PROGRAMMATIC EXPERIENCE ON REVITALIZATION OF THE BABY-FRIENDLY HOSPITAL INITIATIVE (BFHI) IN MALAWI: LESSONS LEARNT ON BARRIERS TO EXCLUSIVE BREASTFEEDING AT FACILITY LEVEL

Background and objectives: In Malawi, optimal breastfeeding practices remain challenging as only 61% of babies are exclusively breastfed, according to 2016 Demographic & Health Survey data. Since approximately three-quarters of deliveries are facility-based, it is imperative to support exclusive breastfeeding (EBF) in the immediate 24 hours postpartum in health facilities. In partnership with the Ministry of Health, USAID's Maternal and Child Survival Project (MCSP), World Health Organization (WHO), and UNICEF worked to revitalize Baby-Friendly Hospital Initiative (BFHI) with linkages to the community-level. BFHI is a global initiative to implement practices that protect, promote, and support breastfeeding and can reduce barriers to and improve rates of early initiation of breastfeeding and sustained EBF. Methods: MCSP spearheaded revitalization of BFHI and addressed barriers to early initiation of breastfeeding and EBF in 15 districts by 1) revising infant and young child feeding (IYCF) hospital-based policies to address barriers to early initiation of breastfeeding and continued EBF, and prevention of mother-tochild transmission (PMTCT) of HIV; 2) adapting the WHO BFHI training course to the Malawi context to address breastfeeding challenges; 3) supporting hospitals on the Ten Steps to Successful Breastfeeding through staff capacity building, and; 4) identifying existing referral linkages between the hospital- and the community- levels to continue breastfeeding support to postpartum women after discharge. Results: MCSP supported capacity building on BFHI and breastfeeding with half of health workers trained in 15 health facilities and 3 centers of excellence. Health facilities developed policies stating commitment to BFHI and to addressing barriers to IYCF, such cessation of EBF before 6 months, poor latching/ positioning, and PMTCT of HIV. BFHI has been able to support early initiation of breastfeeding despite limited space in maternity wards and staff shortages. Facilities identified staff to counsel mothers in waiting areas and postnatal wards on EBF. MCSP oriented 1,400+ community-based promoters to support breastfeeding mothers on EBF barriers. The experience resulted in 13,948 mothers initiating breastfeeding within 1 hour and receiving EBF counseling at discharge. Conclusions: BFHI is a successful approach to addressing barriers to EBF at facility and community levels. BFHI promotes multi-level cooperation to address a range of breastfeeding barri