Impact of the baby friendly community initiative on breastfeeding outcomes: A systematic review and meta-analysis

Objective: To examine the impact of the Baby Friendly Community Initiative (BFCI) on breastfeeding outcomes worldwide, specifically the duration of any and exclusive breastfeeding, compared to standard maternal care. Methods: A systematic review and meta-analysis were conducted. Seven electronic databases were searched from November 1998 to July 2024. Quantitative studies examining the effects of BFCI on breastfeeding outcomes were included. The quality of included studies was assessed using the Cochrane risk of bias tools and NHLBI study quality assessment tools. Narrative synthesis was performed for studies not suitable for meta-analysis. Results: Out of 14,495 identified records, 13 were included after the removal of duplicates and ineligible articles. The majority of included studies found that BFCI, whether implemented partially, fully or in combination with other initiatives, is an effective intervention for improving breastfeeding outcomes. The meta-analysis showed an increase prevalence of exclusive breastfeeding at 6 months postpartum in BFCI group (OR=4.00; 95 % CI 1.29-12.38, P = 0.02). Further studies are needed to investigate the statistical significance of BFCI on any breastfeeding from 6 months to 2 years postpartum. Discussion: BFCI has the potential to significantly enhance long-term exclusive breastfeeding rates and may also improve any breastfeeding rates from 6 months onward. However, the nature of BFCI implementation posed limitations to study design, which reduced the overall methodological quality of the included studies. Registration: The protocol for this review was registered on PROSPERO (registration number CRD42023460801) on 17th September 2023.