Did the Baby Friendly Hospital Initiative change its definition of exclusive breastfeeding?

Word CHANGE made with wood building blocks

Yesterday I wrote about the new JAMA review of the World Health Organization’s Baby Friendly Hospital Initiative.

I reported that although the review is couched in careful language, the conclusions are devastating: the BFHI ignores the scientific evidence, risks babies’ lives and isn’t even particularly effective.

I noted that the review suggest that the BFHI has changed its definition of “exclusive breastfeeding.”

[The Institutional Guidance] national monitoring definition of exclusive breastfeeding is now receiving “only breastmilk during the previous day.”

I was startled by this claim since the breastfeeding professionals at the WHO had already gone on record that babies who are injured and die because of insufficient breastmilk are not a priority:

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]It’s still business as usual at the BFHI where the babies who suffer, are brain-injured and die from insufficient breastmilk are not a top priority.[/pullquote]

When asked whether WHO plans to inform mothers of the risks of brain injury from insufficient breast milk, and that temporary supplementation can prevent complications, Dr. Rollins responded that this recommendation was not identified as a “top priority.”

Therefore, I was especially heartened by this purported change since it would be both brain- and life- saving. It would be an acknowledgement that early judicious formula supplementation not only saves lives, but it doesn’t harm breastfeeding, and it would make it possible for women who supplemented babies before their milk came in to still claim they were exclusively breastfeeding.

This change would reduce the number babies who suffered brain injuries and died because of the breastfeeding profession’s reflexive demonization of early formula supplementation. It would alleviate the suffering of hundreds of thousands of babies who endure desperate hunger in their early days because the BFHI has substituted lactivists’ personal beliefs and wishful thinking for scientific evidence.

Alas, in carefully examining the multiple documents that were cited in the review, I can find no evidence that the BFHI has changed its definition at all.

Indeed, the current World Health Organization definition of exclusive breastfeeding is:

Exclusive breastfeeding means that the infant receives only breast milk. No other liquids or solids are given – not even water – with the exception of oral rehydration solution, or drops/syrups of vitamins, minerals or medicines.

As far as I can determine, in the hundreds of pages of both evidence and guidance documentation, there is only one instance of exclusive breastfeeding being defined as only breastmilk in the previous day. That occurs in a chart in Protecting, promoting and supporting BREASTFEEDING IN FACILITIES providing maternity and newborn services:


This chart illustrates the impact of additional foods or fluids at 3 months of age on breastfeeding. Exclusive breastfeeding is mentioned more than 100 times through the document but this is the only use of the purportedly revised definition that I could find.

Like many of the charts and analyses in the document, it tracks the impact of various interventions on breastfeeding, NOT on babies. It’s almost as if the BFHI cares more about promoting breastfeeding than whether babies live or die!

As far as I can determine (feel free to correct me if you find evidence otherwise), there has been NO change in the definition of exclusive breastfeeding, NO recognition of the widespread prevalence of insufficient breastmilk (up to 15% of first time mothers in the early days of breastfeeding), NO acknowledgement of the suffering, brain injuries and deaths due to insufficient breastmilk, not to mention the literally tens of thousands of newborn hospital readmissions that result.

It’s still business as usual at the BFHI where the babies who suffer, are brain-injured and die from insufficient breastmilk are not a top priority.