The goal of the BFHI is to ensure that women are provided with information, care and services that maximize their opportunities to establish and maintain exclusive breastfeeding i.e. to
ensure that health care providers do not contribute to women not reaching their breastfeeding goals by in appropriate use of formula. The BFHI respects that all women will make an informed
decision about feeding their babies, and requires that the hospital have an exclusive breastfeeding rate for healthy term babies from birth to discharge of 75%. Calculation of this rate is
explained in this
document from the BCC website.
• Babies supplemented with expressed breast milk or human donor milk are included in the exclusive breastfeeding category.
• If the exclusive breastfeeding rate is less than 75%, babies who have been supplemented with formula for medically indicated reasons (outlined by WHO/UNICEF, and anticipated
to be a low % as the special care population of babies is excluded) may be added to this category. Many facilities keep formula in a locked cupboard where it is signed out by
staff to encourage consideration of whether the supplement is really medically necessary. Formula is kept out of sight to create an environment where breastfeeding is the norm.
• The BFHI standards thus allow that 25% of healthy term babies may be either mixed feeding or exclusively formula feeding by parental informed decision. This would indicate
that work can be done on the health promotion messages in the community, especially during prenatal care, to influence the intention and commitment of women to exclusively
breastfeed from birth to 6 months, as per Health Canada and WHO recommendations.
Mothers who decide to formula feed receive the same standard of care as breastfeeding mothers i.e. skin-to-skin care to safely transition the infant after birth (blood sugar,
heart, temperature and breathing stability) and help with infant feeding. Some babies latch by themselves during the skin-to-skin care period, and thus some mothers change their minds
about formula feeding. The provision of information regarding the risks and costs of artificial feeding and the parents informed decision to use formula is recorded in the patient’s chart
for medico-legal purposes. Mothers who elect to formula feed receive one-to-one education from staff on how to safely prepare, feed and store formula to safeguard their babies. The hospital
provides formula that has been procured in an ethical way (according to the WHO International Code for the Marketing of Breastmilk Substitutes) for the mothers who need or want it during their
stay in the hospital. Nofree samples or gift packs are sent home with the mother. The WHO Code protects formula feeding mothers by requiring minimum standards for the quality of artificial infant
feeding products, and appropriate teaching by health professionals rather than marketing by company representatives.
The BFHI offers an evidence-based standard of care to all women, regardless of their choice of infant feeding methods, while working to ensure that staff are able to provide the information
and help that will maximize breastfeeding outcomes.