New Year’s Greetings from Baby-Friendly USA!
2020 will be a very important year for the Baby-Friendly Hospital Initiative (BFHI) in the US. In December, BFUSA released Interim Guidelines and Evaluation Criteria (GEC), which applies to assessments taking place between February 1, 2020 and December 31, 2022. We have received much positive feedback on how the changes we’ve made add greater clarity, further empower moms and families, and encourage more collaborative conversations between parents and providers.
In a few months, we will be releasing the completely revised GEC, which will finalize our alignment with the 2018 WHO BFHI Implementation Guidance and will apply to assessments taking place beginning in January 2023.
As we approach this important milestone, we believe it is important to accomplish two things. First, we want to make it clear that the GEC has evolved to optimize its relevance and responsiveness. We are not “rearranging our policies” or “backpedaling,” as has been claimed.1 Quite the opposite, the GEC remains the highest standard of evidence-based infant feeding care – and study after study has demonstrated that adherence to the Ten Steps has a positive impact on breastfeeding rates.2
Just the Facts…
Secondly, we want to take this opportunity to continue to clarify some aspects of the GEC that continue to be misunderstood and misrepresented. Below, we highlight a few persistent inaccuracies that have appeared once again in recent articles and blog posts. We resolve to continue to present the facts about the BFHI for as long as is necessary to ensure parents and providers have an accurate understanding of what to expect in a Baby-Friendly designated facility.
No Threshold EBF Requirement
Specific exclusive breastfeeding rates are NOT a criterion for Baby-Friendly designation in the US. There is no “one-size-fits-all exclusive breastfeeding metric of 80%,” as has been claimed.1 The GEC states that “Facilities should strive to reach the Healthy People 2020 goal for exclusive breastfeeding,” but there is no threshold requirement. While the WHO’s 2018 BFHI Implementation Guidance includes an exclusive breastfeeding metric of 80%, this requirement is not incorporated into the US program.
Acceptable Reasons for Supplementation
While supporting mothers to exclusively breastfeed is its primary goal, the GEC does not consider supplementation with formula to be a “no-no,” as has been reported.3 The GEC is clear that supplementation with a breast milk substitute is acceptable for multiple reasons, including medical indications and informed parental decision. In fact, the GEC requires that facilities support mothers who choose to formula feed with information about safe preparation, handling, storage, and feeding of infant formula.
Doctor’s Orders Not Required for Parental Request of Formula
Doctor’s orders are required when formula is used to address issues related to medical indications. It has been suggested1 that doctor’s orders are also required when formula is utilized in accordance with informed parental request. This is not the case.
No Forced Nursery Closing
Rooming-in is the standard practice in Baby-Friendly designated facilities, but we recognize some circumstances necessitate mother-baby separation. In fact, language has been added to the Interim GEC to clarify that this includes medical reasons, safety-related reasons, or maternal concerns. The GEC does not include a requirement for nursery closure, as has been suggested.4,5
We call on all individuals and organizations to present accurate and truthful information about the BFHI as we implement the upcoming changes to the GEC. Parents and the hospitals who have worked so hard to earn the Baby-Friendly designation deserve nothing less.
In the meantime, we wish a happy and healthy New Year to all!
- https://www.ncbi.nlm.nih.gov/pubmed/26924775 and https://www.ncbi.nlm.nih.gov/pubmed/18829830
- Fed Is Best Foundation “Letter to Hospitals”