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Publication Date

February 29, 2016


Journal Article

Impact of the Baby-friendly Hospital Initiative on Breastfeeding and Child Health Outcomes: A Systematic Review

By Perez-Escamilla R, Martinez J, Segura-Perez S


The Baby-friendly Hospital Initiative (BFHI) is a key component of the World Health Organization/United Nations Children’s Fund Global Strategy for Infant and Young Child Feeding. The primary aim of this narrative systematic review was to examine the impact of BFHI implementation on breastfeeding and child health outcomes worldwide and in the United States. Experimental, quasi-experimental and observational studies were considered eligible for this review if they assessed breastfeeding outcomes and/or infant health outcomes for healthy, term infants born in a hospital or birthing center with full or partial implementation of BFHI steps. Of the 58 reports included in the systematic review, nine of them were published based on three randomized controlled trials, 19 followed quasi-experimental designs, 11 were prospective and 19 were cross-sectional or retrospective. Studies were conducted in 19 different countries located in South America, North America, Western Europe, Eastern Europe, South Asia, Eurasia and Sub-Saharan Africa. Adherence to the BFHI Ten Steps has a positive impact on short-term, medium-term and long-term breastfeeding (BF) outcomes. There is a dose–response relationship between the number of BFHI steps women are exposed to and the likelihood of improved BF outcomes (early BF initiation, exclusive breastfeeding (EBF) at hospital discharge, any BF and EBF duration). Community support (step 10) appears to be essential for sustaining breastfeeding impacts of BFHI in the longer term.

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Date Added
November 15, 2017

Pérez-Escamilla R, Martinez J, Segura-Perez S (2016) 'Impact of the Baby-friendly Hospital Initiative on Breastfeeding and Child Health Outcomes: A Systematic Review'. Journal of Maternal and Child Nutrition: Vol. 12, Issue 3, pp. 402-417. Available online: http://onlinelibrary.wiley.com/doi/10.1111/mcn.12294/full?wol1URL=/doi/10.1111/mcn.12294/full®ionCode=US-GA&identityKey=ea266257-b24c-4dc9-acd6-e0f0991d25f2