Baby Friendly Hospital Initiative

BFHI
The Baby-Friendly Hospital Initiative, launched in 1991, is an effort by UNICEF and the World Health Organization to ensure that all maternities, whether free standing or in a hospital, become centers of breastfeeding support.

Criteria
A maternity facility can be designated 'baby-friendly' when:
it does not accept free or low-cost breast milk substitutes feeding bottles or teats has implemented 10 specific steps to support successful breastfeeding.

Implementation
Implementation guides for the BFHI have been developed by UNICEF and WHO. process is currently controlled by national breastfeeding authorities

using Global Criteria that can be applied to maternity care in every country.

The internationally defined term 'BabyFriendly' may be used only by maternity services that have passed external assessment according to the Global Criteria for the BFHI. Descriptions such as 'breastfeedingfriendly', 'mother-child friendly' or 'probreastfeeding' may be used for such other complementary efforts to help mothers to breastfeed.

Evidences:

In Cuba, where 49 of the country's 56 hospitals and maternity facilities are baby-friendly, the rate of exclusive breastfeeding at four months almost tripled in six years from 25 per cent in 1990 to 72 per cent in 1996.
In the first two years of BFHI implementation at the Central Hospital of Libreville in Gabon, cases of neonatal diarrhoea fell by 15 per cent, diarrhoeal dehydration declined by 14 per cent and mortality fell by 8 per cent. In China, which now has more than 6,000 Baby-Friendly Hospitals, exclusive breastfeeding in rural areas rose from 29 per cent in 1992 to 68 per cent in 1994; in urban areas, the increase was from 10 per cent to 48 per cent.

In areas where hospitals have achieved baby-friendly status, more mothers are breastfeeding their infants, and child health improves as a consequence.

Ten Steps for Successful Breast Feeding

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.

Contd..
Give newborn infants no food or drink other than breast milk, 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.

Nepal Situation

BABY FRIENDLY HOSPITAL INITATIVE ACHIEVEMENTS What percentage of hospital and maternity facilities that provide maternity services has been designated baby-friendly based on the Global Criteria ?
Only 7 of 103 Hospital has achieved BFHI Status

Nepal Rating

6.79% Poor

Why should we worry ?

Overview on Health & Nutrition Situation in Nepal

Background indicator Infant Mortality Rate (IMR) (per 1000) Result 64.4% Source and Date NDHS 2001

Low Birth Weight

Under weight (< 5 yrs) Wasting (< 5 yrs) Stunting (< 5yrs) Households with clean water supply

30-50%
48.3% 9.6% 50.5% 11.2%

Community studies
NDHS 2001 NDHS 2001 NDHS 2001 BCHIMES 2001

Prevalence of Malnutrition
Protein Energy Malnutrition Anaemia Vitamin A Deficiency IDD 78% 32% 35% 54%

Percentage of babies breastfed within an hour of birth in Nepal

31.1% babies in Nepal breast fed within one hour

of birth

Rating of activities of BF = Fair

98% babies in Nepal are ever breastfed

Source : Nepal Demographic Health Survey (NDHS) 2001

Initial Breastfeeding by Sex

100 90 80 70 60 50 40 30 20 10 0
Ever breastfed Within 1 Within 1 Received received hour of day of birth prelacteal the first birth feed milk

percent

Male Female

Initial Breastfeeding by Ecological Zone

100 90 80 70

percent

60 50 40 30 20 10 0 Ever breastfed Within 1 hour of birth Within 1 day of birth Received prelacteal feed Receved the first milk Mountain Hill Terai

Percentage of babies 0 - < 6 months of age exclusively breastfed in Nepal

68.3% babies 0 - < 6 months of age exclusively breastfed

in Nepal Rating on Exclusively breastfeeding : Good

72.8% babies 0 - < 4 months of age exclusively breastfed

in Nepal
54.2% babies 4 - < 6 months of age exclusively breastfed

in Nepal
Source : Nepal Demographic Health Survey (NDHS) 2001

Children Under Six Months By Breastfeeding Status

1%

10.1% 8.9%

Exclusively breastfeeding Plain water only Water based liquids

68.3%

11.7%

Other milk Complemenary foods

Trends in Exclusively Breastfeeding

Age in months 1996 DHS 2001 NDHS

<2

89.0%

86.7%

2-3

76.7%

72.8%

4-5

61.0%

54.2%

6-7

28.3%

17.7%

8-9

13.0%

4.5%

Median duration of breastfeeding of children under 36 months of age in Nepal

33 months is the median duration of

breastfeeding of children under 36 months of age

Rating on Duration of Breastfeeding = Very good

Source : Nepal Demographic Health Survey (NDHS) 2001

Percentage of breastfed babies 0 - < 12 months of age who received any food or drink (even breast milk) from bottles in Nepal

