One of the actions to be carried out in Spain within JAPreventNCD is mentoring in the joint accreditation process of 16 healthcare centers in the Castelló Department of Health, following the program of the Initiative for their designation by the Iniciativa para la Humanización de la asistencia al Nacimiento y la Lactancia (IHAN) initiative, an action framework promoted by the World Health Organization (WHO) and UNICEF.
It is proven that breastfeeding generates significant health benefits for both the breastfed baby and the breastfeeding mother. In the short term, it significantly reduces the risk of sudden death, infectious diseases (bronchiolitis, otitis, gastroenteritis, etc.) and necrotizing enterocolitis in newborns and infants. In the long term, it also reduces the risk of allergic or autoimmune diseases, obesity, hypertension, and hyperlipidemia (and thus cardiovascular risk in adults), and has a positive effect on cognitive development. Mothers also have a lower risk of breast cancer, diabetes, and postpartum depression. In addition, there are other recognized benefits for the family and social environment: increased family savings, reduced healthcare costs, on demand availability, zero impact on the environment, among others.
It has also been proven that one of the most efficient mechanisms for successfully promoting breastfeeding is for healthcare centers (maternity wards, neonatal units, or health centers) to join the IHAN designation program.
This initiative is part of the international Baby Friendly Hospital Initiative launched by the World Health Organization (WHO) and UNICEF in 1991. IHAN accreditation, an internationally recognized indicator of quality care, is granted to healthcare centers that comply with the “10 steps to successful breastfeeding” for hospitals and 7 steps for health centers.
Among other conditions, professionals at the center must receive training that enables them to provide adequate breastfeeding care. Information is provided to pregnant women on the benefits of breastfeeding and how to do it, and mothers are helped to start and maintain breastfeeding. The center must also comply with all the provisions of the WHO International Code of Marketing of Breast-milk Substitutes (such as not giving out samples or advertising infant feeding products).
The accreditation strategy is divided into four phases (4D: Discovery, Development, Dissemination, and Designation), which allows for setting short-term goals and better planning from an administrative and management standpoint.
Over the next two years, we will accompany and advise our colleagues at these 16 centers on the path to IHAN accreditation in order to:
- Compose all documents: the center's infant feeding policy, adherence to the Code of Marketing of Breast-milk Substitutes, informational documents for pregnant women and mothers, educational materials, etc.
- Implement all protocols: coordination with the referral maternity ward, care and information for pregnant women, and protocols for caring for mothers and babies on their first and subsequent visits.
- Proceed with the training and education program for professionals.
- Conduct surveys of mothers of young children to track the evolution of breastfeeding indicators.
- Make the necessary changes to create a receptive and welcoming atmosphere for breastfeeding, in accordance with the International Code of Marketing of Breast-milk Substitutes.
- Implement breastfeeding workshops in accordance with IHAN recommendations and in collaboration with community breastfeeding support groups.
The fact that it is a joint designation means that the centers share all the documentation produced by consensus, as well as the training plan, and conduct simultaneous surveys for breastfeeding indicators, which facilitates the work and reduces costs.
As tutors of this program, we build on the previous experience that this accreditation process has brought to our health centers. In addition to noticing an improvement in breastfeeding rates, we have also observed other benefits that may be more difficult to measure, but are no less real. Frequent and intense teamwork has been necessary, which has had a very positive effect on the relationship between professionals and between them and the community (authorities, support groups, etc.).
Despite some initial reluctance, training courses for professionals are generally generating very positive changes in their awareness of breastfeeding and in the quality of its management, as well as a recognized degree of satisfaction in their implementation. We also believe that our ability to empathize with breastfeeding mothers and children has clearly improved. Families are very receptive to these changes, expressing a high degree of confidence and satisfaction with the care they receive.
In conclusion, we are convinced that committing to breastfeeding and IHAN accreditation is a safe bet for the health (and why not speak it out, the happiness) of the community.
Authors
References
Victora C, et al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet 2016; 387: 475-490.
J Aguayo, et al. IHAN Calidad en la asistencia profesional al nacimiento y la lactancia. Ministerio de Sanidad, Política Social e Igualdad, 2011.
A Urtasun, E Jareño et al. Evolución en 12 años de los indicadores de lactancia y factores asociados en un centro de salud acreditado IHAN. Acta pediatr esp 78 (3-4).