and Quebec Working Group. Aim: To determine the level of compliance with the recommendations outlined in the "Baby-friendly Hospital Initiative for neonatal wards" (Neo-BFHI) in the South African neonatal wards. Method: In this cross-sectional survey, the sample included neonatal wards (N = 33) from public and private hospital facilities. Using EasyTrial software, the Neo-BFHI self-assessment questionnaire was utilized to collect the data. The data was transferred to MS Excel (version 15.0.5127.1000) and analysed with the Statistical Package for Social Sciences version 24. Results: The South African median score for Neo-BFHI compliance was 77. Neonatal wards in public hospitals scored higher (85) than those in private hospitals (73). Neonatal wards in hospitals that were accredited Baby-friendly had higher compliance scores than those without accreditation. The country had the highest compliance scores (100, 90) on Guiding Principle 1 (respect towards mothers) and step 5 (breastfeeding support), respectively. However, it scored low (71, 58) on steps 4 (enhancing kangaroo mother care) and 7 (maternal infant "togetherness"), respectively. Level 1 and 2 care facilities scored significantly higher than level 3. Conclusion: Although South Africa successfully implemented the Neo-BFHI recommendations, private hospitals had a smaller number of BFHI-accredited facilities and lower compliance than public hospitals. Strategies should be developed to strengthen and improve BFHI accreditation and compliance, particularly in private hospitals. [ABSTRACT FROM AUTHOR]

We assessed the prevalence of the “Ten Steps to Successful Breastfeeding” in Hungary and identified possible associations of the steps with breastfeeding. Our quantitative, cross-sectional research was conducted anonymously online in Hungary with a self-administered questionnaire in 2021. Targeted sampling was used, with biological motherhood and having at least one child no older than 60 months as inclusion criteria (n = 2008). The implementation of the “Ten Steps to Successful Breastfeeding” was analyzed separately for breastfeeding and non-breastfeeding mothers. A breastfeeding mother was defined as breastfeeding for at least six months. Descriptive statistics, χ2 test, and t-test were calculated with SPSSv25 (p < 0.05). No significant differences were found between breastfeeding and non-breastfeeding mothers in terms of supplementary feeding at the advice of a health professional (p = 0.624) and in terms of assistance with breastfeeding or suggested breastfeeding positions during hospitalization (p = 0.413). Significant differences were found for receiving breastfeeding-friendly recommendations by staff (p = 0.006), valuing breastfeeding (p < 0.001), skin-to-skin contact within 1 h (p = 0.002), receiving supplementary feeding (p < 0.001), rooming-in (p < 0.001), responsive feeding, recognizing hunger signs (p < 0.001), pacifier/bottle use (p < 0.001), and availability of breastfeeding support (p = 0.005). Significant differences were observed between breastfeeding and non-breastfeeding subsamples regarding the implementation of baby-friendly steps (p < 0.001). Breastfeeding mothers experienced the implementation of more baby-friendly steps and a higher rate of breastfeeding, while there was no significant difference in the duration of exclusive (p = 0.795) and partial breastfeeding (p = 0.250) based on the results. We concluded that exposure to the Baby-Friendly Hospital Initiative may be associated with increased 6-month breastfeeding but may not influence longer durations.

Background: The aim of this study is to identify factors associated with successful breastfeeding in late preterm infants (LPIs) and explore the initiation of complementary feeding; Methods: Prospective cohort study was conducted of infants born at 34+0 to 36+6 weeks gestational age in the Hospital of the Lithuanian University of Health Sciences Kaunas Clinics during 2020–2021. Families were followed up until the infants reached 12 months of age. Average breastfeeding initial time, average breastfeeding duration time, prevalence of exclusive breastfeeding and average solid-food feeding initiation time were examined. The correlations among factors that might affect breastfeeding rates were calculated using the chi-square test (p < 0.05); Results: In our study with 222 eligible participants, we observed a statistically significant delay in breastfeeding initiation only in the 34+0+6 gestational age group (p < 0.001). At discharge, the 36+0+6 group exhibited a significantly higher exclusive breastfeeding rate (p < 0.001). Over the first year, breastfeeding rates varied, with no correlation found between duration of exclusive breastfeeding and gestational age. Initial solid-food feeding times were similar across groups, and all infants were introduced to vegetables first; Conclusions: Vaginal delivery, skin-to-skin contact after birth, early rooming-in, and breastfeeding within 2 h after birth statistically significantly causes earlier breastfeeding initiation and longer duration of breastfeeding in LPIs. All infants began solid-food feeding at an average age of 5 months, with vegetables being the primary food choice.

