Dear Jeremy Hunt,
La Leche League Great Britain is writing to provide feedback on changes to the Global Baby-Friendly Hospital Initiative (BFHI) proposed by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF). We are an Affiliate of La Leche League International, which is a core partner of the World Alliance for Breastfeeding Action (WABA).
We are heartened that WHO and UNICEF have listened to previous feedback from stakeholders and made some modification to the original proposals. However, many critical issues remain unaddressed. We are deeply concerned that, if adopted, the current draft proposals would undermine BFHI and jeopardise its effectiveness.
Mr Hunt, as the UK Chief Delegate at the World Health Assembly, we urge you to support the continued delay of publication of the proposed Operational Guidance, so there is sufficient time for additional discussions and to introduce further improvements.
We would like to add our support to the following points raised by WABA, which we believe are critical to achieve a robust, revitalised BFHI.
1) Retain global guidelines and criteria, streamlined monitoring tools, streamlined assessment tools, and scoring systems, as these are the foundation of the BFHI.
2) Retain standardized model training courses, which can be used or adapted globally.
3) Continue accreditation based on external assessment, inclusive of mother interviews, and conducted by knowledgeable individuals, as part of the process.
4) Welcome the indication by WHO and UNICEF that they will maintain the metrics hospitals must achieve at the current 80% standard.
5) Welcome that the Code and internal monitoring is proposed to be incorporated into Step 1 on infant feeding policies.
6) Advocate for revised language for the re-introduced Step 9, to clarify facility responsibility for minimising the use of bottles, teats and pacifiers. Include language about risks, and the advisability of using only when medically necessary or parents are appropriately educated.
7) Continue safe and respectful birth practices as a component of the BFHI.
8) Use empowering language throughout the Operational Guidance document.
9) Keep the BFHI about healthy term infants. Adopt a separate set of standards pertaining to breastfeeding support for preterm and sick infants, such as the NEO BFHI Baby-Friendly Hospital Initiative for Neonatal Wardswhich was initially developed by the Nordic-Quebec Working Group.
10) Include a discussion of the ethical issues related to doing randomized trials on infant and young child feeding including those specific to breastfeeding.
Incorporate a robust discussion regarding the interrelationship between each of the 10 Steps and how they work together as a comprehensive breastfeeding support program.
Council of Directors, LLLGB
La Leche League Great Britain (an affiliate of LLLI) is a company limited by guarantee registered in England Number 01566925. Registered Office: 129a Middleton Boulevard, Wollaton Park, Nottingham, NG8 1FW. Registered Charity Number 283771