Ireland shutters Baby Friendly Hospital Initiative

Old blue closed sign hanging in a shop window

Hallelujah! A national Baby Friendly Hospital Initiative is being shut down.

Without consultation or notice, in early 2016 the HSE Health Promotion & Improvement, Health & Wellbeing Division reduced the grant-aid it had been providing to the BFHI (which ranged over recent years from slightly under €50,000 to zero). The HSE then directed maternity units not to participate in BFHI activities, ceased all funding, and would not engage in any discussion of these precipitous HSE actions…

Why? Because it doesn’t work.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]”There was no difference in breastfeeding rates in hospitals that had achieved baby friendly designation and those that had not achieved this designation. “[/pullquote]

As a member of the Irish governing party explained:

The initiative is funded by the Health Service Executive, which in 2016 commissioned a research team at Trinity College Dublin to undertake a review of the initiative… A key finding of the Trinity review was that there was no difference in breastfeeding rates in hospitals that had achieved baby friendly designation and those that had not achieved this designation. Following completion of the Trinity review, the HSE initiated engagement with the baby friendly hospital initiative and other stakeholders on developing a revised model.

What about all the healthcare dollars/euros that lactivists insist would be saved by increasing breastfeeding rates? No one — not the government nor the BFHI — can point to any real world savings.

I’ve made no secret of my contempt for the breastfeeding promotion campaign known as the Baby Friendly Hospital Initiatve (BFHI). Nearly a year ago, I contended that the BFHI has been a deadly failure. I cited three papers:

Together these US papers show 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 and deaths when babies fall from or get smothered in their mothers’ hospital beds.

And that doesn’t even take into account the babies who have sustained brain injuries or died due to dehydration, hypoglycemia and severe jaundice because the BFHI refuses to acknowledge that up to 15% of first time mothers cannot produce enough milk to fully sustain a baby.

The BFHI is the epitome of paternalism in medicine. Lactation professionals have decided what is “best” for mothers and babies without consulting mothers themselves. They insist that “science” shows that breast is best and therefore, they are justified in forcing breastfeeding on every woman regardless of her experiences and values, and regardless of whether it is a safe or realistic goal.

Yet informed consent requires presenting the risks of breastfeeding — insufficient breastmilk, dehydration, failure to thrive — as well as the benefits. Informed consent means that it is up to MOTHERS to determine whether to offer supplemental formula or pacifiers, NOT up to providers.

BFHI Ireland does not deny this; it does not even mention it. Instead of addressing the failure of the BFHI to increase breastfeeding rates, and the injuries and deaths that have resulted, BFHI Ireland defends itself thus:

An independently evaluated and published survey in March 2017 found that directors of midwifery and clinical midwife specialists in lactation were overall happy with the Initiative as currently run, valued the Initiative, and thought there would be negative effects if it was discontinued.

But the fact that those who were employed by the program were happy with the program has nothing to do with safety or effectiveness. Indeed, it supports my view that the program isn’t “baby friendly”: it’s “lactivist friendly” and baby-harmful.

What now?

If the BFHI were based on science, its members would ask themselves why it doesn’t work and investigate how it could be made more effective and safer. But the BFHI is based on personal conviction, not science, so there will be no attempt made to understand why it is ineffective.

A news story in The Times laments:

Only 15 per cent of children in Ireland are exclusively breastfed for the first six months, as advised by the WHO, compared with a global average of 38 per cent.

Yet Ireland has one of the lowest infant mortality rates in the world (3.3/1000), far lower than many countries with much higher breastfeeding rates. That’s not surprising since there is no real world evidence from any country that breastfeeding rates have any correlation with infant mortality.

The sad truth is that the BFHI is a boondoggle for lactation professionals, no more and no less. It was started with the best of intentions, but it is based on personal belief, not science and, indeed, is contradicted by the best scientific evidence. Hopefully Ireland will be merely the first of countries that recognize that money spent on funding the BFHI is money wasted. The end of the BFHI will be both baby friendly and mother friendly; it can’t come soon enough.