Baby-friendly hospitals in Turkey: evaluation of adherence to the Ten Steps to Successful Breastfeeding

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Caylan N., Kilic M., YALÇIN S. S. , Tezel B., Kara F.

EASTERN MEDITERRANEAN HEALTH JOURNAL, vol.28, no.5, pp.352-361, 2022 (SCI-Expanded) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 28 Issue: 5
  • Publication Date: 2022
  • Doi Number: 10.26719/emhj.22.021
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Social Sciences Citation Index (SSCI), Scopus, BIOSIS, CAB Abstracts, Child Development & Adolescent Studies, CINAHL, EMBASE, Index Islamicus, MEDLINE, Veterinary Science Database
  • Page Numbers: pp.352-361
  • Keywords: Baby-Friendly Hospital Initiative, Ten Steps to Successful Breastfeeding, International Code of Marketing of Breastmilk Substitutes, adherence rate, Turkey, reassessment, HEALTH OUTCOMES, DELIVERY, IMPROVE, IMPACT, RATES
  • Hacettepe University Affiliated: Yes


Background: The Baby-Friendly Hospital Initiative (BFHI) is a World Health Organization and United Nations Children's Fund joint global programme to protect, promote and support breastfeeding. Sustainability of the BFHI standards is important for health facilities and country-level implementation. Aims: To analyse the 2018-2019 external reassessment results of baby-friendly hospitals (BFHs) in Turkey. Methods: We included 414 BFHs. The Ten Steps to Successful Breastfeeding were divided into 2 groups: critical management procedures (Steps 1 and 2) and key clinical practices (Steps 3-10). Results: All 10 steps were fulfilled by 60.1% of the hospitals. Steps 3 and 2 had the lowest compliance rates (81.6% and 85.7%), and Steps 7 and 8 had the highest rates (97.1% and 98.1%). Caesarean section rates in the fourth quartile were associated with significantly lower adherence to Steps 3 and 10. The presence of another external reassessment within 5 years was associated with a significantly higher adherence rate to Step 3, and a significantly higher full implementation rate for the clinical practices. Hospitals that fully implemented management procedures had a significantly higher fulfilment percentage for all clinical practices. The western region had higher adherence rates for all the clinical practices than other regions. Conclusion: Reassessments seem useful for sustainability. Full compliance with Steps 1 and 2 is important for higher adherence to the clinical steps. Regional variations should be taken into account in the implementation of the programme.