Impact of baby-friendly hospital initiatives on breastfeeding outcomes: Systematic review and meta-analysis

Abstract

Background: The Baby-Friendly Hospital Initiative (BFHI) is a global effort promoting the Ten Steps to support breastfeeding in maternity-care facilities. Aim: This study examined the effect of BFHI on breastfeeding outcomes, focusing on initiation rates, exclusive breastfeeding durations, and factors influencing its effectiveness. Methods: A systematic review and meta-analysis were conducted by searching nine databases (1991 to February 2024). Included studies were experimental, quasi-experimental, or observational studies, with sites implementing the full BFHI or at least three steps. Two reviewers independently screened studies, assessed risk of bias, and extracted data. Random-effects models were used for pooled results, with subgroup analyses based on BFHI status and country income level. Discussion: Eighty-six studies were included. Infants in BFHI hospitals were more likely to be exclusively breastfed at ≤ 3 months (OR= 1.77; 95 % CI: 1.37–2.29) and 3–6 months (OR= 1.82; 95 % CI: 1.26–2.61). Higher rates of any breastfeeding were observed at ≤ 3 months (OR= 1.48; 95 % CI: 1.17–1.87), 3–6 months (OR= 1.75; 95 % CI: 1.18–2.61) and at > 6 months (OR= 2.34; 95 % CI: 1.04–5.27). Conclusions: BFHI implementation positively impacts breastfeeding outcomes, with both short- and long-term effects. Partial implementation also correlates with higher exclusive breastfeeding rates. Insignificant differences across income levels may reflect the limited number of studies in low-and middle- income countries. Further research with longer-term follow up is needed to confirm long-term effects.