Breastfeeding policies and practices in healthcare facilities in the Western Cape Province, South Africa

The Baby-Friendly Hospital Initiative is a global effort to improve the role of maternity services and enable mothers to breastfeed infants, ensuring the best start in life. The foundation for the BFHI is the Ten Steps to Successful Breastfeeding (BF). It has been shown that selective implementation of only some of the steps may be ineffective and discouraging to successful BF practices. An initial study was conducted to assess the extent of implementation of the Ten Steps in both public and private maternity facilities. The poor performance for some steps led to a follow-up study to investigate the knowledge and attitudes of healthcare workers (HCW) and mothers and to evaluate exclusive BF practices in private BF clinics. Both studies followed descriptive, cross-sectional designs, set in the Cape Metropole, Western Cape. Twenty-six maternity facilities participated in the initial study, for which observation lists were completed and verified by interviewer-administered questionnaires to mothers and HCW. Eighteen private BF clinics participated in the follow-up study and included observations and interviewer-administered questionnaires to 64 mothers and 25 HCW. During the initial study, lower mean scores were noted for Steps 1, 2, 6 and 10 and overall the implementation of the Ten Steps was average. The findings highlight the importance of the establishment and implementation of BF policies, appropriate and continuous BF training and better referral systems to ensure initiation and establishment of early BF, exclusive BF practices and support on an ongoing basis to ensure that infants get the best start in life.