Background: WHO guidelines dealing with the Ten Steps to Successful Breastfeeding of Baby Friendly Hospital Initiative (BFHI) have been shown to improve breastfeeding outcomes and target hospitals. The Code is a minimum standard for regulation of marketing practices related to breastfeeding support.
Objectives: The aim of this evidence translation and implementation was to increase compliance with the Baby Friendly Hospital Initiative (BFHI) and the requirements of the International Code of Marketing of Breastmilk Substitutes (the Code).
Methods: WHO BFHI guideline was implemented using clinical audits/feedback and GRiP (Getting Research into Practice) framework. Firstly, we identified a group of stakeholders in one hospital in the Czech Republic. We carried out a baseline audit in January 2021. The clinical team and external breastfeeding experts discussed challenges and devised an implementation plan using the Getting Research into Practice framework. A follow-up audit was undertaken in 2021 and in May 2022.
Results: The Ten Steps of BFHI have never been implemented and compliance was very limited, as the Code was not being followed. The identified barriers included lack of knowledge and skills, heterogeneity in lactation counselling, low motivation, no infant feeding policy, antenatal services, and post-discharge services available. The follow-up audit showed improvements in Code compliance, in breastfeeding and infant feeding promotion and support, antenatal classes, and post-discharge services and follow-up. All neonatal staff were trained in breastfeeding. A Code compliant brochure was prepared and distributed. There was improvement across all audited criteria.
Conclusions: Breastfeeding support requires a sustained long-term effort before it becomes fully established. The involvement of national-level policy makers is needed. Patient, public, and/or healthcare consumer involvement: healthcare facility management, neonatal department leaders, and highly skilled external breastfeeding experts.