Naslov
Challenges and Triumphs in Impelementing the Baby- friendly Initiative in Croatia

Autori
Zakarija-Grković, Irena

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, prošireni sažetak, stručni

Izvornik
Maternal and Child Nutrition 2015, Supplement 2: 3-131 / - , 2015, 128-129

Skup
MAINN Conference 2015

Mjesto i datum
Grange-over-Sands, Ujedinjeno Kraljevstvo, 10.06.2015. - 12.06.2015

Vrsta sudjelovanja
Pozvano predavanje

Vrsta recenzije
Međunarodna recenzija

Ključne riječi
Baby-Friendly Hospital Initiative ; Croatia ; challenges ; facilitators

Sažetak
It has been 22 years since Croatia began implementing the Baby-Friendly Hospital Initiative (BFHI). Today, all bar one of its maternity facilities have been designated as ‘Baby-Friendly’ and several new initiatives are underway aimed at spreading breastfeeding support to the community and other health facilities. It has been a challenging journey- littered with obstacles and setbacks- but endured upon thanks to the visionary work of dedicated individuals, and the support of UNICEF Croatia and the Croatian Ministry of Health. The role of the UNICEF Office for Croatia has been instrumental in implementing the BFHI for it was UNICEF that was among the first international organisations to set up an office in the newly recognised Republic of Croatia and to assist the government in helping children caught up in the devastation of war that engulfed Croatia from 1991 to 1995. Subsequently, in 1993, two years after the BFHI was globally launched, Croatia began with the translation of BFHI materials and the training of all involved personnel. By 1999, 15 out of the then 34 maternity facilities were 'Baby– Friendly', placing Croatia in third place in Europe, following Sweden and Norway. As a leader in the region, Croatia trained health professionals from neighbouring countries and had plans, in 1998, for introducing the '10 steps' into the primary care setting. A constant threat to the protection, promotion and support of breastfeeding in Croatia has been the pressure and influence from pharmaceutical companies to market breast milk substitutes. The Croatian government succumbed to this pressure, at the end of 1998, when it decided to endorse hospital discharge packs which were in violation of the International Code of the Marketing of Breastmilk Substitutes (UNICEF, 1981). Consequently, UNICEF withdrew its support of the BFHI and hospital standards fell. International policies are a great opportunity to revitalise country initiatives and so it was with the announcement of the Global Strategy for Infant and Young Child Feeding (WHO, 2002). This decisive document, together with the United Nations Convention on the Rights of the Child, proved a strong basis for building a case for breastfeeding in Croatia. In response to its periodic report as a member state, Croatia received a letter of recommendation in 2004 from the UN Committee on the Rights of the Child, encouraging compliance with the Code and promotion of breastfeeding. This gave strength to two national documents published in 2006, dealing with population health, which led to the formation of a National Breastfeeding Committee (NBC). Intense lobbying by the NBC, resulted in the Croatian Ministry of Health withdrawing its support for the hospital discharge packs, which was confirmed by an official letter sent to all maternity units in September 2007. Concurrently, UNICEF began a 'Young Child Development Program' encompassing positive parenting and optimal infant feeding, with a strong emphasis on renewing the BFHI. A national BFHI project team was formed and coordinators were assigned. The new revised, updated and expanded BFHI training materials were translated, assessors and coordinators trained- followed by hospital staff- all at the expense of UNICEF Croatia. A combined ‘bottom- up’ and ‘top-down’ approach proved most efficacious at implementing the initiative and maintaining standards. Close collaboration between the BFHI project team and the NBC, NGOs, local governments, media and professional organisations was essential in achieving this result. With high breastfeeding initiation rates being the norm in Croatia, and all maternity hospitals dedicated towards implementing the BFHI, our focus shifted towards ensuring adequate support for mothers following hospital discharge. In 2008, the ‘breastfeeding-friendly primary care offices’ initiative was launched, encouraging paediatricians and general practitioners to implement the ‘Ten Steps’ in their practices. Currently, 14 physicians hold this designation. Ensuring access for mothers to breastfeeding support groups has been an ongoing endeavour in Croatia, and was recently boosted by a nation-wide, UNICEF sponsored, series of breastfeeding workshops for community nurses. In 2015, 166 community nurse-led breastfeeding support groups were registered. Finally, the realisation that all children are entitled to the best possible start, triggered by the ‘Expert Group Recommendations for the Expansion of the BFHI to the NICU’ (Nyqvist et al, 2013), has resulted in a new initiative in Croatia aimed at raising the awareness of the value of human milk for premature and sick infants and creating a family-centred, supportive environment in NICUs. The Recommendations have been translated and widely distributed, workshops have been held, NICUs have been refurnished and attempts are being made to bring this segment of health care to the level it deserves. Still, many challenges remain, including the absence of human milk banks in Croatia, ongoing violation of the Code and lack of training of health professionals in providing breastfeeding support. On 7th May 2015 the Croatian government accepted the ‘Program for the Protection and Promotion of Breastfeeding in Croatia’, empowering the NBC to address these challenges.

Izvorni jezik
Engleski

Znanstvena područja
Javno zdravstvo i zdravstvena zaštita

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