The Baby Friendly Hospital Initiative is worse than a failure

Stop Doing What Doesn't Work

An extraordinary editorial in the latest issue of JAMA confirms what I have been writing about for years: the Baby Friendly Hospital Initiative is worse than a failure. It not only doesn’t work at promoting breastfeeding, but it actually harms infants and mothers in the process.

The editorial accompanies publication of the new USPSTF (United States Preventive Services Task Force) breastfeeding promotion guidelines. Interventions Intended to Support Breastfeeding Updated Assessment of Benefits and Harms by Flaherman and Von Kohorn is remarkable for its honesty.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]It’s the inevitable result of replacing scientific evidence with lactivist ideology.[/pullquote]

The BFHI doesn’t work.

…[O]nly individual-level interventions demonstrated effectiveness at improving breastfeeding, whereas system-level interventions, including the World Health Organization’s Baby-Friendly Hospital Initiative (BFHI), did not.

That’s a stunning admission. After millions of dollars in expenditure and countless tears of starving infants and guilt ridden mothers, the BFHI doesn’t even achieve its only objective: to increase breastfeeding rates.

If that weren’t bad enough, it has become clear that the BFHI is actually harming babies.


The BFHI bans pacifiers in contradiction to the scientific evidence.

Counseling to avoid the use of pacifiers in the newborn period is an intervention commonly used to support breastfeeding. However, evidence has been building that infant use of a pacifier may be associated with a reduced risk of sudden infant death syndrome,7 the most common cause of postneonatal death in the United States. The evidence review showed that avoiding pacifiers was not associated with any breastfeeding outcomes assessed in the evidence review. A recent Cochrane systematic review reached the same conclusion. Thus, routine counseling to avoid pacifiers may very well be ethically problematic.

The BFHI bans formula supplementation in contradiction to the scientific evidence.

Counseling mothers to avoid giving infants any food or drink other than breast milk during the newborn period is step 6 of the BFHI and one of the primary care interventions most commonly used to support breastfeeding. Three randomized trials have specifically examined the effectiveness of counseling to avoid giving newborns any food or drink other than breast milk; none showed a beneficial effect of such counseling on breastfeeding duration.

And that’s harmful:

… For women who have scant colostrum and no copious milk production for 4 to 7 days, exclusive breastfeeding in the first few days after birth is associated with increased risk of hyperbilirubinemia, dehydration, and readmission.14- 16 Although these conditions are generally mild and often resolve rapidly, their frequency is high; 1% to 2% of all US newborns require readmission in the first week after birth, and the risk is approximately doubled for those exclusively breastfed.15,17 If counseling to avoid food and drink other than breast milk is not an effective method to support breastfeeding, the frequent low morbidity and rare high morbidity outcomes could potentially be avoided without reducing breastfeeding duration.

That’s in addition to previously described harms.

As noted in Unintended Consequences of Current Breastfeeding Initiatives:

Enforced prolonged skin to skin contact leads to deaths from Sudden Unexpected Postneonatal Collapse (SUPC).

Reports of SUPC include both severe apparent life-threatening events (recently referred to as brief resolved unexplained events) and sudden unexpected death in infancy occurring within the first postnatal week of life. A comprehensive review of this issue identified 400 case reports in the literature, mostly occurring during skin-to-skin care, with one-third of the events occurring in the first 2 hours after birth …

Infant injuries and deaths as a result of enforced 24 hours rooming in and closing well baby nurseries.

An overly rigid insistence on these steps in order to comply with Baby-Friendly Hospital Initiative criteria may inadvertently result in a potentially exhausted or sedated postpartum mother being persuaded to feed her infant while she is in bed overnight … This may result in prone positioning and co-sleeping on a soft warm surface in direct contradiction to the Safe Sleep Recommendations of the National Institutes of Health. In addition, co-sleeping also poses a risk for a newborn falling out of the mother’s bed in the hospital, which can have serious consequences.

How did a program designed to promote breastfeeding end up harming so many babies? It’s the inevitable result of relying on lactivist ideology instead of scientific evidence. Sadly, hospitals, doctors and nurses allowed the breastfeeding industry, including lactation consultants, to set policy.

Lactivists and lactation consultants appear to believe that only continuous, extended, exclusive breastfeeding has value, but that’s not what the scientific evidence shows. Instead of promoting science based support of breastfeeding, the BFHI promotes depriving infants of vital formula supplements, life saving pacifiers and safe sleeping arrangements. Instead of promoting science based support of women who want to breastfeeding, the BFHI focuses on shaming and blaming mothers who can’t or don’t wish to breastfeed.

The deadly results that I and others have been warning about for years were tragically inevitable.

Pediatricians have taken critical first steps in acknowledging that the tenets of the BFHI lead to preventable infant deaths, but it’s long past time to start dismantling the BFHI. How can we possibly justify maintaining a punitive program designed by lactivists designed to enforce an unscientific ideology in hospitals, facilities devoted to promoting infant and maternal health?