The State of the World's Children 1998: Focus on Nutrition

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Panel 13

BFHI: Breastfeeding breakthroughs

Photo: A woman breastfeeds her newborn at a hospital in China. BFHI has increased breast feeding rates significantly in the country.

Smiling at her infant in her arms, Elba Diaz awaits Juanito's six-month check-up at a primary health care centre in southern Santiago. Her third child draws nothing but compliments from health workers, unlike Ms. Diaz's first two children, who were not so healthy. The difference is that Juanito - born at the Barros Luco Hospital, one of 19 baby-friendly hospitals in Chile - is the only child she has been able to breastfeed exclusively.

"Immediately after Juanito was born," recalls Ms. Diaz, "he was laid on my body. Words can't describe how blissful I was, feeling his warmth and looking at his flushed face so close to me. I began nursing him at the breast while we were still in the delivery room, and he was beside me always, receiving only my breastmilk."

In Chile, breastfeeding support and counselling for mothers have led to enormous health benefits for tens of thousands of children like Juanito in little more than a decade. In 1985, only 4 per cent of infants were exclusively breastfed for the first six months of their lives. Remarkably, only a year after the Baby-Friendly Hospital Initiative (BFHI) was launched in 1991, a study of 9,200 infants nationwide showed that the rate had risen to 25 per cent. And preliminary results of a national survey in 1996 suggest that the exclusive breastfeeding rate for the first six months is now about 40 per cent.

What lies behind this transformation? Training is an important part of the answer. With support from the NGO Wellstart International and UNICEF, training materials were adapted, and in just four years over 7,500 health workers learned to help women breastfeed effectively. Strong support from the Ministry of Health was another factor, and UNICEF provided sustained advocacy. The Na tional Breastfeeding Commission, organized in 1992, has also kept breastfeeding high on Chile's child health agenda.

Another effective measure was expanding 'baby-friendly' practices into primary health care centres, where trained staff offer breastfeeding education and support. "The staff acquainted me with breastfeeding during my pregnancy," said one mother. "The first week after delivery, I joined a group session at the clinic to share my concerns with other breastfeeding mothers. I feel very secure, having easy access to professional advice on any breastfeeding questions."

These achievements in Chile have been replicated across the world through BFHI and related efforts. In Cuba, only about 63 per cent of newborns were breastfed exclusively at the time they left the hospital in 1990. Now, six years after BFHI was introduced, an estimated 98 per cent of newborns are exclusively breastfed when they leave the maternity ward. And more strikingly, about 72 per cent of those infants are exclusively breastfed through four months of age, up from 25 per cent in 1990. All 44 hospitals handling over 1,000 deliveries a year and 42 per cent of smaller hospitals in the country are baby-friendly. In 1996, Cuba extended the baby-friendly programme to the community level by putting it into practice at small community health centres attended by family doctors.

On the other side of the globe, China had over 6,300 baby-friendly hospitals at the end of 1996. Thanks to BFHI and some regulation of the marketing of breastmilk substitutes, 48 per cent of infants in urban areas and 68 per cent in rural areas are now exclusively breastfed for four months, a 1994 survey found. Just two years earlier, the rates were 10 and 29 per cent respectively. Considering that about 20 million infants are born each year in China, this represents a remarkable accomplishment.

Iran, which began promoting breastfeeding in the 1980s, has held training workshops for over 30,000 health professionals each year between 1991 and 1996 after BFHI was introduced. The national support has led to a leap in the exclusive breastfeeding rate from 10 to 53 per cent in that period. An added windfall is the more than $50 million that the country saves annually, as infant formula imports dropped by 75 per cent from 48 million tins in 1991 to 12 million in 1996.

Because of the many benefits of breastfeeding since BFHI started, it is impossible to calculate the lives saved and those made better - though they certainly number in the millions. It is difficult to imagine any other way in which these results could have been achieved so effectively and in such a short time. Baby-friendly hospitals have surely made the world a friendlier place for babies and their families.

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