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:

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.

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:

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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.

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  • AirPlant

    What is breaking me is that the previous 24 hr definition is a much better definition. it isn’t like you can formula feed and then suddenly bust on over to breastfeeding to make the definition work for like a doctor’s appointment, you are just talking about situations where if the baby is left with grandma for an afternoon they might get some formula to tide them over. It is a perfectly functional way to describe an infant receiving the vast majority of its calories from breast milk.

    Being that I am one of the younger people in my department I have noticed that in previous generations they had a much more flexible definition of an infant being breastfed. My mother described me as breast fed and I only found out a couple years ago that she quit at three months (no supply issues she just hated it). I even found a photo in my baby book of my dad feeding a newborn me a bottle of formula and apparently this was a common occurrence when my mom needed a break. My coworker described his now teenage twin daughters as breastfed and their mother supplemented the entire time and quit entirely at six months. If I told either of these stories on a mommy blog today neither of these cases would be considered good enough breastfeeding, but if I told either of those parents that they didn’t really exclusively breastfeed they would laugh in my face.

    So it isn’t a novel thought but seriously I wish I could dump something in the water to make everyone calm down about a dozen notches because the old fashioned view of a breastfeeding baby being any baby that gets most of its nutrition from breastmilk seems a whole lot healthier for everyone.

    • Merrie

      Yes, I noticed the same thing reading my own baby book. My mom wrote that I weaned myself and it only took about a week from first bottle to last nursing, but then she threw in a casual (except relief bottles), to note that even when I was getting basically breastmilk I’d still get the occasional bottle.

      • AirPlant

        Right? It was just so chill. Like is your baby on a boob? Like ever? Cool! Is you baby drinking only formula? Cool! Does breastfeeding massively suck for you? Quit!

        I am sure there was judgement and bad shit going all around but the baby feeding conversation seems night and day better.

  • Emilie Bishop

    Yeah, I figured that was too good to be true. Sad that I expected so little from an organization claiming to promote the health of the world.

  • So why don’t oral rehydration, vitamin drops, and medicine count against “exclusive breastfeeding”? None of those items is composed of breastmilk. Is it for the same reason that pregnant women are warned against lunchmeat but rarely, if ever, told to avoid salad?

    • The Bofa on the Sofa

      As I mentioned yesterday, I find it amusing that the “redefined” exclusive breastfeeding to include non-exclusive breastfeeding. So they’ll call it exclusive breastfeeding, even if it isn’t exclusively breastfeeding.

      • Griffin

        Yeah, it’s just so grotesque.

    • Juana

      Well, because they are necessary for other reasons than giving the mother some respite.

      • But they aren’t breastmilk. And so the purpose of the label “exclusive breastfeeding” becomes clear: To promote a “virtuous” fluid (breastmilk) and denigrate “artificial” formula.

        • Cristina

          “We’re exclusively breastfeeding. Now excuse me while I take the baby to the ER for rehydration, which is so much better than toxic formula.”

          • The Bofa on the Sofa

            Make no mistake – we have heard those who have claimed that it is better to feed a baby with a feeding tube than to resort to formula.

            As long as it is breastmilk, of course.

          • space_upstairs

            It seems that many hard-core “natural health” devotees are convinced that mainstream food and medicine should only ever be used during an emergency. This is because they believe that any attempt to *prevent* emergencies using mainstream food and medicine will inevitably cause more problems than it can prevent, as the alleged overuse of mainstream food and medicine is thought to be the root of all chronic or incurable illness. And why would they believe this? As one natural health devotee recently put it, “hope.” These people find it much easier and more promising to avoid mainstream food or medicine than, say, to confront the issue of old age and the possibility that some problems cannot realistically be solved within the lifetimes of even the young and healthy, or to confront problems that cannot be solved on an individual level like the modern economy and its effects on social life.