WHO's baby friendly hospital plan boosts breastfeeding rates even in C-sections

Evidence from a handful of hospitals that have been certified as breastfeeding friendly shows that changes in hospital policy can push up rates for initiation of breastfeeding a child within one hour of birth, whether the delivery was vaginal or caesarean. This offers hope for addressing the abysmal rates in India as revealed by the latest National Health Survey.

Though institutional deliveries in India increased between 2015-16 and 2019-21, from 79% to 89%, the proportion of children who were breastfed within an hour of birth went up only marginally from 41.6% to 41.8%.

The “Ten Steps to Successful Breastfeeding” are the foundation of the WHO/UNICEF Baby Friendly Hospital Initiative (BFHI). Just 40 hospitals in India volunteered to get certified as breastfeeding friendly. The improvement in breastfeeding rates in most of them indicated the efficacy of the ten steps even in caesarean deliveries which, according to several studies, can negatively affect breastfeeding rates.

After the Command Hospital of the Southern Command in Maharashtra was certified as breastfeeding friendly, initiation of breastfeeding within an hour of birth went up from 65% to 99.7% of babies delivered through caesarean section and from 97.7% to 100% for babies delivered vaginally.

In Sitaram Bhartia Institute of Science and Research, the adoption of the ten steps, a requirement to be accredited as a breastfeeding friendly hospital, pushed up the proportion of babies breastfed within an hour of delivery by caesarean section rose from 40.7% to 75% and from 87.6% to 89.5% in the case of babies delivered vaginally.

Colostrum, the baby’s first meal, which is thick milk that is somewhat sticky and dark yellow in colour, is highly concentrated with nutrients and antibodies to fight infection and protect the baby. Hence it is considered important to initiate breastfeeding within an hour of birth. “Breastfeeding has immense short- and long-term health benefits for newborn babies and infants. Exclusive breastfeeding for the first six months of life significantly reduces the risk of infant mortality,” said Dr Arun Gupta of the non-profit Breastfeeding Protection Network of India (BPNI), which has launched a campaign to make hospitals breastfeeding friendly. He added that most certified hospitals managed to ensure that almost all babies delivered there were breastfed within the first hour of birth.

The ten steps include discussing the importance and management of breastfeeding with pregnant women and their families right from the antenatal period, having a written breastfeeding policy that is routinely communicated to staff and patients, ensuring that staff have sufficient knowledge, competence and skills to support breastfeeding, facilitating immediate and uninterrupted skin-to-skin contact and not giving breastfed newborns any food or fluids other than breast milk, unless medically indicated.

“A systematic review of 58 studies on maternity and newborn care published in 2016 demonstrated clearly that adherence to the Ten Steps impacts early initiation of breastfeeding immediately after birth, exclusive breastfeeding and total duration of breastfeeding,” according to the WHO.