Compliance with Baby-Friendly Policies and Practices in Hospitals and Community Health Centers in Quebec

Abstract

Background:

Since 2001, Quebec’s ministry of health and social services has prioritized implementation of the Baby-Friendly Initiative (BFI), which includes the original hospital initiative and its expansion to community services.

Objective:

The objective was to document across the province compliance with the BFI’s Ten Steps to Successful Breastfeeding in hospitals, Seven Point Plan in community health centers (CHCs), and International Code of Marketing of Breast-Milk Substitutes (Code).

Methods:

Using managers/staff, mothers, and observers, the author measured the extent of implementation of indicators formulated for each step/point and the Code, based on the revised WHO/UNICEF recommendations.

Results:

Mean compliance scores in Quebec were 3.13 for 140 CHCs (range, 0 to 7) and 4.54 for 60 hospitals/birthing centers (range, 0 to 10). The mean compliance score for the Code was 0.69 for both CHCs and hospitals/birthing centers. The evaluation documented marked variations in implementation level for each of the steps/points and the Code. Also, managers/staff, mothers, and observers differed in their report of BFI compliance for most steps/points and the Code. Facilities that had applied for or obtained BFI designation demonstrated higher compliance with the BFI than those that had not.

Conclusions:

Results disseminated to participating organizations allowed comparisons on a regional/provincial perspective and in relation to BFI-designated facilities. Furthermore, this first portrait of BFI compliance in Quebec provided provincial, regional, and local health authorities with valuable information that can be used to bring about policy and organizational changes to achieve the international standards required for Baby-Friendly certification.