title: The Baby-Friendly Hospital Initiative as an Intervention to Improve Breastfeeding Rates: A Review of the Literature.
abstract: BACKGROUND
  The Baby-Friendly Hospital Initiative (BFHI) is considered to be an evidence-based program that improves breastfeeding outcomes, but primary research on the topic has been limited. The purpose of this review was to evaluate the literature and synthesize findings to determine the effectiveness of the BFHI as an intervention to improve breastfeeding initiation, duration, and exclusivity.
  
  
  METHODS
  A review of literature published from 1991 to October 2014 using MEDLINE, CINAHL, PsycINFO, and Web of Knowledge with the search term "Baby-Friendly Hospital Initiative." The 724 titles initially identified were reviewed using these inclusion criteria: English language, primary research, and available electronically or via interlibrary loan. Studies were excluded if they explicitly stated that they had omitted specific portions of the BFHI or did not fully implement the intervention; considered breastfeeding rather than the BFHI as an intervention; used the BFHI to improve neonatal intensive care unit outcomes specifically; or measured outcomes other than breastfeeding initiation, duration, or exclusivity. This yielded 25 studies for review.
  
  
  RESULTS
  There are more studies that support the BFHI as an intervention to increase breastfeeding than there are studies that demonstrate no effect of the intervention. However, design weaknesses, settings outside the United States, and disparate methods impede the ability to reach firm conclusions regarding the effectiveness of the BFHI in improving breastfeeding initiation, duration, and exclusivity rates in the United States.
  
  
  CONCLUSIONS
  Many of the studies regarding the effectiveness of the BFHI have been hampered by weak designs or methodologic limitations. Research conducted in the United States and employing experimental designs would help to more conclusively determine the effectiveness of the BFHI as an intervention to improve breastfeeding rates.
authors.forename: Abigail
authors.initials: A
authors.lastname: Howe-Heyman
authors.forename: Melanie
authors.initials: M
authors.lastname: Lutenbacher
mesh_terms: D001942:Breast Feeding; D005260:Female; D006293:Health Promotion / Q000379:methods*; D006761:Hospitals; D006801:Humans; D007231:Infant, Newborn; D015397:Program Evaluation; D014481:United States
keywords: Baby-Friendly Hospital Initiative; breastfeeding duration; breastfeeding exclusivity; breastfeeding initiation