title: The baby-friendly hospital initiative in Switzerland: trends over a 9-year period.
abstract: BACKGROUND
  This article reports the trends over a 9-year period for 4 steps of the Baby-Friendly Hospital Initiative (BFHI) (exclusive breastfeeding, uninterrupted rooming-in, no use of pacifiers, and initiation of breastfeeding within the first 2 hours after birth) during hospital stays in Switzerland.
  
  
  METHODS
  Data were collected annually over a period of 9 years from a monitoring survey of all BFHI-accredited hospitals in Switzerland (between 41 and 65 hospitals). The number of participants included in the study per year ranged between 15 627 and 31 141 healthy mother-newborn pairs.
  
  
  RESULTS
  Significant improvements were found for 3 of the 4 steps of the BFHI between 2000 and 2008: rates of exclusive breastfeeding during postpartum stay (35.9%-57.6%, P < .001), uninterrupted rooming-in (48.2%-73.1%, P < .001), and no use of pacifiers (33.6%-48.1%, P < .001). Initiation of breastfeeding within the first 2 hours after birth was always > 90% and did not change significantly over the 9 years. Exclusive breastfeeding during hospital stay was significantly related to no use of pacifiers (P < .001) and to uninterrupted rooming-in (P < .001) in the years when exclusive breastfeeding particularly increased (2003, 2004, and 2008).
  
  
  CONCLUSIONS
  Rates of exclusive breastfeeding during hospital stay and uninterrupted rooming-in increased significantly over the 9 years. Continued promotion of the BFHI may be needed to maintain or further improve the breastfeeding rates and to find ways to deal with difficulties that hospitals face when applying the 10 steps of the BFHI.
authors.affiliation: 1Swiss Tropical and Public Health Institute, Basel, Switzerland.
authors.forename: Christine
authors.initials: C
authors.lastname: Forrester-Knauss
authors.forename: Sonja
authors.initials: S
authors.lastname: Merten
authors.forename: Carine
authors.initials: C
authors.lastname: Weiss
authors.forename: Ursula
authors.initials: U
authors.lastname: Ackermann-Liebrich
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Zemp Stutz
mesh_terms: D000328:Adult; D001942:Breast Feeding / Q000706:statistics & numerical data*; D036861:Delivery, Obstetric / Q000379:methods; D005260:Female; D019983:Guideline Adherence; D006293:Health Promotion / Q000458:organization & administration*; D006739:Hospital Administration; D006801:Humans; D007231:Infant, Newborn; D041361:Pacifiers / Q000706:statistics & numerical data; D010298:Parity; D017410:Practice Guidelines as Topic; D015397:Program Evaluation; D013557:Switzerland
keywords: Baby-Friendly Hospital Initiative; breastfeeding; exclusive breastfeeding; initiation of breastfeeding; monitoring; pacifier use; trends; uninterrupted rooming-in