The studies in this section reflect the effects of the Baby Friendly Initiative in supporting feeding and relationship building. For further information on going Baby Friendly, see our accreditation section. For a summary of how Baby Friendly impacts on long term public health outcomes, see our theory of change document on the About Baby Friendly page.
What will it take to increase breastfeeding?
A new report published in Maternal and Child Nutrition highlights the urgent need for greater enforcement of the International Code of Marketing of Breastmilk Substitutes (the Code) and increased interventions which promote, protect and support breastfeeding in order to ensure optimal short- and long-term health outcomes for babies, their mothers and families around the world. The report also includes the Baby Friendly Initiative as an evidence-based intervention instrumental in supporting breastfeeding on a large scale.
GIRFT Programme National Specialty Report
The new GIRFT ‘Getting It Right First Time’ neonatology review provides an update to the NHS Neonatal Critical Care Transformation Review (NCCR) and explores areas for improving clinical care and patient safety. Key recommendations focus on improving families’ experiences of care and developing the expert neonatal workforce, including strong endorsement of the UNICEF UK Baby Friendly Initiative. The review also advocates for parents as partners in the care of their infant and highlights the importance of improving early access to breastmilk for babies born preterm, as well as reducing parent-baby separation on neonatal units. The review urges funding at local and national levels for evidence-based programmes such as the UNICEF UK Baby Friendly Initiative to support improvements in these areas.
Countries’ experiences scaling up national breastfeeding, protection, promotion and support programmes: Comparative case studies analysis
This four-country case study analysis across Burkina Faso, the Philippines, Mexico and the U.S. examined the implementation of breastfeeding policies and programmes over time and used qualitative thematic analysis to map factors facilitating or hindering the scale up of these initiatives. Key themes which emerged include evidence-based advocacy, multisectoral political will, financing, research and evaluation and coordination. Investment in Baby Friendly was seen as key in furthering promotion and protection of breastfeeding, with the US case study sharing: “Sustainability of programmes and initiatives as well as its monitoring are very strong in the United States, as evidenced by the Baby-Friendly Hospital Initiative.”
2022). Countries’ experiences scaling up national breastfeeding, protection, promotion and support programmes: Comparative case studies analysis. Maternal & Child Nutrition, e13358. https://doi.org/10.1111/mcn.13358, , , , , & (
Becoming breastfeeding friendly in Wales: Recommendations for scaling up breastfeeding support
Implementing the Becoming Breastfeeding Friendly initiative in Scotland
A new review on behalf of the Scottish Becoming Breastfeeding-Friendly committee highlights the nation’s strong political commitment and scaling-up environment for the promotion, protection and support of breastfeeding, evidenced by its effective leadership, strong infant feeding policies and investment in implementing the UNICEF UK Baby Friendly standards in services across the country. The report shares: “Investment by the government in 100% coverage of the UNICEF UK Baby Friendly Initiative signifies a robust political and financial commitment to breastfeeding in Scotland.” Read more on the Baby Friendly news page.
Enabling children to be a healthy weight – what we need to do better in the first 1,000 days
A new report from First Steps Nutrition Trust identifies key actions needed to protect children from overweight and obesity in the first 1,000 days of life, including requiring services to become Baby Friendly accredited. The report outlines 18 key actions needed to promote a healthy weight in the early years, including increasing investment in universal breastfeeding support, regulating the misleading commercial influence of food and drinks for infants and young children, and offering greater support for families to practise age-appropriate introduction of solids and responsive feeding.
Effect of a baby-friendly workplace support intervention on exclusive breastfeeding in Kenya
This study assessed the effectiveness of a Baby Friendly workplace support intervention on exclusive breastfeeding in Kenya between 2016 and 2018 on an agricultural farm in Kericho County. The intervention targeted pregnant/breastfeeding women residing on the farm and consisted of a variety of workplace support policies and programme interventions, including providing breastfeeding flexi-time and breaks for breastfeeding mothers. The study included 270 and 146 mother-child dyads in the nontreated (preintervention) group and treated (intervention) group, respectively. Overall, The Baby Friendly workplace support intervention promoted exclusive breastfeeding, especially beyond 3 months in this setting.