Background: Improved breastfeeding practices have the potential to save the lives of over 823,000 children under 5 years old globally every year. The Baby-Friendly Hospital Initiative (BFHI) is a global campaign by the World Health Organization and the United Nations Children's Fund, which promotes best practice to support breastfeeding in maternity services. The Baby-Friendly Community Initiative (BFCI) grew out of step 10, with a focus on community-based implementation. The aim of this scoping review is to map and examine the evidence relating to the implementation of BFHI and BFCI globally. Methods: This scoping review was conducted according to the Joanna Briggs Institute methodology for scoping reviews. Inclusion criteria followed the Population, Concepts, Contexts approach. All articles were screened by two reviewers, using Covidence software. Data were charted according to: country, study design, setting, study population, BFHI steps, study aim and objectives, description of intervention, summary of results, barriers and enablers to implementation, evidence gaps, and recommendations. Qualitative and quantitative descriptive analyses were undertaken. Results: A total of 278 articles were included in the review. Patterns identified were: i) national policy and health systems: effective and visible national leadership is needed, demonstrated with legislation, funding and policy; ii) hospital policy is crucial, especially in becoming breastfeeding friendly and neonatal care settings iii) implementation of specific steps; iv) the BFCI is implemented in only a few countries and government resources are needed to scale it; v) health worker breastfeeding knowledge and training needs strengthening to ensure long term changes in practice; vi) educational programmes for pregnant and postpartum women are essential for sustained exclusive breastfeeding. Evidence gaps include study design issues and need to improve the quality of breastfeeding data and to perform prevalence and longitudinal studies. Conclusion: At a national level, political support for BFHI implementation supports expansion of Baby-Friendly Hospitals. Ongoing quality assurance is essential, as is systematic (re)assessment of BFHI designated hospitals. Baby Friendly Hospitals should provide breastfeeding support that favours long-term healthcare relationships across the perinatal period. These results can help to support and further enable the effective implementation of BFHI and BFCI globally. [ABSTRACT FROM AUTHOR]

Background: The Baby‐Friendly Hospital Initiative suggests that in‐hospital supplementation should be avoided unless medically indicated. The supporting evidence is contradictory, as nonexperimental studies have shown an association between supplementation and decreased breastfeeding rates, whereas trials have failed to do so. The aim of this study was to investigate whether in‐hospital supplementation is associated with exclusive breastfeeding to the age of 5 months and any breastfeeding to the age of 12 months in full‐term, normal‐weight singleton infants. Methods: This is a secondary analysis of national‐level, cross‐sectional survey data. The data were collected in child health clinics in Finland. Families attending a regular health examination with a child aged 2 weeks to 12 months were eligible to participate. Full‐term, normal‐weight, singleton infants (n = 3025) were included in this study. Multivariate logistic regression was performed using in‐hospital supplementation and socioeconomic characteristics as covariates and exclusive and any breastfeeding as outcomes. Results: In total, 55.3% (n = 1631) of the infants received in‐hospital supplementation. After controlling for socioeconomic factors, in‐hospital supplementation was associated with decreased exclusive breastfeeding to the age of 5 months and with a decrease in any breastfeeding to the age of 7 months. Conclusions: Our findings suggest that noncontrolled supplementation, without a trial's rigorous procedures of care, is associated with decreased breastfeeding postdischarge. Both donor milk and infant formula use were associated with lower breastfeeding rates, although the association was stronger with formula use. In clinical settings, liberal, nonmedically indicated supplementation should be avoided. [ABSTRACT FROM AUTHOR]

Background: There have been no comprehensive predictive measurement instruments published that account for the dynamic interaction between maternal, infant, and functional factors related to breastfeeding difficulty. The Lactation Care Assessment Tool (LACT) was developed by the authors as a predictive measure of lactation acuity to identify families at risk for breastfeeding difficulty and facilitate access to the most effective level of care. Research Aim: To describe the development, content validation, and interrater reliability of the LACT. Methods: This study was a cross-sectional, online survey. Upon reading a standardized case scenario reflective of common experiences among families with goals to breastfeed, participants (N = 82) anonymously completed the LACT, which consisted of 16 measures based upon research relevant to maternal, infant, and functional factors affecting breastfeeding success. Descriptive statistics were used to summarize and describe the characteristics of the study sample. Interrater reliability was evaluated using Krippendorff's alpha. Results: An acceptable degree of interrater reliability (α = 0.70) among participants was detected for the 16 measures included in the instrument. Conclusion: This instrument supports Baby-Friendly Hospital Initiative Step 10 to facilitate more precise and timely continuity of care after discharge from the hospital by identifying families in need of referral to a level of care consistent with their lactation acuity. Future research is necessary to determine appropriate levels of care and support based on the instrument scores in diverse breastfeeding dyads during early lactation and through the duration of breastfeeding. [ABSTRACT FROM AUTHOR]

