Improving breastfeeding support through the implementation of the Baby-Friendly Hospital and Community Initiatives: a scoping review

Background Improved breastfeeding practices have the potential to save the lives of over 823,000 children under  5 years old globally every year. The Baby-Friendly Hospital Initiative (BFHI) is a global campaign by the World Health  Organization and the United Nations Children’s Fund, which promotes best practice to support breastfeeding in  maternity services. The Baby-Friendly Community Initiative (BFCI) grew out of step 10, with a focus on community-based implementation. The aim of this scoping review is to map and examine the evidence relating to the implementation of BFHI and BFCI globally. Methods This scoping review was conducted according to the Joanna Briggs Institute methodology for scoping  reviews. Inclusion criteria followed the Population, Concepts, Contexts approach. All articles were screened by two  reviewers, using Covidence software. Data were charted according to: country, study design, setting, study population, BFHI steps, study aim and objectives, description of intervention, summary of results, barriers and enablers  to implementation, evidence gaps, and recommendations. Qualitative and quantitative descriptive analyses were  undertaken. Results A total of 278 articles were included in the review. Patterns identifed were: i) national policy and health  systems: efective and visible national leadership is needed, demonstrated with legislation, funding and policy; ii)  hospital policy is crucial, especially in becoming breastfeeding friendly and neonatal care settings iii) implementation  of specifc steps; iv) the BFCI is implemented in only a few countries and government resources are needed to scale it;  v) health worker breastfeeding knowledge and training needs strengthening to ensure long term changes in practice;  vi) educational programmes for pregnant and postpartum women are essential for sustained exclusive breastfeeding. Evidence gaps include study design issues and need to improve the quality of breastfeeding data and to perform  prevalence and longitudinal studies. Conclusion At a national level, political support for BFHI implementation supports expansion of Baby-Friendly Hospitals. Ongoing quality assurance is essential, as is systematic (re)assessment of BFHI designated hospitals. Baby Friendly  Hospitals should provide breastfeeding support that favours long-term healthcare relationships across the perinatal  period. These results can help to support and further enable the efective implementation of BFHI and BFCI globally