Kimani-Murage EW, Wilunda C, Macharia TN, Kamande EW, Gatheru PM, Zerfu T, Donfouet HPP, Kiige L, Jabando S, Dinga LA, Samburu B, Lilford R, Griffiths P, Jackson D, Begin F, Moloney G. Effect of a baby-friendly workplace support intervention on exclusive breastfeeding in Kenya. Matern Child Nutr. 2021 Apr 8:e13191. doi: 10.1111/mcn.13191. Epub ahead of print. PMID: 33830636.
Exposure to Baby-Friendly Hospital Practices and Breastfeeding Outcomes of WIC Participants in Maryland
Ducharme-Smith K, Gross SM, Resnik A, et al. Exposure to Baby-Friendly Hospital Practices and Breastfeeding Outcomes of WIC Participants in Maryland. Journal of Human Lactation. February 2021. doi:10.1177/0890334421993771
Social value of maintaining baby-friendly hospital initiative accreditation in Australia: case study
This study was conducted in the maternity unit of Calvary Public Hospital, Canberra, an Australian BFHI-accredited public hospital. The costs for maintaining BFHI accreditation in a relatively affluent urban population were assessed and interviews were conducted with the hospital’s Director of Maternity Services and the Clinical Midwifery Educator, guided by a structured questionnaire, which examined the cost (financial, time and other resources) and benefits of each of the Ten Steps. The authors applied the Social Return on Investment (SROI) framework, which consists of mapping the stakeholders, identifying and valuing outcomes, establishing impact, calculating the ratio and conducting sensitivity analysis. The ultimate SROI ratio was approximately AU$ 55:1, meaning every AU$1 invested in maintaining BFHI accreditation by this maternal and newborn care facility generated approximately AU$55 of benefit.
Pramono, A., Smith, J., Desborough, J. et al. Social value of maintaining baby-friendly hospital initiative accreditation in Australia: case study. Int J Equity Health 20,22 (2021). https://doi.org/10.1186/s12939-020-01365-3
UNICEF UK Baby Friendly Initiative: Providing, receiving and leading infant feeding care in a hospital maternity setting—A critical ethnography
This research uses a critical ethnographic approach to explore the influence of the national Unicef UK Baby Friendly Initiative (BFI) standards on the culture of one typical maternity service in England, over a period of 8 weeks, across four phases of data collection between 2011 and 2017. A total of 21 staff and 26 service users engaged in moderate-level participant observation and/or guided interviews and conversations. Basic, organising and a final global theme emerged through thematic network analysis, describing the influence of the BFI on providing, receiving and leading infant feeding care in a hospital maternity setting. It is recommended that ongoing infant feeding policy, practice and leadership balance relational and rational approaches for positive infant feeding care and experiences to flourish.
UNICEF UK Baby Friendly Initiative: Providing, receiving and leading infant feeding care in a hospital maternity setting—A critical ethnography. Matern Child Nutr. 2021;e13114. https://doi.org/10.1111/mcn.13114, , , .
Cost-effectiveness analysis of Baby-Friendly Hospital Initiative in promotion of breast-feeding and reduction of late neonatal infant mortality in Brazil
The purpose of this study was to analyse the cost-effectiveness of Baby-Friendly Hospital Initiative (BFHI) in promoting breastfeeding during the first hour of life and reducing late neonatal mortality. The study was carried out in six hospitals in the city of São Paulo (Brazil) (three being Baby-Friendly Hospitals (BFH) and three non-BFH), with a range of mothers with 24 h postpartum, over 18 years old, single fetus and breastfeeding at the time of the interview. Ultimately, it was concluded that the cost-effectiveness of the BFHI in promoting breastfeeding and reducing neonatal mortality rates justifies the investments required for its expansion within the Brazilian health system.
Silva, O., Rea, M., Sarti, F., & Buccini, G. (2020). Cost-effectiveness analysis of Baby-Friendly Hospital Initiative in promotion of breast-feeding and reduction of late neonatal infant mortality in Brazil. Public Health Nutrition, 1-11. doi:10.1017/S1368980020001871
Motivating Change: a grounded theory of how to achieve large-scale, sustained change, co-created with improvement organisations across the UK
This study explored how we can achieve large-scale, sustained improvements and innovations in healthcare organisations. Taking learnings from Unicef UK, NHS Highland, Healthcare Improvement Scotland and the Baby Friendly Gold accredited East Lancashire Hospitals NHS Trust, the authors highlight the importance of giving staff the opportunity to witness effective change and positive outcomes in order to motivate sustained improvement activity. They also show the value of having a flow of trust within organisations that capitalises on positive peer pressure and suppresses infectious negativity.
