Compliance with the Baby-friendly Hospital Initiative for neonatal wards (Neo-BFHI).

An international Self-Assessment survey of policies and practices to protect, promote and support breastfeeding in neonatal wards. Principal investigators: Ragnhild Maastrup, Denmark and Laura N. Haiek, Quebec, Canada.​

The survey is published as an open access article in journal of Maternal and Child Nutrition, and could be found at this link: Compliance with the "Baby-friendly Hospital Initiative for Neonatal wards" in 36 countries.

Article abstract:

In 2012, the Baby-friendly Hospital Initiative for Neonatal Wards (Neo-BFHI) began providing recommendations to improve breastfeeding support for preterm and ill infants. This cross-sectional survey aimed to measure compliance on a global level with the Neo-BFHI's expanded Ten steps to Successful Breastfeeding and three Guiding Principles in neonatal wards. In 2017 the Neo-BFHI Self-Assessment questionnaire was used in 15 languages to collect data from neonatal wards of all levels of care. Answers were summarized into compliance scores ranging from 0 to 100 at the ward, country and international levels. A total of 917 neonatal wards from 36 low, middle and high-income countries from all continents participated. The median international overall score was 77, and median country overall scores ranged from 52 to 91. Guiding Principle 1 (respect for mothers), Step 5 (breastfeeding initiation and support), and Step 6 (human milk use) had the highest scores, 100, 88, and 88, respectively. Steps 3 (antenatal information) and 7 (rooming-in) had the lowest scores, 63 and 67, respectively. High-income countries had significantly higher scores for Guiding principle 2 (family-centered care), Step 4 (skin-to-skin contact) and Step 5. Neonatal wards in hospitals ever-designated Baby-friendly had significantly higher scores than those never designated. Sixty percent of managers stated they would like to obtain Neo-BFHI designation. Currently, Neo-BFHI recommendations are partly implemented in many countries. The high number of participating wards indicates international readiness to expand Baby-friendly standards to neonatal settings. Hospitals and governments should increase their efforts to better support breastfeeding in neonatal wards.


A PowerPoint presentation of the results can be found here: Neo-BFHI survey 2018 presentation (PowerPoint).​

Contact information for the Neo-BFHI survey:

Ragnhild Maastrup, RN, PhD, IBCLC.
Knowledge Centre for Breastfeeding, Infants with Special Needs, Dept. of Neonatology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark

Laura N. Haiek, MD, MSc,
Medical consultant, Ministère de la Santé et des Services sociaux du Québec;
Assistant professor, Department of Family Medicine, McGill University; Member, St. Mary Hospital Research Center, Quebec, Canada   

Responsible editor