University of Liverpool research, published in Maternal and Child Nutrition, finds limited evidence regarding the impact of an initiative introduced to the UK almost 30 years ago to improve breastfeeding and subsequent maternal and infant health outcomes.
According to both the World Health Organization (WHO) and UNICEF, the Baby Friendly Initiative (BFI) is revolutionising healthcare for babies, their mothers and families in the UK. The initiative enables public services to better support families with breastfeeding and developing close, loving relationships, ensuring that all babies get the best possible start in life.
Global evidence demonstrates that adherence to the BFI has a positive impact on multiple child health outcomes, including breastfeeding initiation and duration up to one year postpartum. However, it is currently unclear whether these findings extend to specific countries with resource rich environments.
To examine the impact of BFI implementation (both the Baby Friendly Hospital Initiative (BFHI) and the Baby Friendly Community Initiative (BFCI)) on maternal and infant health outcomes in the UK, and to explore the experiences and views of women receiving BFI-compliant care in the UK, University researchers, led by psychologist Dr Vicky Fallon, systematically reviewed all the research currently available pertaining to UK BFI.
The researchers found there was insufficient evidence to draw firm conclusions about the impact of BFI implementation on maternal and infant health outcomes in the UK. Also, there was no data available relating to wider physical maternal or infant health outcomes.
Two studies found indicated that BFHI implementation has a positive impact on breastfeeding to one week but this is not sustained. No evaluation of the full BFCI programme was available.
However, the researchers did find evidence suggesting BFI related support is highly influential to women’s experiences of BFI-compliant care, but current provision may promote unrealistic expectations of breastfeeding, not meet women’s individual needs, and potentially foster negative emotional experiences.
Tailored breastfeeding initiatives
Dr Vicky Fallon, said: “We were surprised that despite the BFI programme being introduced to the UK almost 30 years ago there was very little evidence examining UK-BFI.
“The initiative is a nationally recognised mark of quality of care, and the NHS long term plan aims to roll this out in every maternity unit by 2019/2020 to support breastfeeding and ultimately enable better health outcomes for mothers and infants. Yet there is currently no UK data available relating to wider physical maternal or infant health outcomes. There is also no UK evidence examining the effects of the intervention on breastfeeding outcomes up to six months despite the initiative being underpinned by the WHO/UNICEF recommendation of exclusive breastfeeding to six months.
“The evidence relating to shorter-term breastfeeding outcomes is limited and varies a lot in terms of quality. It is not enough to apply global evidence for BFI to a specific country and assume that it works there because it works elsewhere in the world. Barriers and determinants of breastfeeding behaviour differ according to income setting which shows that we need tailored breastfeeding promotion and support. Furthermore, breastfeeding rates differ by country income which indicates that we need to tailor breastfeeding initiatives to specific patterns recorded in each country.
“Future work is needed to confirm whether BFI is effective in supporting longer-term breastfeeding and wider maternal and infant health outcomes in the UK.”
The full study, entitled ‘The impact of the UK Baby Friendly Initiative on maternal and infant health outcomes: A mixed methods systematic review’ , can be found here.
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