3.5% of breastfed babies 0 - < 12 months of age received

any food or drink (even breast milk) from bottles. Rating on Bottle Feeding : Good

Source : Nepal Demographic Health Survey (NDHS) 2001

Percentage of breastfed babies 6 - < 10 months of age who received complementary foods in Nepal

66.2% of breastfed babies 6 - < 10 months of age also

received complementary foods in Nepal Rating of Timely Complementary Feeding : Fair

Source : Nepal Demographic Health Survey (NDHS) 2001

NATIONAL COORDINATORS AND COMMITTIES

Are there national breast feeding or infant and young child feeding coordinators and committees ?

Score Rating

2 Poor

INTERNATIONAL CODE OF MARKETING

Is the International Code of Marketing of Breast-milk Substitutes in effect ?

Some articles of the Code implemented Score Rating 4 Poor

LEGISLATION PROTECTING AND SUPPORTING BREAST FEEDING AMONG WORKING MOTHERS

Is there legislation that meets International Labour Organization (ILO) standards for protecting & supporting breast feeding among working mothers ?

Score Rating

0 Poor

HIV AND INFANT FEEDING

Are appropriate policies and programmes in place to ensure that mothers with HIV are informed about the risks and benefits of different infant feeding options and supported in their infant feeding decisions ?

Score Rating

4 Poor

INFANT AND YOUNG CHILD FEEDING IN EMERGENCIES

Are appropriate policies and programmes in place to ensure that mothers , infants and children will be provided adequate protection and support for appropriate feeding during emergencies?

Score Rating

0 Poor

Recommended Future Acticvities

A. Protection, Promotion & Support of

Breastfeeding
1. Promote early initiation of breast

feeding (within one hour) and exclusive breastfeeding for 6 months. 2. Implement, strengthen and monitor Breast milk Substitute (Marketing Control) Act.

Recommended Future Activities..Cont 3. Ratification of ILO convention, increase maternity leave to 6 months 4. Build capacity of health workers on breast feeding 5. Promote mother & child friendly working environment 6. Increase awareness about breastfeeding & HIV

Recommended Future Activities..Cont 7. Reactivation of BFHI 8. Promote family/community support groups with trained lactation management counsellors

9. Strengthen integration of nutrition on IMCI, Neonatal & safe motherhood program and other program.

Complementary Feeding
1. Capacity building of health worker on

complementary feeding
2. Capacity building of health workers to

identify, treat & rehabilitate malnourished children

3. Explore innovative approach through

fortification, dietary modification to reach most vulnerable

Complementary Feeding cont 4. Formulate necessary guidelines on complementary feeding 5. Develop mandatory standard for complementary foods, fortification & marketing 6. Create awareness about home based foods 7. Make facility for severely malnourished children at zonal & regional hospital

Complementary Feeding cont

8. Foster community based networks for mother to mother support & referral system 9. Promote & support community based optional feeding practices

C. Feeding During Exceptional Circumstances

Stressing LBW and Premature Babies in

neonatal survival program

Specific guidelines for care of LBW at health facility & community level

Revise existing curricula to enhance

capacity of health personals

D. Feeding During Emergencies & Unusual Settings

1. Develop & implement nutritional surveillance

2. Monitor availabilities & access to food

3. Integration of nutrition in EPP (Emergency Preparedness Package)

4. Develop guideline for food distribution program 5. Collaboration with relief agencies

E. Breastfeeding & HIV

1.

Increase awareness on breastfeeding in relation to HIV

2. Develop evidence based guidelines on HIV & young child feeding

3. Capacity building of health worker for counselling HIV positive mother 4. 5. Increase access to voluntary & confidential HIV counselling Co-ordinate with stakeholder to prevent spread of HIV

Activities Sensitization meeting with key stakeholders on Infant feeding & HIV (8th June 2005)
Celebration of World Breastfeeding Week Organizing core group meeting on Global

Nepal Breastfeeding Promotion Forum (NEBPROF)

Strategy of IYCF
Organizing South Asia Breastfeeding Partners

Forum 2 meeting at Kathmandu from 26 28 October 2005