Resumen: Introducción: En 2017 se realizó una encuesta a nivel mundial sobre el cumplimiento de las prácticas que promueve la Neo-IHAN (Iniciativa para la Humanización de la Asistencia al Nacimiento y la Lactancia en las unidades neonatales). Objetivo: Presentar los resultados de las unidades españolas que participaron en la encuesta mundial y compararlos con los obtenidos internacionalmente. Material y métodos: Estudio transversal mediante una encuesta sobre el cumplimiento de los requisitos de la Neo-IHAN («Tres principios básicos», «Diez pasos adaptados a unidades neonatales» y el «cumplimiento del Código internacional de comercialización de sucedáneos de leche materna»). El cumplimiento se calculó como la media en cada indicador y una puntuación media final para cada unidad neonatal. Para las puntuaciones parciales y finales de cada país y a nivel internacional se utilizó la mediana. Las puntuaciones van de 0 a 100. Resultados: La tasa de respuesta en España fue del 90% de las unidades de nivel 2 y 3. El rango de la media para las unidades neonatales fue de 37 a 99, sin diferencias según el nivel asistencial. La puntuación global de España (72) está por debajo de la mediana internacional (77), así como en 8 de los 14 requisitos de la Neo-IHAN. Las unidades neonatales de hospitales con maternidades acreditadas IHAN obtuvieron una puntuación media final significativamente mayor, así como en 9 de los 14 requisitos frente a las no acreditadas. Conclusiones: Los resultados, tanto internacionales como nacionales, indican una mejora de las prácticas de la lactancia materna en las unidades neonatales. Los beneficios de la acreditación IHAN de las maternidades alcanzan a las unidades neonatales. España tiene varios puntos clave por debajo de la puntuación internacional. Abstract: Introduction: In 2017, a worldwide survey was conducted on compliance with the practices promoted by Neo-BFHI (Baby-friendly Hospital Initiative expansion to neonatal wards). Objective: Present the results of the Spanish wards that participated in the global survey and compare them with those obtained internationally. Material and methods: Cross-sectional study through a survey on compliance with the Neo-BFHI (“Three basic principles”, “Ten steps adapted to neonatal wards” and “the compliance with the International Code of Marketing of Breast-milk Substitutes” and subsequent relevant World Health Assembly resolutions). Compliance was calculated as the mean in each indicator and a final mean score for each neonatal unit. For the partial and final scores for each country and at the international level, the median was used. All score ranged between 0 and 100. Results: The response rate in Spain was 90%. The range of the national mean for neonatal wards were from 37 to 99, with no differences in the final score according to the level of care. The global score for Spain (72) is below the international median (77) and this also occurs in 8 of 14 items. The neonatal wards from BFHI designated hospitals, obtained a significantly higher mean global score, and in 9 of 14 items than the non-accredited ones. Conclusions: Both international and national results indicate an improvement in breastfeeding practices in neonatal units. The benefits of the BFHI accreditation of maternity reach neonatal wards. Spain has several key points below the international score.

Background: The Baby-Friendly Hospital Initiative (BFHI) was launched in 1991 to promote breastfeeding through hospital policy. Researchers have reported breastfeeding improvements after hospitals became "Baby-Friendly." In Hong Kong, the first public hospital was designated as a Baby-Friendly Hospital in 2016. Research Aim: To examine the influence of the BFHI on breastfeeding by comparing breastfeeding outcomes in a study cohort recruited before the implementation of the BFHI and a cohort recruited after its implementation. Methods: This was a quasi-experimental interrupted time-series design. Two cohorts of mother-infant pairs (N = 2369) were recruited immediately postpartum from four public hospitals in Hong Kong and followed up prospectively. Comparisons were made in five of the BFHI steps experienced in both cohorts and the duration of any and exclusive breastfeeding. Results: A higher proportion of participants from the post-implementation cohort breastfed and breastfed exclusively at all follow-up periods. Participants in the pre-BFHI cohort, on average experienced 3.10 (SD = 1.42) of the BFHI steps, whereas the participants in the post-BFHI cohort experienced 3.59 (1.09) of the BFHI steps. Half of the participants discontinued any breastfeeding by 13 weeks in the pre-BFHI cohort; more than half in the post-BFHI cohort were still breastfeeding at 6 months postpartum (p <.001). Giving only human milk in the first 48 hr of delivery and not providing pacifiers or bottles were associated with lower risk of not exclusive breastfeeding in both cohorts. Conclusion: Implementation of the BFHI was associated with improvements in breastfeeding practices and outcomes. [ABSTRACT FROM AUTHOR]

Background: Breastfeeding is vital for the health and well-being of both mothers and infants, and it is crucial to create supportive environments that promote and maintain breastfeeding practices., Objective: The objective of this paper was to describe the development of a breastfeeding-friendly app called "bfGPS" (HKU TALIC), which provides comprehensive territory-wide information on breastfeeding facilities in Hong Kong, with the goal of fostering a breastfeeding-friendly community., Methods: The development of bfGPS can be categorized into three phases, which are (1) planning, prototype development, and preimplementation evaluation; (2) implementation and updates; and (3) usability evaluation. In phase 1, a meeting was held with experts, including maternal and child health researchers, app developers, breastfeeding individuals, and health professionals, to discuss the focus and functionality of the breastfeeding app. A prototype was developed, and breastfeeding facilities in various public venues in Hong Kong were assessed using a structured checklist. For the preimplementation evaluation, 10 focus groups and 19 one-on-one interviews were conducted between May 2019 and October 2020 with staff working in public premises (n=29) and breastfeeding individuals (n=29). For phase 2, bfGPS was published on iOS (Apple Inc) and Android (Google) platforms in September 2020. App updates were launched in September 2021 and May 2022 based on the suggestions provided by the participants in the preimplementation evaluation. For the usability evaluation, semistructured, in-depth, one-to-one interviews were conducted with breastfeeding individuals (n=30) to understand their experiences of using bfGPS. Content analysis was used to analyze the data., Results: bfGPS is a mobile app that was developed to assist breastfeeding individuals in locating breastfeeding facilities in public venues in Hong Kong. In the preimplementation evaluation, the participants gave comments on the layout and interface of bfGPS, and suggestions were given on incorporating new functions into the app. Based on the suggestions of the participants in the preimplementation evaluation, a few additional functions were added into bfGPS, including allowing the users to rate and upload recent information about breastfeeding facilities and an infant tracker function that encourages users to record infant development. In the usability evaluation, 3 main themes emerged-bfGPS improves the community experience for breastfeeding individuals, facilitates tracking the infant's growth, and provides suggestions for further development., Conclusions: The bfGPS app is the first user-friendly tool designed to assist users in locating breastfeeding facilities within the community. It stands as a guide for similar health care app developments, emphasizing the importance of accurate, current data to ensure user adoption and long-term use. The app's potential lies in the support and reinforcement of breastfeeding practices coupled with self-management strategies., (© Heidi Sze Lok Fan, Emily Tsz Yan Leung, Ka Wing Lau, Janet Yuen Ha Wong, Edmond Pui Hang Choi, Christine Lam, Marie Tarrant, Hextan Yuen Sheung Ngan, Patrick Ip, Chia Chin Lin, Kris Yuet Wan Lok. Originally published in JMIR Formative Research (https://formative.jmir.org).)

