CHISELA KALIWILE, Lusaka
WHAT does this mean as one would think that a facility should be friendly to babies.
In this context, it means the health facility practices will help a mother to successfully breastfeed her baby through the support it provides.
Breastfeeding is important to ensure children receive breast milk which is an ideal food for infants in the first six months of life as it provides the first immunisation to the baby, provides all the necessary water and food that the baby needs.
Breastfeeding confers such advantages to the mother as a family planning method and reduces the risk of developing both breast and ovarian cancer.
Breast milk continues to provide quality nutrients up to 24 months of the baby’s life or beyond.
However, it is not optimally practised by all the mothers due to a number of reasons such as inappropriate health facility practices where mother and baby are separated after delivery, culture, and inappropriate marketing of breast milk substitutes and other baby foods.
For example, in some societies, it is culturally accepted to both breastfeed and to give water in the first six months of life.
The Baby-Friendly Hospital Initiative (BFHI) was launched by UNICEF and WHO in 1991 in order to promote optimal breastfeeding among mothers. Contrary to the notion that health facilities will promote breastfeeding regardless, evidence shows that it is the deliberate strategic efforts of the health facility leadership with guidance from higher levels of the health care system entrenched in the national policy framework that bring about the most tangible results.
The BFHI implements the ten steps to successful breastfeeding through legislative protection, social promotion and health worker and health system support.
A facility that is declared baby-friendly will be implementing at least 8 of the 10 steps.
Step 1: Have a written breastfeeding policy that is routinely communicated to all health care staff: This helps to ensure all health workers that work in the facility are routinely communicated to on what they need to do to support mothers and caretakers to breastfeed.
Step 2: Train all health care staff in skills necessary to implement this policy: Health workers are normally considered an authentic source of information on how to feed children by the mother, families and communities.
The facility should have trained all staff based in the maternity ward and other areas responsible for the care of mothers, newborns and young children in breastfeeding promotion and support.
This is aimed at increasing their knowledge and sharpening their skills towards successful execution of the Ten Steps to Successful Breastfeeding.
Step 3: Inform all pregnant women about the benefits and management of breastfeeding: Over years it has been learnt that if a mother is helped before delivery, she is more likely to successfully breastfeed as she knows what to do as soon as the child is born.
Step 4: Help mothers initiate breastfeeding within the first hour of birth: Mothers who are supported to initiate breastfeeding soon after the baby is born are more likely to have a successful breastfeeding experience.
Step 5: Show mothers how to breastfeed and how to maintain the flow of breast milk even if they should be separated from their infants: Beyond the transfer of information, pregnant women, mothers with newborns and older children are impacted by practices reinforced within the health facility.
Step 6: Give newborn infants no food or drink other than breastmilk unless medically indicated: Families and health workers may believe that infants need pre-lacteal feeds of glucose or formula, water or other drinks before their mother’s milk “comes in.” This may lead to failure to breastfeed.
Step 7: Practise rooming in – allow mothers and infants to remain together – 24 hours a day: This promotes the opportunity for the mother to breastfeed frequently, which is key to ensure that the milk flow continues as we know that the more the baby suckles, the more milk is made.
Step 8: Encourage breastfeeding on demand: Beyond keeping the mother with the baby there is need to encourage the mother to feed frequently.
Step 9: Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants: Artificial teats and pacifiers can cause ‘nipple confusion’ where a baby who is introduced to artificial teats and pacifiers starts experiencing difficulties to latch on and hence does not breastfeed well.
Artificial teats and pacifiers also carry the risk of contamination.
Step 10: Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic: This is key for sustained breastfeeding practices that are in accordance with the recommendations.
The BFHI implements the ten steps to successful breastfeeding through a comprehensive, multi-sectoral and multi-level effort.
This includes legislative protection, social promotion, health worker and health system support, appropriate marketing and distribution of breast milk substitutes and baby foods to only those who genuinely need them.
The process of implementing BFHI requires that the facility carries out a self-appraisal in readiness for external assessment.
Once the facility is designated baby-friendly, monitoring should continue to ensure adherence to the ten steps.
The facility should have undergone external assessment by which their practices are measured against a set global criteria, and this should be continuous to re-assess the facilities’ full compliance to the required standards.
As a client, you will be able to recognise a baby-friendly facility initiative if all the staff are aware and in support of breastfeeding and if eight of the ten steps are being implemented successfully.
BFHI has impact on the level of exclusive breastfeeding among breastfeeding mothers. For those health facilities who are not yet baby-friendly, it is not too late as they can start the process now.
The Ministry of Health, the National Food and Nutrition Commission and other partners are ready to offer their support through all the stages.
For comments, contact : Nutrition Association of Zambia on firstname.lastname@example.org
CHISELA KALIWILE, Lusaka