Earlier this week, we published an article showing that higher Baby-Friendly penetration rates are clearly associated with higher breastfeeding initiation rates across the country and across time. This finding served to (a) debunk the conclusions of a study published in the Journal of Pediatrics, which claimed there was no correlation between the two based on incorrect analysis of the data; and (b) lay bare the misleading and inflammatory statements in the wake of this article from Fed Is Best (FIB), which has leveraged it to spread the false claim that the Baby-Friendly Hospital Initiative (BFHI) “does not work.”

We posted a link to our article on BFUSA’s Facebook page after publishing it on our website. Among the many, many positive comments we received after our publication, there were three negative responses to our Facebook post, two of which were made by familiar BFHI detractors. We would like to respond to these comments directly.

Comment #1:

The first comment is from Jody Lynne – also known as Fed Is Best co-founder Jody Segrave-Daly:

BFUSA’s Response:

She is correct. In our desire to respond to the Journal of Pediatrics article as expeditiously as possible, we inadvertently pulled data from the wrong year. We thank Ms. Segrave-Daly for pointing this out and would like to take this opportunity to correct the error. The original chart and the corrected chart are below:

     

                               Original                                                                           Corrected*

The chart is different, but the conclusion is the same: higher Baby-Friendly penetration rates are indisputably correlated with higher breastfeeding initiation rates across the country and across time.

Comment #2:

The second comment is from Amy Tuteur:

BFUSA’s Response:

Of course, there are many factors responsible for the rise in breastfeeding rates in the US, which began well before the BFHI started to take hold in this country. We have never claimed that the BFHI is the only factor and also made no claim that the increase in BFHI during the period in question caused the concurrent rise in breastfeeding initiation rates during that time. In fact, our article specifically states that “we cannot infer causality” in the very first sentence after this chart is presented. Our sole objective was to reveal the false claim made by the authors of the Journal of Pediatrics study that there was no correlation between the percent of live births occurring at Baby Friendly facilities and the percent of babies “Ever Breastfed.” As our article outlines, a complete and statistically sound examination shows that there was, in fact, a clear correlation.

Secondly, there is, in fact, a large body of evidence showing implementation of the BFHI can significantly influence breastfeeding success. The WHO and UNICEF present a summary of this evidence in the introduction to their 2018 BFHI Implementation Guidance (pp 12-13). One can argue the strengths or merits of various studies or present research with an opposing viewpoint. But one cannot claim that “there is no evidence that the BFHI has had anything to do with the increase in breastfeeding rates.” This is plainly and simply not true.

Comment #3:

The third comment is from Debbie Hinkley:

BFUSA’s Response:

We agree that initiation does not equal continuation. We chose this metric in this case because that is the metric that the authors of the Journal of Pediatrics chose as their metric for asserting that there was no correlation between Baby-Friendly penetration and breastfeeding rates. To debunk that claim, we chose to use the same metric in our more complete analysis.

While we do view initiation rates as the most important metric for Baby-Friendly, we agree that the continuation rates are also important. So, based again on the data provided in the CDC’s Report Card,  here are the charts showing a very similar picture for “exclusively breastfed through 3 months” and “breastfeeding at 6 months”:

     

As stated earlier, we are not claiming causality here, merely that there is a clear and undeniable correlation.

* The CDC began publishing the Breastfeeding Report Card biannually in 2014 and did not issue a report in 2015. Therefore, we do not have data from the CDC on the “Percent of live births occurring at Baby-Friendly Facilities” in 2015. We know it was higher than 7.2% (which is what it was in 2014) and lower than 18.3% (which is what it was in 2016). Based on the overall trend plus BFUSA’s own knowledge of the growth in the number of facilities designated each year, we have estimated the 2015 rate to be 11.5%.