A cross-sectional study on key clinical practices to support breastfeeding: inequalities across Europe?
1
WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health IRCSS Burlo Garofolo, Trieste, Italy
2
School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
Popul. Med. 2026;8(Supplement Supplement 1):A2245
ABSTRACT
BACKGROUND:
The perinatal period is critical for establishing lactation and ensuring breastfeeding success. However, implementation of key clinical practices supporting breastfeeding is rarely monitored systematically across Europe. This study aims at exploring the implementation of baby friendly hospital initiative (BFHI) breastfeeding support practices in 11 European countries using data from the IMAgiNE GLOBAL survey.
METHODS:
Women aged ≥18 who delivered in a healthcare facility in the WHO European Region between May 2023 and March 2025 completed a validated, WHO standard-based online questionnaire. Eight questions related to BFHI steps 4,5,6,7, and 10 were analysed and combined into a primary single composite outcome. Between-country differences were tested using chi-square tests and multivariate logistic regressions.
RESULTS:
Of 21798 women, just 24.0% reported experiencing all key breastfeeding practices (composite outcome), ranging from 2.2% in Croatia to 37.0% in Belgium. Substantial variations were observed between countries and across BFHI steps. Immediate skin-to-skin contact and early breastfeeding (BFHI Step 4) were reported by 72.4% and 71.8% of women, respectively. Support with breastfeeding and information on milk expression (BFHI Step 5) were reported by 67.0% and 51.8%. Exclusive breastfeeding during hospitalisation (BFHI Step 6) was reported by 47.3%. Rooming-in was practised by 75.6%, and 94.1% were allowed to stay with their baby as desired (BFHI Step 7). Finally, 72.0% received information on where to access timely support after discharge (BFHI Step 10). All between-country differences were statistically significant in both bivariate and multivariate analyses.
CONCLUSIONS:
Key clinical practices supporting breastfeeding are not consistently implemented across Europe, highlighting the need for standardised monitoring systems and targeted quality improvement strategies. Great efforts and investment are needed to protect, promote and support breastfeeding during childbirth hospitalisation, ensuring that all women receive adequate support, regardless of their chosen method of infant feeding.
The perinatal period is critical for establishing lactation and ensuring breastfeeding success. However, implementation of key clinical practices supporting breastfeeding is rarely monitored systematically across Europe. This study aims at exploring the implementation of baby friendly hospital initiative (BFHI) breastfeeding support practices in 11 European countries using data from the IMAgiNE GLOBAL survey.
METHODS:
Women aged ≥18 who delivered in a healthcare facility in the WHO European Region between May 2023 and March 2025 completed a validated, WHO standard-based online questionnaire. Eight questions related to BFHI steps 4,5,6,7, and 10 were analysed and combined into a primary single composite outcome. Between-country differences were tested using chi-square tests and multivariate logistic regressions.
RESULTS:
Of 21798 women, just 24.0% reported experiencing all key breastfeeding practices (composite outcome), ranging from 2.2% in Croatia to 37.0% in Belgium. Substantial variations were observed between countries and across BFHI steps. Immediate skin-to-skin contact and early breastfeeding (BFHI Step 4) were reported by 72.4% and 71.8% of women, respectively. Support with breastfeeding and information on milk expression (BFHI Step 5) were reported by 67.0% and 51.8%. Exclusive breastfeeding during hospitalisation (BFHI Step 6) was reported by 47.3%. Rooming-in was practised by 75.6%, and 94.1% were allowed to stay with their baby as desired (BFHI Step 7). Finally, 72.0% received information on where to access timely support after discharge (BFHI Step 10). All between-country differences were statistically significant in both bivariate and multivariate analyses.
CONCLUSIONS:
Key clinical practices supporting breastfeeding are not consistently implemented across Europe, highlighting the need for standardised monitoring systems and targeted quality improvement strategies. Great efforts and investment are needed to protect, promote and support breastfeeding during childbirth hospitalisation, ensuring that all women receive adequate support, regardless of their chosen method of infant feeding.
| eISSN: | 2654-1459 |
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