National staffing guidelines for hospital lactation services do not account for the lactation acuity of breastfeeding patients. Higher acuity breastfeeding couplets require a higher level of knowledge and skill from lactation care providers. In these cases, a referral to an International Board Certified Lactation Consultant (IBCLC) is recommended for appropriate management. Use of a lactation acuity classification system as a clinical practice innovation was implemented at Oklahoma University Medical Center to improve the distribution of staff resources for optimal care of breastfeeding patients. Lactation service reports from this facility, a tertiary care teaching hospital, were reviewed to evaluate staffing, number of lactation consults, reason for and acuity of consults, and time spent. The review included over 10,000 lactation consults completed over a 1-year period. Once the lactation acuity system for IBCLC staff was in place, there was an increased mean direct consult time and acuity level with 85% of IBCLC time allocated to high acuity consults. Trained bedside nurses handled most low-acuity patients. The percentage of patients needing a lactation consult who received one increased along with the number of consults per patient. Data on time spent per consult were stratified by acuity, location, and reason for consult, including details on priority consults for neonatal intensive care unit patients. The productivity of the lactation team was higher with the use of a lactation acuity system compared to without it. The data reported support the use of lactation acuity in making recommendations for staffing of hospital lactation services., Competing Interests: Disclosures and Conflicts of InterestThe author declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: In 2013, the author was also still serving as coordinator of the lactation service for the study site.

Background: The Baby-Friendly Hospital Initiative aims to improve breastfeeding by implementing the Ten Steps to Successful Breastfeeding (Ten Steps) into routine breastfeeding support in birth hospitals. Maternal perspective to breastfeeding support is important to consider as mothers and their infants are in the center of that support. Objectives: To review and synthesize the existing literature on maternal perceptions and experiences of breastfeeding support in Baby-Friendly hospitals. A sub-aim was to describe differences in breastfeeding support between Baby-Friendly hospitals and non-Baby-Friendly hospitals from maternal perspective. Data sources and review methods: An integrative literature review. A systematic literature search was conducted in October 2021 in five databases: PubMed, CINAHL, Cochrane, Scopus, Web of Science. Original peer-reviewed studies published in English exploring maternal viewpoints on breastfeeding support in Baby-Friendly hospitals were included. Two reviewers independently screened the titles (n=914), abstracts (n=226), and full texts (n=47). The review comprised of seventeen studies and includes both quantitative studies (n=14) and qualitative studies (n=3). Inductive content analysis and descriptive synthesis were conducted. Results: Most studies (n=14) measured hospitals’ compliance with the Ten Steps practices from maternal perspective. Mothers were provided with breastfeeding information and encouragement, however, a qualitative finding indicated that information focused on positive aspects of breastfeeding. Early skin-to-skin contact between the mother and infant was well facilitated although often not lasting more than 30 min. Breastfeeding was facilitated by practical support but according to findings of two qualitative studies, support was not always adequate to address mothers’ problems with breastfeeding. Most mothers were exclusively breastfeeding during the hospital stay and no supplemental milk was offered to infant. Mothers were roomed-in together with their infant and were mostly encouraged to breastfeed on demand. Differences between Baby-Friendly hospitals and non-Baby-Friendly hospitals were observed particularly for steps 6 and 9: supplementary feeding and pacifier use were less common in Baby-Friendly hospitals. Conclusions: From the maternal perspective, breastfeeding support in the Baby-Friendly hospitals was mainly but not completely in adherence with the Ten Steps practices. Low compliance with some of the Ten Steps indicates a need for a more frequent assessment of the breastfeeding support practices and consideration of strategies facilitating a more sustainable implementation of the initiative. Regardless of some shortcomings with the breastfeeding support, mothers were mainly satisfied with the support in the hospital. Mothers in the Baby-Friendly hospitals perceived that breastfeeding support was more adherent to the Ten Steps compared to mothers in non-Baby-Friendly hospitals.

