New approach to assessing the impact of the Baby-friendly Hospital Initiative on exclusive breastfeeding rates in developing countries

Background: The goal of the WHO/UNICEF Baby-friendly Hospital Initiative (BFHI) is to promote maternal and child health by supporting breastfeeding in maternity centers. Few studies have examined its impact on trends in exclusive breastfeeding (EBF) using country-level data. Objectives: This study examines the impact of the BFHI on EBF in the first 2 months in a sample of 20 developing countries that implemented the BFHI before 2003. Methods: EBF data are from the DHS Surveys, 1986-2005, and BFHI prevalence from UNICEF reports. Because programs were initiated in different years, data points were realigned to the year that the first Baby-friendly Hospital (BFH) was certified in that country. Pre-and post-implementation time periods for those countries that had achieved at least 10% BFHs (n=12), versus those that did not achieve 10% BFHs (n= 8), were analyzed using linear mixed modeling, and bootstrapping techniques employed to determine 95% CIs for regression coefficients. Sub-analyses examined trends in countries with high vs low starting EBF prevalence, defined as EBF at 0-1 months of age. Results: Significant positive linear trends in EBF were observed following implementation of the BFHI. These trends were statistically significant only in countries with at least a 10% or greater BFH certification rate. This association was strongest in countries with initial EBF rates <50%. Conclusion: This is the first multi-country controlled study to show the extent to which the BFHI is an effective programmatic intervention for increasing EBF in developing countries. It has clear policy and program implications for breastfeeding support.