A cross-sectional study of newborn feeding practices and support at healthcare facilities in Gauteng

Abstract

Background: Although breastfeeding is a key child survival strategy, breastfeeding practices in South African health institutions can generally be categorised as being poor. The global Baby-Friendly Hospital Initiative (BFHI), led by UNICEF and the WHO, aims to create a health care environment that promotes breastfeeding as the norm. This study aimed to document practices around breastfeeding support and compliance with the BFHI’s “10 steps to successful breastfeeding” in both baby-friendly accredited and non-accredited facilities. Methods: This was a cross-sectional study, conducted in nine facilities in Gauteng, including tertiary, secondary and districts hospitals, and midwife obstetric units. Convenience sampling was used. Study questionnaires were based on the generic BFHI assessment tool, but were modified to include more detailed investigation of HIV related factors. The questionnaire was verbally administered on-site to 165 mothers of well infants, and 65 nursing staff. Results: Suboptimal practices were identified in both baby-friendly and non-baby-friendly accredited facilities, but more so in the latter. None of the facilities passed all of the 10 BFHI steps. None of the baby-friendly certified institutions achieved a score sufficient to be still deemed baby-friendly. Steps that required advice and support from nursing staff, viz. step 5 (showing mothers how to breastfeed), step 8 (encouraging breastfeeding on demand), and step 10 (breastfeeding support after discharge from the facility), were particularly poorly done in the majority of facilities. Baby-friendly certified institutions were significantly better than non-accredited facilities for steps 2 (training), 4 (initiating breastfeeding within 1 hour), and 7 (rooming-in). Conclusion: Although baby-friendly accredited facilities generally performed better than non-accredited facilities, their performance failed to justify maintenance of their accredited status based on this assessment. However, some positive practices were sustained over time. There is a dire need for greater attention to be directed to the promotion of good breastfeeding practices by health professionals and institutions.