If improving breastfeeding rates is the purpose of BFHI, then why is the key document an “infant feeding” policy rather than a breastfeeding policy? Interestingly, in some of the BFHI documentation from the WHO, breastfeeding policy and infant feeding policies are used interchangeably - each term popping up 8 times in the 2018 implementation guidance, for example.
In various forums, I have heard criticisms of the term “infant feeding policy” over the years. One criticism is that “infant feeding” creates an excessive focus on the “feeding” and nutrition aspect rather than the relationship and other health impacts of breastfeeding or not. Another is that it suggests hesitancy to recognize breastfeeding as the normal care that an infant should receive or a reluctance to say even the word “breast”. This thinking suggests that rather than normalize breastfeeding, we have instead replaced it with a term that’s more acceptable.
While I recognize that we have a long way to go in many places to reach the point where breastfeeding is the norm and that we must remain vigilant about creating inaccurate equivalences and “choices”, I ultimately believe that infant feeding is a useful concept that is appropriate for a policy that lays out the clinical and institutional practices involved in the Baby-Friendly Initiative.
As I touched on in a prior post, how “breastfeeding” is defined is both critical and very challenging to find consensus on. When a policy is titled “breastfeeding”, the common impression is that it is intended to support the suckling of an infant at their own mother’s breast. While some will argue that breastfeeding includes feeding at the chest, feeding of expressed milk and feeding of human milk substitutes at the breast or chest, these are each unique experiences for both the infant and their family, as well as for the team supporting them.
Infant feeding remains an imperfect term to capture the experiences and concepts involved in BFHI - yet, it is a useful one. We are working towards improving health outcomes, not breastfeeding rates and reaching the “highest attainable standard of health” for all is ultimately the goal.
World Health Organization. (2018). Protecting, promoting, and supporting breastfeeding in facilities providing maternity and newborn services: the revised Baby-friendly Hospital Initiative 2018 - Implementation guidance. Accessed April 7, 2021 at https://www.who.int/nutrition/publications/infantfeeding/bfhi-implementation/en/
World Health Organization. (2017). Human rights and health. Accessed April 7, 2021 at https://www.who.int/news-room/fact-sheets/detail/human-rights-and-health
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