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Baby-Friendly Hospital Initiative (BFHI)

Potential for Public Health Impact

The Baby-Friendly Hospital Initiative (BFHI) implemented at Boston Medical Center (BMC) has a high potential for public health impact.

Reach:  As an organizational policy intervention, the BFHI has potential to reach almost all mothers of newborns in hospitals that adopt it.

Effectiveness:  During the three-year study period, rates of breast feeding initiation and exclusive breast feeding increased substantially. Breastfeeding initiation during hospitalization increased from 58% (1995) to 77.5% (1998) to 86.5% (1999). Exclusive breastfeeding during hospitalization increased from 5.5% (1995) to 28.5 (1998) to 33.5% (1999). Those increases were sustained over at least two additional years. Of particular note, rates increased substantially among U. S.-born black women.

Adoption:  The BFHI had been adopted by 102 maternity facilities nationwide as of December 2010.

Implementation:  Becoming Baby-Friendly is a complex process that requires staff time and hospital resources.  Once a hospital has become Baby-Friendly, however, policies that were difficult to implement become routine practice.  At BMC, the Breastfeeding Task Force no longer exists, as the policies for which it advocated are now standard of care.

Maintenance:   BMC has maintained its Baby-Friendly status for over a decade.  In the interim, Baby-Friendly practices have increasingly been accepted as best practices.  In 2008, the National Quality Forum released 17 measures of quality in maternity care, one of which was rate of exclusive breastfeeding at discharge.   In 2010, the Joint Commission adopted exclusive breastfeeding rate at discharge as one of its new Perinatal Core Measures.  The identification of exclusive breastfeeding rates as an indicator of quality care has underscored the importance of implementation of Baby-Friendly practices as standard of care.