The impact of the UK Baby Friendly Initiative on maternal and infant health outcomes: A mixed methods systematic review.

Global evidence demonstrates that adherence to the Baby Friendly Initiative (BFI) has a positive impact on multiple child health outcomes, including breastfeeding initiation and duration up to one year postpartum. However, it is currently unclear whether these findings extend to specific countries with resource rich environments. This mixed methods systematic review aims to a) examine the impact of BFI implementation (hospital and community) on maternal and infant health outcomes in the UK, and b) explore the experiences and views of women receiving BFI-compliant care in the UK. Two authors independently extracted data including study design, participants, and results. There is no UK data available relating to wider maternal or infant health outcomes. Three quantitative studies indicate that Baby Friendly Hospital Initiative (BFHI) implementation has a positive impact on breastfeeding outcomes up to one week postpartum but this is not sustained. There was also some evidence for the positive impact of individual steps of Baby Friendly Community Initiative (BFCI) (n=3) on breastfeeding up to eight weeks postpartum. Future work is needed to confirm whether BFI (hospital and community) is effective in supporting longer-term breastfeeding and wider maternal and infant health outcomes in the UK. A meta-synthesis of five qualitative studies found that support from health professionals is highly influential to women's experiences of BFI-compliant care, but current delivery of BFI may promote unrealistic expectations of breastfeeding, not meet women's individual needs, and foster negative emotional experiences. These findings reinforce conclusions that the current approach to BFI needs to be situationally modified in resource rich settings.