Efforts to Encourage Breastfeeding Like the Baby-Friendly Hospital Initiative (BFHI) May Have Unintended Consequences
“Breast is best,” but current efforts to increase the rate of breastfeeding may be misguided. A recent article in JAMA Pediatrics by pediatricians Joel Bass, Tina Gartley, and Ronald Kleinman is titled “Unintended Consequences of Current Breastfeeding Initiatives.” They criticize the Baby-Friendly Hospital Initiative (BFHI), saying “there is now emerging evidence that full compliance…may inadvertently be promoting potentially hazardous practices and/or having counterproductive outcomes.”
The Baby-Friendly Hospital Initiative was launched by WHO and UNICEF in 1991 and has been adopted in 152 countries. In the US it has been promoted as the standard of care by government agencies like the CDC and the Joint Commission, and has been implemented by a growing number of hospitals. The criteria for a hospital’s Baby Friendly accreditation include:
- Have a written breastfeeding policy that is routinely communicated to all health care staff.
- Train all health care staff in skills necessary to implement this policy.
- Inform all pregnant women about the benefits and management of breastfeeding.
- Help mothers initiate breastfeeding within one half-hour of birth.
- Show mothers how to breastfeed and maintain lactation, even if they should be separated from their infants.
- Give newborn infants no food or drink other than breastmilk, not even sips of water, unless medically indicated.
- Practice rooming in – that is, allow mothers and infants to remain together 24 hours a day.
- Encourage breastfeeding on demand.
- Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants
- Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic.