Indian Journal of Pediatrics, Volume 77—June, 2010 689

Correspondence and Reprint requests : Dr Richa Nigam, AssistantProfessor, Department of Community Medicine, Sri AurobindoInstitute of Medical Sciences, Sanwer Road, Indore (M.P.), India.

[DOI-10.1007/s12098-010-0079-0][Received December 11, 2009; Accepted March 11, 2010]

Clinical Brief

Breastfeeding Practices in Baby Friendly Hospitals ofIndore

Richa Nigam, Manish Nigam1, R.R. Wavre, Ajit Deshpande and R.K. Chandorkar

Departments of Community Medicine and 1Forensic Medicine, SAIMS Medical College, Indore, India

ABSTRACT

An interview based cross sectional study was conducted in two of the designated Baby Friendly Hospitals of Indore in the year2008. None of the hospitals were having a written breastfeeding policy, which is routinely communicated to all the healthworkers and no regular training regarding the Programme was being imparted. There is a need to develop a BFHIMonitoring System to ensure that the status is kept in check. Training regarding essential Criteria of BFHI should be therefor all the staff. [Indian J Pediatr 2010; 77 (6) : 689-690] E-mail: richamanish2007@yahoo.co.in

Key words: B.F.H.I.; Exclusive breastfeeding; Essential criteria

World Health Organization (WHO) and UNICEF jointlylaunched a new international initiative aimed atprotecting, promoting and supporting breastfeeding in1991, entitled the ‘Baby Friendly Hospital Initiative’(BFHI). The BFHI policy included ten Steps to guide everymaternity service in the quest to become ‘Baby Friendly’.The concept of BFHI came in Madhya Pradesh in the year1993. Since then 68 hospitals have been designated asBaby Friendly Hospitals. In Indore, till now only 2hospitals have been given Baby Friendly certificationnamelym M.Y. Hospital and District Hospital, Designatedas BFH-1 and BFH-2, respectively. There has been noreinspection by the BFHI authorities since then. Hence, itwas felt to have a critical appraisal of the process ofimplementation of the BFHI practices in Indore.

MATERIAL AND METHODS

For the study, Baby Friendly hospitals of Indore wereselected. Amongst the health care providers, two subcategories were taken i.e., one at the management leveland other at the professional level that is consultants,resident doctors and nurses in the pediatric ward andoutdoor. After taking the consent, data was collected fromthe respondents, by interviewing them. The interviewincluded questions about knowledge and implementationof ten essential criteria.

A passive observation checklist was also maderegarding any advertisement of infant milk substitutes.

RESULTS

None of the designated hospitals were practicingwritten breastfeeding policy that is routinelycommunicated to all health workers. Designatedhospitals were also not imparting training to the healthcare staff regarding BFHI, antenatal counseling forbreastfeeding and did not have mother support groups.

Artificial teats or pacifiers and advertisement ofInfant Milk Substitutes were not encouraged in any ofthe Baby friendly hospitals.

Out of total 20 doctors, 7 (04 BFH-1, 3 BFH-2) hadknowledge about written breast feeding policy, 9 (07BFH-1, 2 BFH-2) about training of health care staff, 10 (6BFH-1, 4 BFH-2) about informing pregnant female aboutbenefits of breast feeding, 11 (8 BFH-1, 3 BFH-2) aboutbreast feeding even if mother and child is to be separated.All 20 doctors had knowledge about initiation of breastfeeding within half an hr of birth exclusive breast feedingand rooming in. All of them knew the importance of ondemand feeding and no artificial teats or pacifiers to beused. 3 out of total 20 doctors (2 BFH-1, 1 BFH-2), hadknowledge about establishing mother support groups.

While assessing the knowledge of the nurses about theessential criteria of BFHI, it was found that out of total 40nurses, 1 (1 BFH-1, 0 BFH-2) about written breast feedingpolicy, 03 (02 BFH-1, 01 BFH-2) about training of healthcare staff, 3 (3 BFH-1, 0 BFH-2) about informing

Richa Nigam et al

690 Indian Journal of Pediatrics, Volume 77—June, 2010

pregnant female about benefits of breast feeding. All the40 nurses had knowledge about initiation of breastfeeding within half an hr, 24 (15 BFH-1, 9 BFH-2) aboutbreast feeding even if mother and child is to beseparated, 33 (18 BFH-1, 15 BFH-2) about exclusive breastfeeding, 27 (16 BFH-1, 11 BFH-2) about rooming in and 38(20 BFH-1, 18 BFH-2) about encouragement on demandfeeding. All 40 nurses had knowledge that artificial teatsor pacifiers should not be used and (4 BFH-1, 1 BFH-2)about establishing mother support groups.

similar study in New Zealand public hospital found thatall six of the hospital organizations had developed abreastfeeding policy, although there were variations inthe extent to which these were finalized.3

A Cattaneo and R Buzzetti found that specific stafftraining in BFHI was an important component inobtaining their compliance with and commitment toimplement Ten Steps.4 Studies have also found thatmothers assigned to BFHI intervention had increasedrates of exclusive breastfeeding.5, 6 However, a Turkishstudy found that in none of five hospitals analyzed wereimplementing all the Ten Steps.7

CONCLUSIONS

Even after 13 yr of BHFI in Madhya Pradesh, only twoHospitals of Indore have been accreditated as BFH. Thus,there is need to develop a BFHI monitoring andreinspection. Regular training of 10 steps of BFHI shouldbe imported to all the staff.

Acknowledgements

I convey my utmost thanks to my senior professors and thecoauthors for their guidance and support.

Contributions: All authors contributed to the preparation ofquestionnaire and data analysis.

Conflict of Interest: None.

Role of Funding Source : None.

REFERENCES

1. Hambayi, Mutinta, Nseluke, Hadzima, Rufaro. UNICEF Anevaluation report of breastfeeding practices in hospitals andcommunities of Zambia 1997.

2. Okolo SN, Ogboma C. Knowledge, attitude and practice ofhealth workers in Keffi local government hospitals regardingBaby-Friendly Hospital Initiative (BFHI) practices. Eur J ClinNutr 2002; 56: 438-441.

3. Moore T, Gauld R, Williams S. Implementing Baby FriendlyHospital Initiative Policy; the case of New Zealand publichospitals. Internat Breastfeeding J 2007; 2: 8.

4. Cattaneo A, Buzzetti R. Effect on rates of breast feeding oftraining for the Baby Friendly Hospital Initiative. BritishMedical Journal 2001; 323: 1358-1362.

5. Kramer MS et al. Promotion of breastfeeding intervention trial(PROBIT): a randomized trial in the Republic of Belarus. J ofthe Amer Med Association 2001; 285: 413-420.

6. Braun M, Giugliani E, Soares M, Giugliani C, de Oliveira P,Danelon C. Evaluation of the impact of the Baby-FriendlyHospital Initiative on rates of breastfeeding. Amer J PublicHealth 2003; 93: 1277-1279.

7. Gokay G, Uzel N, Kayaturk F, Neyzi O. Ten steps forsuccessful breastfeeding: assessment of hospital performance,its determinants and planning for improvement. Child: Care,Health and Dev 1997; 23: 187-200.

TABLE 1. Knowledge About Essential Criteria of BFHI AmongstDoctors and Nurses

Global Criteria Doctors NursesBFH-1 BFH-2 BFH-1 BFH-2

Written Breast 04 03 01 00Feeding Policy

Training of Health 07 02 02 01Care Staff

Inform PregnantFemale About Benefits of 06 04 03 00Breast Feeding

Initiation of BreastFeeding With in 10 10 20 20Half an Hour

Breast Feeding EvenIf Mother and Child 08 03 17 12are to be Separated

Only Exclusive 10 10 18 15Breast Feeding

Rooming in Support 10 10 16 11Groups

Encourage on 10 10 20 18Demand Feeding

No Artificial Teats 10 10 20 20or Pacifiers

Establish Mother 02 01 00 00Support Groups

DISCUSSION

In a similar study by National Food and NutritionCommission in Zambia (1997), 61% managers stated“yes” for the existence of training programme for thestaff, 22% said “no” and 17% denied their presence if suchprogramme existed.1 S N Okolo and health workers wereaware of the need for initiating breastfeeding within 30min of birth and 92 (36.8%) were aware of breastfeeding.2

In the present study, there was no breastfeeding policythat is routinely communicated to all health workers.Trinie Moore, Robin Gauld and Sheila Williams, in a