The Kramer study in Belarus compared a group of 16 hospitals training their
staff using an 18 hour course (Breastfeeding Management and Promotion in a
Baby-Friendly Hospital) with another group of 15 which was discouraged from
providing such training or making changes during the study period.

But none of the hospitals in the intervention sought or achieved
Baby-Friendly designation, and at present only 4 hospitals in Belarus are
listed by UNICEF as having achieved this award. In their JAMA article
Kramer et al were conscientious in not describing the intervention hospitals
as Baby-Friendly.

Even so, this useful study shows quite dramatically the good effects of
providing some training and making some improvements in observed practice, with measurable results even
before fulfillment of the Global Criteria of the BFHI. 

Citing the Kramer article
may help LactNetters to move their health systems toward implementation of
the Ten Steps to Successful Breastfeeding, as it offers hope of increased
breastfeeding exclusivity and durations and reduced eczema even before the
process is complete.

Jan Barger points out a research opportunity -- to look at durations (and
exclusivity to 6 months too, I should think) following birth in fully certified Baby
Friendly Hospitals. Any takers?



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