Hypernatremic dehydration in term newborns has steadily increased in incidence with increasing efforts to promote exclusive breastfeeding before hospital discharge, a key metric of the Baby-Friendly Hospital Initiative. The following report details a case of a term newborn infant who had evidence of poor intake while exclusively breastfeeding during his hospital stay that may not have been recognized by health care providers. The infant was discharged home and was subsequently found by the parents in cardiac arrest 12 h after discharge and was found to have hypernatremic dehydration. Although return of spontaneous circulation was achieved after fluid resuscitation, the infant sustained extensive hypoxic-ischemic brain injury due to cardiovascular collapse. Due to the infant's extremely poor prognosis, life support was withdrawn at 19 days of age and the infant expired. This sentinel case demonstrates multiple pitfalls of current perceptions of normal vs. abnormal newborn feeding behavior, weight loss percentages, elimination patterns, and acceptable clinical thresholds believed to be safe for neonates. Newer data have shown that hypernatremia occurs commonly in healthy, term breastfed newborns at weight loss percentages previously deemed normal by most health professionals and hospital protocols. In-hospital strategies to prevent excessive weight loss and screening for hypernatremia in response to signs of inadequate feeding have the potential to prevent tens of thousands of readmissions for feeding complications a year, as well as hundreds of millions in health care costs. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Human Lactation is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract Background Although the positive effects of good clinical quality standards in perinatal care and breastfeeding support for women, newborns and families have been already demonstrated, many of these practices were disrupted during the COVID-19 pandemic. The objective of this study was to analyse the impact of the COVID-19 pandemic on perinatal care and breastfeeding support practices offered by the Spanish maternity hospitals committed to the UNICEF Baby-friendly Hospital Initiative (BFHI), to women with and without COVID-19. Methods Implementation of perinatal practices was assessed by a cross-sectional survey conducted in May 2020 using an online questionnaire. Comparison with pre-pandemic situation and level of commitment to BFHI practices was performed. Results Response rate was 50% (58/116). Mothers with COVID-19 suffered greater restrictions in the practices compared to women without COVID-19, with lower rates of companion of choice during labour (84% vs 100%; p = 0.003), skin-to-skin contact (32% vs 52%; p = 0.04), rooming-in (74% vs 98%; p

The Baby-Friendly Hospital Initiative has yet to achieve widespread global implementation. The implementation of the Baby-Friendly Hospital Initiative has been recognised as complex. The challenge has been to maintain accreditation. To explore and gain a deeper understanding of the healthcare professionals' perceptions of the implementation process and the maintenance of the Baby-Friendly Hospital Initiative. A qualitative descriptive study with focus groups (n = 10) of the nurses, midwives and unit leaders (n = 43) perceptions of the implementation process were analysed using inductive thematic analysis. Analysis of the data revealed five main themes: groundwork for the baby-focused breastfeeding context, management support throughout the process, promoting baby-friendly practices, effective communication ensuring the right track, and supporting the maintenance of BFHI designation. The main themes describe the implementation as a journey of climbing a hill and after reaching the top trying to maintain their position. The starting point for implementation was an optimal environment supporting baby-friendly breastfeeding practices. The support of the management of the organisation was an important way of moving the implementation forward. Commitment to the common goal strengthened the baby-friendly approach and with concrete and immediate feedback the right pathway on a journey was ensured. Practical ways to support the implementation journey include regular update education on breastfeeding and continuous monitoring, as well as providing statistics to health professionals. Global guidelines on how to sustain change are needed. This will ensure that the work done is not wasted. [ABSTRACT FROM AUTHOR]

Communities and Hospitals Advancing Maternity Practices (CHAMPS) is a public health initiative, operating in Mississippi since 2014, to improve maternal and child health practices and reduce racial disparities in breastfeeding. Using the Reach, Effectiveness, Adoption, Implementation and Maintenance framework, this study assessed CHAMPS, which used a Quality Improvement intervention at hospitals, and engaged intensively with local community partners. The study team assessed outcomes through quantitative data (2014–2020) from national sources, Mississippi hospitals, community partners and CHAMPS programme records, and qualitative data from focus groups. With 95% of eligible Mississippi hospitals enrolled into CHAMPS, the programme reached 98% of eligible birthing women in Mississippi, and 65% of breastfeeding peer counsellors in Mississippi's Special Supplemental Nutrition Programme for Women, Infants and Children. Average hospital breastfeeding initiation rates rose from 56% to 66% (p < 0.05), the proportion of hospitals designated Baby‐Friendly or attaining the final stages thereof rose from 15% to 90%, and 80% of Mississippi Special Supplemental Programme for Women, Infants, and Children districts engaged with CHAMPS. CHAMPS also maintains a funded presence in Mississippi, and all designated hospitals have maintained Baby‐Friendly status. These findings show that a breastfeeding‐focused public health initiative using broad‐based strategic programming involving multiple stakeholders and a range of evaluation criteria can be successful. More breastfeeding promotion and support programmes should assess their wider impact using evidence‐based implementation frameworks. Key messages: The breastfeeding promotion programme successfully engaged with 95% of birthing hospitals in Mississippi to increase breastfeeding initiation and exclusivity, skin‐to‐skin and rooming rates and to decrease racial disparities in breastfeeding.Broad‐scale breastfeeding promotion and engagement initiatives can be successfully implemented and assessed using evidence‐based implementation science frameworks.Widespread change in health care practices is possible when implemented in partnership with diverse institutions and community groups. [ABSTRACT FROM AUTHOR]

