Objective: The objective was to evaluate implementation of the WHO/UNICEF "Ten Steps to
Successful Breastfeeding" as defined by the Baby-Friendly Hospital Initiative in eight maternity
hospitals in the Moscow region. Four maternity hospitals had been certified Baby-
Friendly Hospitals (BFHs), the experimental group; and four maternity hospitals Not-as-Yet
Baby Friendly, the control group (NBFHs).
Methods: Maternal interviews and infant breastfeeding rates were the primary outcomes of
the study. In total, 741 healthy postpartum women from the experimental and control group
were interviewed: 383 and 358, respectively. Interviews were conducted over 5 months, from
May to July 2004. In addition, an assessment of levels and trends in breastfeeding for the period
of 1998 to 2003 was made for the area served by the BFHs and the NBFHs.
Findings: Analyses of the questionnaires completed by the mothers found a positive effect
of BFH practice on a number of parameters, such as an increased rate of in-hospital exclusive
breastfeeding, mothers’ decisions concerning planned duration of breastfeeding, mothers’ and
babies’ health, and maternal knowledge about the necessary measures in BFHs. Mothers appreciated
baby-friendly changes, such as rooming-in, breastfeeding on baby’s demand, and
taking care of their babies by themselves.
The successful initiation of breastfeeding in the BFHs was shown to favor the promotion
of breastfeeding among 1-year-old babies in the experimental areas. However, there were
some shortcomings in the BFHs: frequent use of labor anesthesia; insufficient placing of newborns
on the mother’s abdomen, rooming-in, and initiating breastfeeding immediately; and
a short length of "skin-to-skin" contact (<30 minutes). The women in BFHs also observed the
use of feeding bottles and dummies, and experienced some problems with breast health.
Conclusions: BFH practices can increase breastfeeding rates as well as maternal satisfaction.
However, shortcomings in the training and support for mothers, and limited help of the medical
personnel were noted. It is recommended that BFHs pay attention to maintaining adherence
to the criteria of the 10 steps of the Baby-Friendly Hospital Initiative. Since 2003 to control
the implementation of the Baby Friendly Initiative principles and sustain the progress in
the hospitals designated as Baby Friendly reassessment of maternity hospitals is held in Russia
in conformity with the requirements of WHO and UNICEF.
