The evidence is clear: the Baby Friendly Hospital Initiative is a deadly failure

12500335 - handwriting blackboard writings - the road to hell is paved with good intentions

The Academy of Breastfeeding Medicine (ABM) blog has been pretty quiet lately. They haven’t published a single substantive post in nearly 6 months, perhaps because their posts were being systematically torn apart by myself and others.

Now, in the face of a several major publications demonstrating that the Baby Friendly Hospital Initiative (BFHI) is a deadly failure, they’ve returned, desperate to prop up the failing boondoggle.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]The Academy of Breastfeeding Medicine is desperate to prop up the BFHI, a failing boondoggle.[/pullquote]

How is the BFHI a boondoggle? Let me count the ways:

  • It is a lactation consultant full employment plan
  • It gave voice to lactivists’ worse bullying impulses
  • It is directly contradicted by science on a variety of issues including the actual benefits of breastfeeding
  • It has been known for years that it is killing babies
  • It violates women’s bodily autonomy

The latest evidence includes:

Together these papers showed that the BFHI doesn’t work, ignores the science on pacifiers, formula supplementation, and Sudden Infant Death Syndrome (SIDS) and leads to preventable infant injuries deaths when babies fall from or get smothered in their mothers’ hospital beds.

You might think that these findings would engender distress at the ABM and an immediate effort to modify the BFHI to reduce injuries and deaths.

You would be wrong.

Instead it has led to reflexive defense of the indefensible.

The piece is written by Melissa Bartick, MD who has staked her career on massively exaggerating the benefits of breastfeeding. She consistently finds the theoretical lifesaving benefits of breastfeeding despite the fact that she literally cannot demonstrate ANY actual lifesaving benefits to breastfeeding in term infants. I’ve publicly challenged her repeatedly and she has yet to present any real world data to support her extravagant claims.

The title is a bald-faced lie: Evidence is Clear: Baby-Friendly Hospital Initiative Increases Breastfeeding Rates in the US and Closes Breastfeeding Disparities. That’s precisely the OPPOSITE of what the evidence shows.

Bartick skips from one lie to another.

On the benefits of the judicious early formula supplementation:

Yet this editorial is what is garnering the most media attention. Interestingly, the editorial does support previous research by one of its authors, Valerie Flaherman, who found that small amounts of formula help women breastfeed longer. This finding, which contradicts previous evidence (here and here) that non-indicated supplemental formula is a strongly associated with breastfeeding failure.

Bartick’s claim is debunked by the ABM’s own Dr. Alison Steube who wrote in April on the very same website:

Delayed onset of lactogenesis is common, affecting 44% of first-time mothers in one study, and 1/3 of these infants lost >10% of their birth weight. This suggests that 15% of infants — about 1 in 7 breastfed babies — will have an indication for supplementation …

On the failure of the BFHI to increase breastfeeding rates:

A national survey of US Baby-Friendly hospitals compared to hospitals that were not designated Baby-Friendly, the hospitals designated as Baby-Friendly in 2001 had elevated rates of breastfeeding initiation and exclusivity, regardless of demographic factors that are traditionally linked with low breastfeeding rates…

But correlation is not causation especially because the BFHI designation is used as a marketing ploy to attract women for whom breastfeeding is a priority…

One way to look at the correlation between BFHI, the Ten Steps, and Breastfeeding Rates is to look at national data itself from the CDC Breastfeeding Report Cards and the CDC National Immunization Survey, for the years 2007 to 2013, the years in which we have data on the percentage of births in Baby-Friendly hospitals from the CDC. We can look at the following metrics: the number of Baby-Friendly designated hospitals, the percentage of live births at Baby-Friendly Hospitals, the rate of exclusive breastfeeding at 3 months … This data show that the mathematical correlation between the increase in births born at Baby-Friendly hospitals and exclusive breastfeeding at 3 months is 0.93, which is extremely high.

But the rate of breastfeeding was rising dramatically BEFORE the BFHI ever existed. The fact that the rate continued to rise is meaningless. It does NOT show that the BFHI had anything to with the rise at all.

What about the fact that the BFHI bans pacifiers despite scientific evidence that shows that pacifiers prevent SIDS?

Bartick ignores that.

What about the scientific evidence that enforced prolonged skin to skin contact leads to infant smothering deaths?

Bartick ignores that.

What about the scientific evidence that mandatory rooming in policies and closing well baby nurseries leads to infant deaths from skull fractures and smothering?

Bartick ignores that.

The bottom line is pretty simple:

I and others can demonstrate literally hundreds, perhaps thousands, of infant injuries and deaths as a result of the BFHI. In contrast, Bartick and her ABM colleagues offer not even a single term baby whose life has been saved by the BFHI.

The BFHI is a deadly failure. It’s time to end it.