The Baby-friendly Hospital Initiative and Qatar, 2016

Abstract

Breastfeeding instills countless benefits that extend beyond the infant and child to the entire nation. One of the global targets set by the WHO to improve maternal, infant, and young child nutrition is to increase the rate of exclusive breast-feeding “in the first 6 months” up to at least 50% by 2025.³ Thus, as a global endeavor to promote and sustain breastfeeding, the WHO and UNICEF launched the Baby-friendly Hospital Initiative (BFHI) 1 year after the Innocenti Declaration of 1990. Regarding the State of Qatar, there was a 34% rate of early initiation of breastfeeding “within the first hour of birth” and a 29% rate of exclusive breastfeeding between 2010 and 2015. In Qatar during 2016, many obstacles in achieving the aforementioned global target remained. In addition, there are still no hospitals with a BFHI accreditation.

Breastfeeding instills countless benefits that extend beyond the infant and child to the entire nation. For the infant, benefits include but are not limited to supply of their total nutritional requirements, protecting them against malnutrition, and preventing respiratory and gastrointestinal illnesses. In addition, breastfeeding protects against Sudden infant death syndrome, diabetes, hypertension, dyslipidemia, and certain cancers later in life. Mothers benefit from breastfeeding as well, as breastfeeding women have lower rates of breast and ovarian cancers, type II diabetes, and postpartum depression. At the national level, there is reduced use of resources to acquire infant formula and hospital utilities needed to treat the resulting diseases and infections. That is especially important in regions where water supplies are not safe and impoverished persons cannot afford infant formula.1, 2

One of the global targets set by the WHO to improve maternal, infant, and young child nutrition is to increase the rate of exclusive breast-feeding “in the first 6 months” up to at least 50% by 2025.³ According to the 2015 World Health Statistics, 40% of infants in the Eastern Mediterranean Region received exclusive breastfeeding during the first six months. During the same year, the Middle East and North Africa Area had a 35% rate of early initiation “within the first hour of birth” of breastfeeding and a 40% rate of exclusive breastfeeding.⁴ Between 2010 and 2015, there was a 34% rate of early initiation of breastfeeding and a 29% rate of exclusive breastfeeding in Qatar according to the Infant, Youth, and Child Feeding (IYCF) database.⁵

A study conducted by Al-Kohji et al. found a 57% rate of early initiation of breastfeeding, 18.9% rate of exclusive breastfeeding under 6 months, and a 49.9% rate of continued breastfeeding at one year among Arab mothers attending primary health care centers in Qatar. Furthermore, the study revealed that 97.9% of children were ever breastfed, the rate of continued breastfeeding at 2 years old was 45.4%, and the rate of predominant breastfeeding during infancy was 11.9%. The proportion of children who were appropriately breastfed was 29%. The rate of “newborns kept in the mother's hospital room instead of a nursery” was 43.9%.⁶

Furthermore, a study by Sidra Medical and Research Centre concluded that many mothers in Qatar discontinue breastfeeding after 40 days or three months because of lack of information and access to professional lactation support. Another finding was that traditional practices involving feeding the newborn sugar water or anise water have a great pull over many new and young mothers. Many participants mentioned that breastfeeding for a long period is troublesome because of the relatively tight maternity leave offered (two months).⁷ Similarly, Qatar's labor law grants women up to 15 days of paid leave prior to delivery, and 35 days of paid leave following birth, provided that the employee has worked at an organization for a full year. New mothers are given at least 1 h of each working day for “nursing time” during the first year of the baby's life.⁸

As a global endeavor to promote and sustain breastfeeding, the WHO and UNICEF launched the Baby-friendly Hospital Initiative (BFHI) in 1991, one year after the Innocenti Declaration.⁹ Furthermore, these practices were later designated as the “Ten Steps to Successful Breastfeeding,” including Promotion (Steps 1 and 3) of optimal feeding, Support (Steps 2, 4, 5, 8, 9, and 10) for practices of optimal infant feeding, and Protection (Steps 6 and 9) from destructive practices. Since its launch, the BFHI has diffused globally, with more than 20,000 hospitals in 152 countries receiving “baby-friendly” accreditation.¹⁰ To become accredited, health facilities must demonstrate a 75% exclusive breastfeeding rate among mothers on discharge, adhere to the “International Code of Marketing Breast-milk Substitutes,” and implement the “Ten Steps to Successful Breastfeeding.”¹¹ Accredited hospitals can become a referral center as well as, in some countries, benefiting from financial incentives for obstetric procedures.¹²

In Qatar during 2016, many obstacles in achieving the aforementioned global target remained. In addition, there are still no hospitals with a BFHI accreditation. Given the short and long-term benefits of breastfeeding to the infant, mother, and society, implementing BFHI – alongside the other objectives stated in the Global Strategy for Infant and Young Child Feeding – continues to have an important role to play in health services worldwide.¹⁰

Authors' contributions

All the authors contributed equally to the conception and designing of the study. All authors participated in the implementation process and finalization of the manuscript. All authors have critically reviewed and approved the final draft and are responsible for the content and similarity index of the manuscript.

Conflict of interest

The authors have no conflict of interest to declare.