Hospital Practices and Breastfeeding Rates before and after the UNICEF/WHO 20-Hour Course for Maternity Staff

Background: The Baby-Friendly Hospital Initiative (BFHI) is the most widely promoted program for increasing breastfeeding rates. Objective: To evaluate the impact of BFHI training on hospital practices and breastfeeding rates during the first 12 months of life. Methods: Eighty percent of maternity medical and nursing staff at the University Hospital in Split, Croatia, completed the updated and expanded United Nations Children's Fund/World Health Organization 20-hour course. Seven hundred seventy-three mothers (388 in the pre- and 385 in the post-training group) were included in a birth cohort and interviewed at discharge and at 3, 6, and 12 months postpartum to evaluate hospital practices and infant feeding. Six out of 10 Baby-Friendly practices were assessed using standard BFHI forms. Results: Three months after training was completed, 3 of the Baby-Friendly practices assessed (Step 4, "Initiate breastfeeding within a half-hour of birth"; Step 7, "Rooming-in"; and Step 8, "Feeding on demand") had significantly improved. The proportion of newborns exclusively breastfed during the first 48 hours increased from 6.0% to 11.7% (P < .005). There was no difference in breastfeeding rates at discharge or at 3, 6, or 12 months between the pre- and post-training groups. Conclusion: Training of health professionals, based on the BFHI, was associated with significant improvement in some Baby-Friendly hospital practices and initial exclusive breastfeeding rates. A high rate of in-hospital supplementation may partly explain the lack of improvement in breastfeeding exclusivity and duration after discharge. Strong institutional support and commitment is needed to enable full implementation of recommended Baby-Friendly practices.