WHO and UNICEF call on governments to scale up Baby Friendly Hospital Initiative implementation to 100% coverage

23 April 2018

Last week, WHO and UNICEF launched revised global Baby Friendly Hospital Initiative standards. This new guidance is underpinned by a resounding and growing body of evidence that breastfeeding saves lives, with health benefits lasting well into adulthood.

We welcome this global recognition that breastfeeding is a vital component of realising every child’s right to the highest attainable standard of health, and the commitment to implementing the Baby Friendly Hospital Initiative as the best evidence based strategy to support breastfeeding.

Since its development in 1991, the Baby Friendly Hospital Initiative (BFHI), based on the Ten Steps to Successful Breastfeeding, has helped maternity and newborn services worldwide to better support breastfeeding and to increase breastfeeding rates. However, the number of infants being born in a Baby Friendly environment worldwide remains low, due to a number of factors, not least a widespread misconception that breastfeeding is largely unnecessary because formula milk is a close second best, an idea perpetuated by a growing breastmilk substitutes industry. These revised standards seek to highlight the vital role that breastfeeding plays in saving lives, improving lifelong health and cutting costs worldwide, and aims to better support services to improve breastfeeding care to enable women to breastfeed for as long as they wish.

Baby Friendly in the UK

In many ways, the UK Baby Friendly journey is a success story; in Scotland and Northern Ireland, for example, all babies are now born in a Baby Friendly environment. The UK programme has expanded well beyond the original Ten Steps and now incorporates independent standards for neonatal units, community services, children’s centres and universities, not only supporting, promoting and protecting breastfeeding, but also helping all parents with feeding, whether breast or formula, and supporting them to build a close and loving relationship with their baby.

Living in a culture where bottle feeding is the norm, we have come a long way; breastfeeding initiation rates have risen steadily from 62% in 1990 to 81% in 2010, and many practices promoted in the Ten Steps, such as supporting breastfeeding initiation through skin-to-skin contact, are now routine practice. It is a credit to all maternity services in Scotland to see that 86% of all mothers and babies now have skin-to-skin contact at birth (93% of vaginal births and 73% caesarean sections).

Despite these successes with initiation rates and positive early practices, breastfeeding drop off rates are high in the UK and continuation rates remain some of the lowest in the world. As well as breastfeeding being viewed by many as unnecessary and difficult to achieve, it is a highly emotive subject because so many families have not breastfed, or have experienced the trauma of trying very hard to breastfeed and not succeeding. The Baby Friendly Initiative in the UK seeks to respond to these issues by supporting the provision of high quality, sensitive and compassionate support for all families, so that more women who wish to breastfeed are enabled to do so, and all families are supported to develop close and loving relationships.

The new global standards

We welcome the revision of the global standards that complement, underpin and reinforce the Unicef UK approach.

Here are some of the highlights, explaining global recommendations compared to current UK Baby Friendly practice:

• Integration of the programme more fully into the healthcare system and within a broader context
  • The Unicef UK Baby Friendly Initiative now incorporates maternity, neonatal, health visiting and children’s centre services.
• Sustainability over time
  • In 2017, Unicef UK introduced a Baby Friendly Achieving Sustainability accreditation (the Gold Award), to help Baby Friendly services to continue delivering high quality care for the longer term.
• Incorporation of breastfeeding in pre-registration education
  • Unicef UK introduced Baby Friendly accreditation for University midwifery and health visiting programmes in 2005; 73% of midwifery programmes are now engaged with the process.
• Governments to be more involved in the national implementation of the Baby Friendly Initiative, including national leadership, co-ordination and data collection
  • In 2016, Unicef UK launched a Call to Action campaign asking UK and devolved governments to take steps to create a supportive, enabling environment for women who want to breastfeed, including the development of a National Infant Feeding Strategy, implementation plan and improved data collection.
• Strengthened monitoring and implementation of the International Code of Marketing Breastmilk Substitutes and WHA resolutions (“the Code”)
  • We campaign for a fuller implementation of the Code in the UK. We strongly support the BFHI’s work to strengthen monitoring processes worldwide and to reinforce the responsibility of healthcare facilities and individuals to protect families from harmful commercial marketing of breastmilk substitutes.

We also welcome the revised standards’ continued emphasis on the value of exclusive breastfeeding for six months, recognising how formula milk can impact the infant’s health and wellbeing. At the same time, we support the emphasis of the new Ten Steps on a mother centred approach to care; providing personalised support which responds to individual need is a key part of Baby Friendly’s work in the UK.

Finally, we welcome the global call for scaling up the Baby Friendly Initiative to 100% coverage of the programme, including national monitoring, continuous communication and advocacy, and secure financing to ensure sustainability over time. We continue to work with Scotland and Northern Ireland to help them sustain their 100% hospital accreditation and to support them to implement the Unicef UK Baby Friendly standards in the community, children’s centres and neonatal units. Only 57% of babies in England and 87% of babies in Wales are born in a Baby Friendly environment, and we are working across healthcare and government settings to widen this reach.

This document reinforces and promotes the UK Baby Friendly standards and our continued efforts to ensure that every baby has the best possible start in life.