Implementation of the ‘10 Steps for Successful Breastfeeding' across maternity clinics in Cyprus

Abstract

Background.Even though the effectiveness of the Baby-Friendly Hospital Initiative's (BFHI) ‘10 steps' for successful breastfeeding has been widely documented, more than two decades later there is still concern that implementation is fragmented. To date, no hospital in Cyprus has the BFHI title and there is only anecdotal evidence with regards to the implementation of the 10 steps.Methods.The degree of implementation of the ‘10 steps' as well as the International Code of Marketing of Breast-milk Substitutes (ICMBS) across all public maternity wards (N = 5) and 29 (of 35) private clinics in Cyprus was assessed based on the responses of a consecutive sample of 568 mothers (response 70.8%) during the study period using the 24 multiple choice WHO/UNICEF BFHI self-assessment questionnaire.Results.There appears to be relatively good adherence to the ICMBS across Cypriot maternity units with 80.9% and 74.4% in public and private clinics respectively reporting not been given leaflets or supplies. A higher degree of implementation was observed with regards to assistance in breastfeeding skills development (step 5) along with encouragement of breastfeeding on demand (step 8). However, only 26.9% of mothers experienced skin-to-skin contact (step 4) while rooming-in (step 7) was more widely practiced in the public sector (60%) compared to the private sector (20%). The lowest implementation was observed with regards to step 9, which refers to the use of pacifiers and bottles.Conclusion.It is not surprising that initiation and continuation of exclusive breastfeeding are particularly low since based on mothers' assessment there appears to be a significant gap in the implementation of the 10 Steps for Successful Breastfeeding practices across Cypriot maternity clinics. This highlights the need for a national breastfeeding strategy including health professional educational interventions as well as nationwide awareness and civic engagement campaigns.