World Breastfeeding Week: URC Helps Implement Baby-friendly Hospital Initiative in Guatemala

Twenty years ago this week, the World Alliance for Breastfeeding Action launched the first World Breastfeeding Week (WBW) campaign to raise awareness and promote practices supportive of breastfeeding—the best source of nutrition for infants and young children. Many new mothers, particularly in areas with poor access to education and low literacy, may not be aware of the benefits of breastfeeding. The first hour immediately after childbirth (before the mother leaves the health facility) is optimal for providing her with the support and information she may need to successfully breastfeed her newborn.

Yet many hospitals and maternities do not offer that kind of support or may inadvertently send the wrong message about breastfeeding by passing along to mothers free samples of formula and bottles. The Baby-friendly Hospital Initiative, established by the World Health Organization and UNICEF, recommends a set of ten steps (see box below) to help hospitals and maternity clinics create an environment that encourages new mothers to breastfeed. Since its launch, the initiative has spread to more than 152 countries. 

In Guatemala, the Ministry of Health provided the baby-friendly steps to the country’s hospitals, but hospital practitioners were unsure how to best implement them. The US Agency for International Development Health Care Improvement Project (HCI), managed by URC, and partners Plan International, UNICEF, and the Pan American Health Organization helped staff successfully apply the steps in 21 hospitals.

Ten steps to successful breastfeeding

  1. Have a written breastfeeding policy that is routinely communicated to all health care staff.
  2. Train all health care staff in skills necessary to implement this policy.
  3. Inform all pregnant women about the benefits and management of breastfeeding.
  4. Help mothers initiate breastfeeding within one half-hour of birth.
  5. Show mothers how to breastfeed and maintain lactation, even if they should be separated from their infants.
  6. Give newborn infants no food or drink other than breast milk, unless medically indicated.
  7. Practice rooming in - that is, allow mothers and infants to remain together 24 hours a day.
  8. Encourage breastfeeding on demand.
  9. Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants.
  10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic.

Applying quality improvement (QI) methods to the initiative, HCI simplified the approach and guided teams of health workers to translate the steps into measurable actions. With QI, teams assessed their own progress without awaiting results from an external evaluator, as required for baby-friendly certification. For example, for step one, teams deliberated how they could communicate the hospital’s breastfeeding policy, what the communication should say, where policy materials should be placed, and how they would measure whether the materials worked. They designed an observation checklist to assess the first step. 

The teams repeated this process for each step, deciding they could measure step two by testing providers and evaluate compliance with steps three to ten by interviewing mothers. After measurement and analysis, the teams continued to identify gaps and brainstorm improvements they could accomplish within the hospital’s means. In addition, HCI brought together teams from different hospitals to learn from each other and compare results.

The teams also expanded on the baby-friendly steps to include cultural adaptations. For example, some hospitals added an eleventh step: “All pregnant women should be accompanied by a spouse at least once [during prenatal care] so that he can learn about the benefits and importance of exclusive breastfeeding.”

Within the first year of the program, three HCI-supported hospitals—Fray Bartolomé de las Casas, Sololá, and San Pedro Necta—received baby-friendly certification by UNICEF through the Guatemalan Ministry of Health, recognizing them for successfully implementing the ten steps and for declining free or low-cost breast milk substitutes or bottles. All 21 hospitals reported compliance above 80% for several steps.

August 07, 2012
Regions/ Countries