Yet another paper shows Baby Friendly Hospital Initiative DOESN’T increase breastfeeding rates

Yet another scientific paper confirms what we have known for several years: the Baby Friendly Hospital Initiative is a failure on its own terms.

I’m not talking about the fact that it harms babies with its dubious “achievement” of making exclusive breastfeeding the leading risk factor for newborn re-hospitalization leading to tens of thousands of re-hospitalizations per year at a cost of hundreds of millions of dollars.

I’m not talking about the fact that its insistence on forcing 24 hour mother-infant rooming in has led to a small epidemic of newborns suffocating in their mother’s hospital beds or sustaining skull fractures from falling out of them.

And I’m not talking about the soul searing guilt that as many as 15% of mothers experience when they are biologically incapable of producing enough breastmilk to fully nourish an infant, especially in the early days after birth.

No, I’m talking about the fact that the Baby Friendly Hospital Initiative (BFHI) appears to have NO IMPACT on breastfeeding rates after hospital discharge.

The newest paper is The impact of Baby Friendly Initiative accreditation: An overview of systematic reviews published in Maternal Child Nutrition.

The authors reviewed the existing systematic reviews. They found:

– There is minimal evidence of the impact of BFI accreditation on maternal and infant health outcomes.
– The majority of current evidence assessing BFI accreditation was of poor methodology or at high risk of bias.
– More contemporary, good-quality randomised controlled trials or well-controlled prospective comparative cohorts are required to better evaluate the impact of BFI accreditation.
– Particular attention is needed to the context of the research, both background socio-economic and breastfeeding practices, and to explore longer term outcomes to see if benefits in breastfeeding duration are sustained.

They note:

Currently, there is a lack of clear evidence around long-term improved duration of breastfeeding and health benefits of BFI, particularly within high-income countries…

Qualitative evidence around BFI has found women to describe that their reality of breastfeeding differed from their expectations and that they can feel pressurised to breastfeed or guilt when unable to succeed in hospitals with BFI accreditation…

The findings of this paper are neither new nor unexpected. We have known for years that the BFHI does not work.

The paper Outcomes from the Centers for Disease Control and Prevention 2018 Breastfeeding Report Card: Public Policy Implications looked at breastfeeding data for all the nearly 4 million infants born in the US in 2015.

The authors failed to find ANY ASSOCIATION (let alone causation) between the BFHI program and breastfeeding continuation rates.

By November 2018, enough data had accumulated for the editor of the premier breastfeeding journal, Breastfeeding Medicine, to call for a review of the Ten Steps on which the BFHI is based since there is no evidence that the BFHI was having any impact on breastfeeding rates.

We should not be surprised. The BFHI incentivizes hospitals, nurses and lactation consultants on exclusive breastfeeding rates at discharge. There was NEVER any data that showed that either was correlated with breastfeeding continuation rates. This new paper adds to the growing body of evidence that the BFHI simply doesn’t work. Even worse, it harms both babies and mothers.

In other words the BFHI — by any rational assessment — is a spectacular failure.