Baby Friendly Hospital Initiative
For the best possible start in life, UNICEF and WHO recommend that all infants should be exclusively breastfed up to 6 months old. In Romania only 12.6% of infants are exclusively breastfed at 6 months. The low rate of breastfeeding has also been linked to infant abandonment because of the lack of mother to child bonding. The Baby Friendly Hospital Initiative (BFHI) was introduced by WHO and UNICEF decades ago as a means of promoting exclusive breastfeeding from birth. A Baby Friendly Hospital must meet 10 steps to gain certification. These include “rooming in” which means the infant is with the mother from birth; training of all maternity staff in ways and means to support the mother; and prohibiting the use of infant formula in the hospital. Romania had a number of baby friendly hospitals in the 1990s but they lost their certification through failure to maintain the required standards, so that by 2008 there were no BFHs in the country.
UNICEF resurrected the BFHI programme in partnership with the Ministry of Health in 2008. Private sector partners such as Arcelor Mittal and UNICREDIT provided considerable support. Primarily in the form of training of hospital personnel to ensure the necessary 10 steps were adopted and applied. Equipment and supplies were also provided as needed. Simultaneously, advocacy was stepped up for a new law on the marketing of breastmilk substitutes so that the ban on their use in hospitals could have a legal basis.
More Results and Next Steps
In this interview Anemona Munteanu, UNICEF consultant, shares the highs and lows of her advocacy efforts in Romania for the adoption of the International Code of Marketing of Breastmilk Substitutes
Q. What was your initial strategy and did you have to change much along the way? Why?
The process of adopting a Romanian Law based on the International Code of Marketing of Breastmilk Substitutes (the Code) started in 1996. At the same time the first 10 hospitals began to work towards Baby Friendly accreditation. The importance of maternity wards supporting breastfeeding couldn’t be stressed enough.
Our initial strategy was to assist the Ministry of Health in developing the draft Law, getting the endorsement of associated Ministries (Food and Agriculture, Industry and Commerce, Finance, Justice), submitting the document to Parliament for a final vote and developing secondary legislation on implementation. After obtaining all endorsements the Ministry of Health was supposed to send the Law to Parliament to be passed. Unfortunately the draft Law drowned several times and, after a decade of mishaps, was beyond resuscitation.
In 2008 we had to fully revamp our strategy. A young and enthusiastic lawyer was hired to revise and update the existing draft Law and to assist the debate on the document with the four main stakeholders: mothers and midwives; the media and marketing agencies; the Government; and the formula milk manufacturers and distributors. After getting feedback from all these groups, the Law was redrafted and a final version presented to the Senate and Chamber of Deputies. This time the document was registered as a Parliamentary initiative. It was a success in the sense that it was signed by representatives of all parties, the leaders and the opposition, senators and deputies, women and men as well.
The new strategy has a PR profile involving numerous public debates, media events and lobbying activities. It was decided that the Parliamentary initiative would speed up the passing of the Law.
Q. Which were the biggest obstacles you encountered along the way?
The biggest obstacles were the bureaucratic delays as well as a certain pressure that formula manufacturers put on people and institutions.
Q. Which was the most important lesson you learned?
There were several lessons but the most important is that if you really, truly believe in something and you want to achieve that thing, keep trying, never give up; eventually it will work out. Also, don’t be afraid to get rid of things, ways of work or ideas that are no longer fit for purpose.
At the end of the day, for me the most important thing in life is not what you have accomplished but the things you will be remembered for. I want to be remembered as one of the “Law on Code” champions.
Q. How does the work you've done on the marketing code compare to other advocacy you have done in the past?
Work on the marketing code has been the toughest since it required the passing of a law and public debates with stakeholder groups. Lessons learned from previous experiences were invaluable. These were related to sex education in schools, to access to family planning services, to the de-institutionalisation of children from huge orphanages. In all these cases, no matter how controversial the subject, the public at large was behind us and there were no commercial interests at stake. With the ‘Law on Code’ we had to convince the Romanian public that we have a case in the first place, that infants’ health is at stake when they are fed with breastmilk substitutes and, also, we are fighting a very vocal and powerful opponent.
Q. Could you share an anecdote which sums up the bright and dark sides of the ‘Law on Code’ effort?
During the years of breastfeeding promotion, several young bright persons were hired, but two of them outranked the others. Now, seven years later, they met on the face of the Code: one is the lobbyist for the industry and the other one helps UNICEF to lobby for Romanian children. Both of them are knowledgeable individuals, both “raised” by UNICEF: our champion but also our competitor! There is a bright and a dark side in this.
Q. What are your hopes and fears for the future regarding the Code?
The main hope is that the Law will be passed by the end of 2012. The main fear is that there is a certain risk that under the pressure of the manufacturers and distributors of formula, the provisions of the Law will not be implemented or that the penalties, if applied, will not be tough enough to motivate observance of the Law.
At the end of 2011, 31 maternity hospitals covering about 40% of annual births in Romania had been certified as baby friendly, which meant that mothers had received all the necessary advice and early support to enable them to breastfeed exclusively for 6 months. This was a considerable achievement considering that there were no certified BFHs in 2008. Although there were no studies done on the subject, anecdotal evidence indicated that infant abandonment was greatly reduced in BFHs.
1. Support the certification of a further 10 hospitals in 2012 and continue support thereafter until all maternities are baby friendly within the next 5 years.