Background: In the past decade, various breastfeeding policies were implemented in Hong Kong, including changes in perinatal guidelines in public hospitals, adoption of the Baby-Friendly Hospital Initiative (BFHI), provision of guidelines for the marketing of formula milk, penalisation of discrimination towards breastfeeding, and extension of the statutory maternity leave. Meanwhile, the COVID-19 pandemic brought new challenges and opportunities to breastfeeding practices. Infection control measures in public hospitals included the cancellation of antenatal classes, hospital tours, and postnatal classes; suspension of perinatal visiting periods; and compulsory separation of COVID-19 positive mothers from newborns. In addition, work-from-home policies were widely implemented. This study aimed to identify the associated factors of six-month predominant breastfeeding (PBF), and to evaluate the impact of COVID-19 on breastfeeding practice. Methods: This study was conducted from 1 March 2021 to 7 April 2021 using a mixed-methods approach. An electronic questionnaire was distributed to members of breastfeeding or parenting groups who have had breastfeeding experience in the past 10 yrs. Logistic and linear regression analyses were conducted to identify factors associated with six-month PBF both in general and during the pandemic period. A qualitative content analysis was conducted using an inductive approach. Results: The study included 793 participants. Giving birth in a public hospital (OR 2.21; 95% CI 1.46, 3.34) and breastfeeding support from family and friends (OR 1.28; 95% CI 1.05, 1.57) were significantly associated with six-month PBF, even during COVID-19. Factors associated with the self-rated impact of COVID-19 on breastfeeding include working from home, the perceived immunological benefits of breastfeeding, and the wish to avoid breastfeeding or expressing breast milk in public premises. Furthermore, breastfeeding practice in public hospitals was more likely to be affected by the busyness of staff, while private hospitals had worse rooming-in practices and staff who had inadequate breastfeeding knowledge. Conclusions: Giving birth in a public hospital and having breastfeeding support from family and friends were associated with six-month PBF. Furthermore, COVID-19 in Hong Kong had an overall positive impact on six-month PBF. Further studies should investigate the impact of hospital practices and the COVID-19 pandemic on breastfeeding behaviours. [ABSTRACT FROM AUTHOR]

Copyright of Eastern Mediterranean Health Journal is the property of World Health Organization and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Human Lactation is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Efforts to provide accessible and effective infant feeding support are advancing to set up new families to meeting their goals. However, data continue to be limited for understanding how inpatient postpartum support and experiences contribute to exclusive breastfeeding during hospitalization. Research Aims: To explore postnatal unit experiences including skin-to-skin contact, overnight support, rooming-in, responsive clinicians, and understandable communication that correlate with early infant feeding outcomes among a sample of mothers who intended to breastfeed. Methods: This was a prospective cross-sectional survey study. Through secure online survey, participants submitted (N = 2,401) responses from November 2016 to May 2017 about their experiences with maternity healthcare and offered thoughts on the postnatal unit environment. Descriptive statistics were used to examine distributions of maternal characteristics, postpartum experience, and birthing facility characteristics. Results: Exclusive breastfeeding was positively correlated with the following postnatal unit experiences: mother did not ask that her infant be taken out of the postnatal unit room; infant staying in postnatal unit room except for treatment(s); mother got help from clinical staff when needed after pressing the call button; and nurse, midwife, and/or doctor always explained information to mother in ways that they understood. Conclusion: Postnatal unit experiences associated with exclusive breastfeeding during postpartum hospitalization were rooming in; parents who did not ask for their infant to be taken out of the unit room; whether mothers received timely help from clinical staff; and information was explained in a way they could understand. [ABSTRACT FROM AUTHOR]

The Baby‐friendly Hospital Initiative for Neonatal Wards (Neo‐BFHI) is an expansion of the WHO/UNICEF Ten Steps to Successful Breastfeeding to address the needs of infants and families in all levels of neonatal care. The Neo‐BFHI includes Three Guiding Principles as basic tenets, Ten Steps to protect, promote and support breastfeeding closely following the original Baby‐friendly Hospital Initiative, and adherence to the International Code of Marketing of Breast‐milk Substitutes. In 2020, the WHO/UNICEF published recommendations for breastfeeding small, sick and preterm newborns that aligns with the Neo‐BFHI. Conclusion: This mini review provides a brief description of the content in the Neo‐BFHI. [ABSTRACT FROM AUTHOR]

