0601. Sustainability of exclusive breast feeding in Baby Friendly Hospitals

Estimates are that most of the world's 10,8 million child deaths in 2000 were from preventable causes and if the few interventions for which there is evidence of effect were fully implemented, then 63% of deaths in under-5's could be prevented. Further projections are that if 90% of infants were exclusively breastfed at 5 months and continued with breast milk until 11 months there would be a 13% reduction in child deaths worldwide. If realised, this result would make breastfeeding the most successful individual paediatric intervention to date, and it is not surprising that pressure has been put on maternity hospitals to achieve accreditation in terms of the WHO/UNICEF Baby Friendly Hospital Initiative. The BFHI involves formal training of staff, and a programme for mothers during hospitalisation. There is also a postnatal component, but it appears that this has largely fallen away in practice. The importance of the postnatal component is well shown in a recent study from Brazil which involved a pre-BFHI measurement of post-hospital breastfeeding as well as post-BFHI measurement of effect in two groups, one with only hospital support and the other with 10 postnatal visits between discharge and 6 months. While in-hospital breastfeeding improved from 21% pre-BFHI to 70% afterwards, this improvement was not sustained, and without postnatal support the number of mothers exclusively breastfeeding at 6 months was similar to the rate before BFHI. On the other hand, postnatal support was associated with a 45% rate of exclusive breastfeeding at 6 months. These results are similar to results obtained in Italy and other parts of Brazil, once again showing that in underdeveloped communities health systems are obliged to provide ongoing support for mothers and their infants if growth, development and disease prevention are to be maintained.

Read more:
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WHO. Ten steps to successful breastfeeding. Geneva:WHO, 1998
Am J Public Health 2003; 93: 1277-79