Satisfaction with code implementation and Baby-friendly practices in the Eastern Mediterranean region: Health professional perspectives from 15 countries

Abstract

Background: The revised ten steps of the baby-friendly hospital initiative (BFHI) in 2018 require breastfeeding protection through the implementation of the International Code of Marketing of breast-milk substitutes (The Code). Aim: The aim of the study was to assess the satisfaction of staff with the implementation of the global criteria of the revised “Ten steps” of BFHI in 15 Eastern Mediterranean region (EMR) countries. Methodology: Professionals representing Member States who registered to an EMR-WHO webinar meeting on monitoring BFHI were involved in giving feedback about the extent to which their workplace abides by the global criteria, Ten Steps including the Code. Feedback was also obtained about the status of adherence to the global criteria of steps 2, 3, 4, 5 6, and 9 using a rating scale (1–10). Countries were grouped into two groups: High income (HIC) and middle and low income (MIC and LIC). The results were statistically analyzed by country groups and by workplaces. Findings: 109 participants representing 15 countries responded. The respondents from HIC gave significantly higher satisfaction scores than MIC and LIC in relation to global criteria for the Code and steps 2, 3, 4, 5, 6, and 9 of the BFHI p<0.05. There were significant correlations between all of the BFHI global criteria of the Code with staff training and competency skills, and some of the clinical practices included within the revised Ten Steps p<0.05 from hospitals but not in the community. There were also significant differences between public and private hospitals in code, 1st h skin-to-skin contact (step 4), and counseling on risks of bottles and pacifiers (step 9). Conclusions: In the EMR implementation of the revised Ten Steps of BFHI particularly the Code, Step 4 and Step 9 need strengthening through monitoring, using the updated indicators, and competency training modules devised by the WHO and UNICEF in 2020.