Objective  The Baby-Friendly Hospital Initiative (BFHI) enables maternity units to be centers of breastfeeding support to increase breastfeeding rates. This study evaluates the impact of the 20-hour BFHI training course on nurses' breastfeeding knowledge, attitude, and confidence in breastfeeding practice in a tertiary hospital in Singapore. Study Design  Seventeen sessions of the 20-hour BFHI training course were conducted by lactation consultants from 2010 to 2013 at the National University Hospital, Singapore. An anonymous self-administered survey on knowledge, attitude, and confidence in breastfeeding practices were distributed to nurses before (2009) and after (2014) the training courses to assess effectiveness of training. Results  One-hundred forty nurses and one hundred forty-eight nurses participated in the surveys in 2009 and 2014, respectively. Majority were registered nurses who worked in the postnatal wards and the neonatal intensive care unit. After training, there were significant improvements for five of eight items in infant feeding knowledge, including greater awareness of the International Code of Marketing of Breastmilk Substitutes and medical contraindication for breastfeeding. Participants reported more confidence in assisting mothers on breastfeeding, 77.1 to 88.5% (p  = 0.019); advising hand expressing breast milk, 75.7 to 86.5% (p  = 0.012); and advising attachment to the breast, 75.7 to 89.2% (p  = 0.004) in 2014 compared with 2009. However, despite having high levels of confidence, only about half the nurses reported being able to assist mothers in breastfeeding, mainly due to time constraints. Conclusion  Implementation of the 20-hour BFHI training program positively influenced nurses' breastfeeding knowledge, attitude, and confidence in breastfeeding practices. Hospital procedures and manpower requirements should be re-examined to overcome nursing constraints in providing breastfeeding help to postpartum mothers. Key Points Nurses have low breastfeeding knowledge pretraining. The 20-hour BFHI training course is effective. Nurses have inadequate time to support breastfeeding. [ABSTRACT FROM AUTHOR]

Background: The Baby-Friendly Hospital Initiative is an effective intervention to support maternal practices around breastfeeding. However, adherence of hospitals to the Baby-Friendly 10 Steps, as determined from the perspective of women participating in the United States Special Supplemental Nutrition Program for Women, Infants, and Children, has not been assessed. Research Aims: (1) To compare maternal perceptions about maternity practices in Baby-Friendly Hospitals and non-Baby-Friendly Hospitals; (2) to evaluate the associations between degree of exposure to the Baby-Friendly 10 Steps and breastfeeding practices through the first 6 months; and (3) to evaluate whether the receipt of specific Steps was associated with breastfeeding practices through 6 months. Methods: This study was a cross-sectional 2 group comparison, using prospective data collected through a self-report telephone survey and retrospective data gathered from participants' records. Women (N = 182) participating in four Maryland Special Supplemental Nutrition Program for Women, Infants and Children agencies were recruited. One hundred and eight (59%) participants delivered at designated Baby-Friendly Hospitals; 74 (41%) delivered in non-Baby-Friendly designated hospitals. Logistic regression models were utilized to determine the influence of perceived Step adherence on exclusive breastfeeding. Results: Reported adherence to 10-Steps policies ranged from 10%–85% (lowest for Step 9, highest for Step 10) and only Step 9 (give no pacifiers or artificial nipples to breastfeeding infants) differed according to Baby-Friendly Hospital status. Greater exposure to the 10 Steps was positively associated with exclusive breastfeeding during hospitalization. The lack of perceived adherence to Step 6 (no food or drink other than human milk), Step 9, and the International Code of Marketing of Breast-milk Substitutes (no formula, bottles, or artificial nipples) significantly decreased the likelihood of exclusive breastfeeding through 6 months. Conclusion: Maternal perception of Baby-Friendly Step adherence was associated with exclusive breastfeeding. [ABSTRACT FROM AUTHOR]

Marina Ferreira Rea is a Brazilian medical doctor. She has a masters and a doctorate degree in public health from the University of São Paulo (USP). She specialized in breastfeeding at Wellstart International, and completed post-doctoral research at Columbia University, New York, USA, focusing on working women and breastfeeding. She was a researcher at the Health Institute at Columbia University in New York, the Center for Population and Family Health, and at the postgraduate studies, Nutrition in Public Health, University of São Paulo, where she advised many students and published many articles and books (a few selected below). She was a Coordinator of International Breastfeeding Actions at the World Health Organization (Geneva), in the early 1990s, when actions like the Baby-Friendly Hospital Initiative, breastfeeding counseling, and other courses were started. During this same period, the World Alliance for Breastfeeding Action (WABA) and World Breastfeeding Week were initiated. In 1981 she participated in the launching of the International Code of Marketing of Breastmilk Substitutes. Marina Rea is a member of the International Baby Food Action Network and its Latin American policy committee, and is the founder of the International Baby Food Action Network (IBFAN) Brazil group. Since 2017, she has been a member of the IBFAN Global Council. She is now retired but continues to volunteer as an IBFAN member. She has two daughters and four grandchildren. A more detailed curriculum vitae in Portuguese can be found here: http://lattes.cnpq.br/8193850878281835 (MR = Marina Rea; MA = Maryse Arendt) [ABSTRACT FROM AUTHOR]

Background: This article informs about the state of breastfeeding in Ukraine after more than 2 years of war. The article presents important information on breastfeeding data, the widespread implementation of the baby-friendly hospital initiative, human milk banks working in difficult situations, the first overestimation of breast milk substitute needs, the International Code, and the presence of donations reaching an overburdened health system. It covers the training of health care professionals as well as counseling in wartime. Conclusion: It is a testimony of important work done on different levels of the Ukrainian population as well as among the aid agencies present and the health system to protect and support breastfeeding for infants and mothers' health in a war situation. The acquired breastfeeding knowledge through BFHI training of health care professionals and the whole package of BFHI measures is important for ensuring the health and survival of children.

