Scientific Article

Counselling instead of banning: the new WHO Baby-Friendly Hospital Initiative

Interview with Prof. Dr. Reinhold Kerbl

In an interview with MAM, the renowned paediatric Consultant Professor Dr Reinhold Kerbl, Head of the Department for Children and Adolescents at LKH Leoben (Austria), talked about the recently updated WHO guidelines on breastfeeding.

Why did the World Health Organisation (WHO) originally launch the Baby-Friendly Hospital Initiative?

Kerbl: The Baby-Friendly Hospital Initiative (BFHI) began in 1991. The aim of the BFHI was to encourage mothers to breastfeed their newborn babies and infants exclusively whenever possible – especially for the first six months. To achieve this aim, a number of measures were set down in writing. These included a "ban" on bottle-feeding and the use of pacifiers during the first six months of an infant's life. This was based on the belief that using either a bottle with a nipple or a pacifier could interfere with breastfeeding.

In April 2018 a revised version of the BFHI was published – what are the main new features of this WHO initiative?

Kerbl: In the new version, some of the "bans" have been withdrawn. So the revised BFHI still has reservations about babies' bottles and pacifiers, but no longer bans them on principle. Step 9 of the "Ten Steps to Successful Breastfeeding" has been changed to "Counsel mothers on the use and risks of feeding bottles, teats and pacifiers", instead of, previously, "Give no artificial teats or pacifiers to breastfeeding infants".

Why is the use of pacifiers and bottles no longer "banned" in the revised BFHI?

Kerbl: In recent years a number of studies have been published which were unable to find any demonstrable detrimental effect on breastfeeding caused by the use of pacifiers and bottles.1 So there is no longer any evidence to support such a "ban". With premature babies, in fact, there was even a positive correlation between using a pacifier and being discharged from hospital earlier.2 It should also be noted that pacifiers are recommended as a way to decrease risk of Sudden Infant Death Syndrome.

The "Ten Steps to Successful Breastfeeding" in the BFHI have also been revised – what are the main changes?

Kerbl: Above all, the "Ten Steps to Successful Breastfeeding" now focus more on the individual "skills" of lactation consultants. Staff must be trained to ensure they have knowledge and skills to support breastfeeding as well as the ability to consider parent’s needs. This is regarded as more important than acting strictly in accordance with a particular training curriculum, because it leaves the healthcare professionals more options for carrying out their work successfully.

What do you think of the revised BFHI guidelines?

Kerbl: This new version makes some sensible changes to the guidelines. Now, points of view which were previously promoted in an almost "militant" manner have been put into perspective based on evidence. "Counseling instead of banning" also takes account of the possible needs of newborns and infants. This may include medical needs, for example if the mother's milk supply is insufficient. It also pays far more attention to young parents' ability to make decisions as individuals. In the revised version of the BFHI, the most important objective is still to achieve the highest possible rate of breastfeeding and using mother's milk. That is the objective that should be implemented across the board. According to the WHO, universal breastfeeding in the first two years of life could save over 800,000 lives a year worldwide.2

Prof. Dr. Reinhold Kerbl

Pediatrician
Prof. Dr Reinhold Kerbl is Head of the Department of Children and Adolescents at Leoben State Hospital (LKH) in Styria, Austria, and one of the leading paediatric experts in the German-speaking world. Prof. Kerbl has won several awards for his work.

1Jaafar, S. H., Ho, J. J., Jahanfar, S., & Angolkar, M. (2016). Effect of restricted pacifier use in breastfeeding term infants for increasing duration of breastfeeding. The Cochrane Library.