Jamaican hospitals still not baby-friendly - Princess Margaret alone making the grade
With only one of Jamaica's 24 public hospitals currently certified 'baby-friendly', Dr Rebecca Tortello, education specialist at the United Nations Children's Fund (UNICEF) office in Jamaica, is calling for more to be done to create an environment that supports breastfeeding in these facilities.
The 'Baby-Friendly' Hospital Initiative (BFHI) was launched in 1991 as a global campaign to prepare health systems and mobilise health-care workers to protect, promote and support breastfeeding.
Ten local hospitals were certified as 'baby-friendly' between 1996 and 2001, but only the St Thomas-based Princess Margaret Hospital has been recertified since the requirements of the World Health Organisation (WHO) and the UNICEF were changed in 2009.
"Jamaica, from a global health perspective, is not meeting standards for breastfeeding in general and for 'baby-friendly' hospitals in particular," Tortello told The Sunday Gleaner.
"The global goal is to have all children breastfed exclusively for up to six months, and we are at 23.8 per cent; that's low.
"There are many reasons for that. There are cultural reasons, there are reasons related to the amount of time a mother is able to take leave from work with pay, and the lack of facilities in the workplaces that might facilitate breastfeeding; the pumping and storing of the milk," added Tortello.
For a hospital to gain accreditation or recertification, the facility has to embrace breastfeeding as the best practice and provide support in cases where breastfeeding is not possible.
The facility then conducts a self-assessment to determine its readiness to be externally assessed. It will then be certified or recertified as baby-friendly once it has met the WHO/UNICEF 10-step criteria which is slated to be updated again by year end.
"Hospitals are not covering the 10 steps required to be assessed," Tortello lamented. "There are a few things that cause challenges for Jamaica; one is putting the baby with the mother a certain amount of minutes after birth; not always possible if you have a lot of people waiting to give birth and not enough time and space."
"Another one is the training of the relevant medical staff. They have to complete a certain number of hours of training, and it is the scheduling of that training for the in-service clinical staff that sometimes proves difficult because they are taking other trainings, they are on call and then they get transferred somewhere else," said Tortello.
Last week, the health ministry admitted that the timely training of medical staff to support, promote and protect breastfeeding has proved problematic.
"It has proven challenging to release the limited number of staff in these speciality areas to facilitate the training. Innovative training modalities are being employed," the health ministry said in an emailed response to The Sunday Gleaner.
"Behaviour change takes time and so the ministry will continue to work with team leaders in the field to support training, promote the message of exclusive breastfeeding, and provide support to mothers, some who, after being educated and counselled on the benefits of breastfeeding, still choose not to, and others who cannot breastfeed for medical reasons," added the ministry.
According to the health ministry, progress is being made as the latest official data for Jamaica in the 2011 Multiple Indicator Cluster Survey indicated that the country was at 23.8 per cent exclusive breastfeeding at six months, an improvement over the 2005 figure of 15 per cent.
The ministry said given the significant gains to the country in the implementation of the baby-friendly hospital, it will continue working with its international development partners to achieve this goal.
The 10 steps to being a baby-friendly hospital
1. Have a written breastfeeding policy that is routinely communicated to all health-care staff.
2. Train all health-care staff in skills necessary to implement this policy.
3. Inform all pregnant women about the benefits and management of breastfeeding.
4. Help mothers initiate breastfeeding within half-hour of birth.
5. Show mothers how to breastfeed and how to maintain lactation, even if they should be separated from their infants.
6. Give newborn infants no food or drink other than breast milk unless medically indicated.
7. Practise rooming-in - allow mothers and infants to remain together - 24 hours a day.
8. Encourage breastfeeding on demand.
9. Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants.
10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic.
- These steps are slated to be revised late this year.