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Objective: This study aims to describe the outcomes of public policies in favor of breastfeeding related to the Baby-Friendly Hospital Initiative from 1992 to 2020 in Brazil. Methods: This is a descriptive study with information and data gathered from August 2020 to August 2021 through searching in Portuguese and English, in Brazilian Federal Government and other sources for the period of 1990 to 2021. Descriptors used included baby-friendly hospital, baby-friendly hospital initiative, baby-friendly and breastfeeding. Results: When the Baby-Friendly Hospital Initiative (BFHI) was launched in Brazil, it found a favorable context for its expansion with its own characteristics in the country, embraced by several Brazilian programs, strategies, actions, laws, decree law and ordinances in favor of breastfeeding. Despite not only being under the program domain, but also under political and coordination domains, the BFHI advanced 1992 to 2006, with deceleration from 2007 to 2015 and a decline from 2019. Such progress and slowdowns have been driven by policies and programs in the field of maternal and neonatal health. Since 2004 there has been a stagnation in the number of designated hospitals and 25 lost their certification from 2017 to 2020. The reasons for this include hospitals having no interest in maintaining the baby-friendly status, hospitals which no longer have maternity wards, and hospitals lacking triennial external re-assessment for over six years. In 2004 there were 301 Baby-Friendly Hospitals (BFH), and currently in 2021 there are 302, constituting less than 10 per cent coverage of the number of hospitals with maternity wards in the country. Even with the stagnation in the number of BFH, the BFHI continues to cover 100 per cent of Brazilian states with at least one BFH per state. Nevertheless, considering that all births in Brazil take place in hospitals, this makes the BFHI a strategy of great impact on breastfeeding rates. In addition, with four decades of policies, programs, and law on women’s and children’s health, Brazil is still a reference model and considered one of the countries with the highest prevalence of breastfeeding in the world, with exclusive breastfeeding at 45.7 per cent in 2019. Conclusions: In the last 17 years, Brazil has not advanced in the number of hospitals designated by BFHI. Although studies showed that BFHs have higher breastfeeding rates in relation to hospitals not designated by BFHI, we need further studies to better understand how to strengthen the program. In any case, perhaps due to four decades of numerous programs protect, support, or promote breastfeeding in some way, even hospitals not designated by the BFHI appear to be having a positive impact on breastfeeding. It is necessary to understand and learn from the progress and setbacks, as the BFHI is a high-impact tool for infant nutrition, as well as an effective, efficient, and sustainable component as part of public policies in favor of breastfeeding. The revision of the BFHI led by WHO in 2018, not yet adopted in Brazil, can help in revitalizing and strengthening the BFHI in the coming years.

Background: Although the positive effects of good clinical quality standards in perinatal care and breastfeeding support for women, newborns and families have been already demonstrated, many of these practices were disrupted during the COVID-19 pandemic. The objective of this study was to analyse the impact of the COVID-19 pandemic on perinatal care and breastfeeding support practices offered by the Spanish maternity hospitals committed to the UNICEF Baby-friendly Hospital Initiative (BFHI), to women with and without COVID-19. Methods: Implementation of perinatal practices was assessed by a cross-sectional survey conducted in May 2020 using an online questionnaire. Comparison with pre-pandemic situation and level of commitment to BFHI practices was performed. Results: Response rate was 50% (58/116). Mothers with COVID-19 suffered greater restrictions in the practices compared to women without COVID-19, with lower rates of companion of choice during labour (84% vs 100%; p = 0.003), skin-to-skin contact (32% vs 52%; p = 0.04), rooming-in (74% vs 98%; p < 0.001), companion of choice during hospital stay (68% vs 90%; p = 0.006), and breastfeeding support (78% vs 94%; p = 0.02). Practices were significantly less prevalent in COVID-19 mothers compared to pre-pandemic situation. A lower accompaniment rate was observed in non-COVID-19 group during delivery (24% vs 47.9%; p < 0.01). Hospitals with higher commitment to BFHI practices reported higher rates of skin-to-skin contact (45.2% vs 10.5%; p = 0.01) and rooming-in (83.9% vs 57.9%; p < 0.05) in COVID mothers. Fewer restrictions were observed in hospitals located in the regions where the pandemic hit harder. In these regions there was a significantly higher level of BFHI commitment of the hospitals, but no significant differences were observed in the average size of the hospital. All the practices suffered even more restrictions during the first weeks of the pandemic. Conclusion: All mothers suffered restrictions in perinatal care during the COVID-19 pandemic. Women with COVID-19 infection suffered more restrictions in perinatal practices than women without infection. The degree of commitment to WHO-UNICEF perinatal quality standards, integrated into the BFHI, was associated with maintenance of good clinical practices. [ABSTRACT FROM AUTHOR]