Breckenridge, J, Gray, N, Toma, M, et al (2019). Motivating Change: a grounded theory of how to achieve large-scale, sustained change, co-created with improvement organisations across the UK. BMJ, doi.org/10.1136/bmjoq-2018-000553
The impact of the UK Baby Friendly Initiative on maternal and infant health outcomes: A mixed‐methods systematic review
This systematic review of the Unicef UK Baby Friendly Initiative includes papers published between 2002 and 2015. The review demonstrates that the Unicef UK Baby Friendly Initiative increases breastfeeding rates up until the age of six weeks and that this is consistent with studies conducted in other resource rich countries.
The review questions the efficacy of the UK Baby Friendly Initiative and its impact on mothers, concluding that Baby Friendly needs to be ‘situationally modified in resource rich settings’. It is important to note that a situational modification was undertaken in the UK in 2012, using some of the papers cited. The UK standards were expanded to include enhanced staff communication skills, responsive feeding, supporting all parents (regardless of feeding method) to build close and loving relationships with their baby and enhanced support for parents who are formula feeding their baby. A global revision of the Baby Friendly Hospital Initiative was also published by the World Health Organization (WHO) in 2018, drawing on the success of the more holistic UK standards.
Fallon, V.M., Harrold, J.A. & Chisholm, A. (2019). The impact of the UK Baby Friendly Initiative on maternal and infant health outcomes: A mixed‐methods systematic review. Maternal and Child Nutrition, doi/abs/10.1111/mcn.12778
- The effect of maternity practices on exclusive breastfeeding rates in US hospitals
- Formula milk supplementation on the postnatal ward: A cross-sectional analytical study
- Baby-Friendly practices minimize newborn infants’ weight loss
- Development and pretesting of “Becoming Breastfeeding Friendly”: Empowering governments for global scaling up of breastfeeding programmes
Hromi-Fiedler, A, dos Santos Buccini, G, Bauermann Gubert, M, et al (2018). Development and pretesting of “Becoming Breastfeeding Friendly”: Empowering governments for global scaling up of breastfeeding programmes. Maternal & Child Nutrition, doi/10.1111/mcn.12659
- The effect of Baby-friendly status on exclusive breastfeeding in U.S. hospitals
- The effect of family policies and public health initiatives on breastfeeding initiation among 18 high-income countries: a qualitative comparative analysis research design
Lubold, AM, (2017). The effect of family policies and public health initiatives on breastfeeding initiation among 18 high-income countries: a qualitative comparative analysis research design, International Breastfeeding Journal, https://doi.org/10.1186/s13006-017-0122-0
- Room for improvement in breastmilk feeding after very preterm birth in Europe: Results from the EPICE cohort
- Baby-Friendly Hospital designation has a sustained impact on continued breastfeeding
- Systematic Review of Evidence for Baby-Friendly Hospital Initiative Step 3 Prenatal Breastfeeding Education
- Empowering women to breastfeed: Does the Baby Friendly Initiative make a difference?
- Impact of the Baby Friendly Hospital Initiative (BFHI) on breastfeeding outcomes in the US
- Impact of the Baby Friendly Hospital Initiative (BFHI) on breastfeeding and child health outcomes
- Baby Friendly community health services: impact on breastfeeding
Bærug, A, et al (2016). Effectiveness of Baby-friendly community health services on exclusive breastfeeding and maternal satisfaction: a pragmatic trial. Maternal & Child Nutrition, doi: 10.1111/mcn.12273.
- Interventions to improve breastfeeding outcomes
Sinha, B. et al (2015). Interventions to improve breastfeeding outcomes: a systematic review and meta-analysis. Acta Paediatrica, Special Issue: Impact of Breastfeeding on Maternal and Child Health. Volume 104, Issue Supplement S467, pages 114-134.
- Factors associated with exclusive breastfeeding at hospital discharge
Related research and further reading
The Lancet: Increasing breastfeeding worldwide could prevent over 800,000 child deaths every year