Since 1998, Ireland has adopted the global quality improvement programme, "Baby Friendly Initiative" (BFI). It is recognised in driving best practices in maternity care to protect, promote and support breastfeeding. Implementing the BFI is a priority under the HSE’s breastfeeding action plan, "National Standards for Safer Better Maternity Services", and the "National Maternity Strategy"
The target set in the HSE’s breastfeeding action plan is for all maternity services to implement standardised infant feeding policies.
National Standards for Infant Feeding in Maternity Services
In 2022, revised Infant Feeding Standards were published in Ireland. This followed a review of the Baby Friendly Initiative (BFI) in Ireland, and the publication of revised WHO guidance for the implementation of baby friendly in 2018. The Standards describe the infant feeding practices and management process required within maternity services in order to implement the HSE Infant Feeding Policy for Maternity and Neonatal services.
Infant Feeding Standards Assessment Tool
NWIHP have been guided by HIQA’s approach to the development and promotion of self-assessment tools. Resources are available to help Maternity Services to assess their own performance against the National Standards (2022). These supports will enable individual maternity services to benchmark progress in implementing the Standards. They will also enable services to identify and address opportunities and challenges. Self-assessment against the Standards has commenced in all 19 maternity hospitals in 2023. The self-assessment cycle will be a three year period. It requires the following elements:
- Service user interviews
- Health care professional interviews
- Healthcare-Provider’s self-assessment against the standards under 8 themes.
Infant Feeding Standards Assessment Tool
National Baby Friendly Initiative Oversight Group
In 2022, NWIHP established the National Baby Friendly Initiative Oversight Group. This group has broad representation of key stakeholders involved in infant feeding services in Ireland and includes services users. The aim of the Oversight Group is to support the ongoing work of the project co-ordinators for the HSE Baby Friendly Initiative with a particular focus on:
- Implementation of the National Standards for Infant Feeding in Maternity Services (2022).
- Reviewing the progress with the implementation of the Standards and self-assessment process.
- Identifying opportunities (operational, research, training, education, strategic etc.) that would further enable the HSE to support exemplar Infant Feeding Practices.
The group will remain in place until 2025, where a review will take place.
Infant Feeding Specialist Support Forum
The Infant Feeding Specialist Support Forum was also established in 2022. The purpose of the Infant Feeding Specialist Support Forum was to support Infant Feeding Specialists in their role as they plan, develop, begin and/or continue implementation of the National Standards for Infant Feeding in Maternity Services. The Forum also provides oversight for the NWIHP on progress.
The forum has regular scheduled meetings arranged over a 12-month period. These meetings are hosted by different hospital sites each time. The forum has been working on the implementation of nine action points.
Health Service Policies and Practices
Two new policies came into effect in 2021 in the HSE within the area of breastfeeding:
- Breastfeeding Policy for Staff working in the Public Health Service - HSE staff can now avail of breastfeeding breaks at work for up to one hour per normal working day, in addition to normal rest breaks;
- HSE Policy on the Marketing of breast milk Substitutes – this policy outlines how the HSE can support the recommendations that all parents, whichever way they feed their baby, have access to accurate and effective information free from the influence of marketing campaigns.
Alignment with International Infant feeding guidance
NWIHP are striving to adopt the nine recommendations by the WHO to national coordinating bodies through the scaling up of this BFI programme to all maternity services in Ireland. As experience of implementing the new Standards grows, there will be on-going evaluation and adaption to ensure the Standards are as effective as possible.
- Establish or strengthen a national breastfeeding coordination body.
- Integrate the Ten Steps into relevant national policy documents and professional standards of care.
- Ensure the competency of health professionals and managers in implementation of the Ten Steps.
- Use external assessment systems to regularly evaluate adherence to the Ten Steps.
- Develop and put in place incentives for compliance and/or sanctions for non-compliance with the Ten Steps.
- Provide technical help to facilities that are making changes to adopt the Ten Steps.
- Track implementation of the initiative.
- Advocate for the BFHI to relevant audiences.
- Identify and allocate sufficient resources to ensure the ongoing funding of the initiative