• Irena Zakarija-Grkovic, Olga Šegvić, Toni Bozinovic, Anamarija Ćuže, Toni Lozancic, Ana Vuckovic, and Tea Burmaz.
• University Hospital Split School of Medicine, Split, Croatia. irena.zakarija-grkovic@mefst.hr
• J Hum Lact. 2012 Aug 1; 28 (3): 389-99.

BackgroundThe Baby-Friendly Hospital Initiative (BFHI) is the most widely promoted program for increasing breastfeeding rates.ObjectiveTo evaluate the impact of BFHI training on hospital practices and breastfeeding rates during the first 12 months of life.MethodsEighty percent of maternity medical and nursing staff at the University Hospital in Split, Croatia, completed the updated and expanded United Nations Children's Fund/World Health Organization 20-hour course. Seven hundred seventy-three mothers (388 in the pre- and 385 in the post-training group) were included in a birth cohort and interviewed at discharge and at 3, 6, and 12 months postpartum to evaluate hospital practices and infant feeding. Six out of 10 Baby-Friendly practices were assessed using standard BFHI forms.ResultsThree months after training was completed, 3 of the Baby-Friendly practices assessed (Step 4, "Initiate breastfeeding within a half-hour of birth"; Step 7, "Rooming-in"; and Step 8, "Feeding on demand") had significantly improved. The proportion of newborns exclusively breastfed during the first 48 hours increased from 6.0% to 11.7% (P < .005). There was no difference in breastfeeding rates at discharge or at 3, 6, or 12 months between the pre- and post-training groups.ConclusionTraining of health professionals, based on the BFHI, was associated with significant improvement in some Baby-Friendly hospital practices and initial exclusive breastfeeding rates. A high rate of in-hospital supplementation may partly explain the lack of improvement in breastfeeding exclusivity and duration after discharge. Strong institutional support and commitment is needed to enable full implementation of recommended Baby-Friendly practices.

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