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Background: The expansion of the Baby-Friendly Hospital Initiative to neonatal wards, known as the Neo-BFHI, provides recommendations to support breastfeeding, as outlined in the Three Guiding Principles, the expanded Ten Steps, and the International Code for Marketing of Breast-Milk Substitutes. In 2017, Russia participated in an international survey about compliance with the Neo-BFHI., Research Aim: To assess breastfeeding support policies and practices in Russian neonatal wards at the country and federal district level in accordance with the Neo-BFHI recommendations., Methods: This study was a prospective cross-sectional survey. We used the Neo-BFHI Self-Assessment questionnaire to collect data from neonatal wards that had all levels of care. A total of N = 60 Russian neonatal wards in hospitals that have ever been designated Baby-Friendly or planned to do so participated in the survey., Results: Compliance scores at the federal district and country level ranging from 0-100 were used to summarize results. The median country overall score was 90 ( IQR = 83 - 93). Respect for mothers, continuity of care, having a breastfeeding policy, and rooming-in had the highest median scores. Family-centered care, antenatal informing, skin-to-skin contact, and human milk use had the lowest median scores. Neonatal wards in the hospitals that were ever designated as Baby-Friendly had significantly higher scores than those that were never designated. Most respondents ( n = 48, 80%) expressed a desire to obtain Neo-BFHI designation in their neonatal wards., Conclusion: Neo-BFHI recommendations can be successfully implemented in Russian neonatal wards at hospitals designated Baby-Friendly or planning to be designated.

Nowadays, the breast-feeding, despite the approved advantages, is not a standard in many communities. The multi-factorial determinants determining its prevalence need to be supported at various levels - from legal and legislative one to views and values of society, conditions of women's labor and also health care system that can develop a favorable environment for breast-feeding. The breast-feeding effects positively on health, economic development and ecology and therefor it is a benefit for children, women and whole society in short-term and long-term perspective. The defense, propaganda and support of breast-feeding need a political will, and financial investments to implement its advantages.

Objective: The objective was to evaluate implementation of the WHO/UNICEF "Ten Steps to Successful Breastfeeding" as defined by the Baby-Friendly Hospital Initiative in eight maternity hospitals in the Moscow region. Four maternity hospitals had been certified Baby- Friendly Hospitals (BFHs), the experimental group; and four maternity hospitals Not-as-Yet Baby Friendly, the control group (NBFHs)., Methods: Maternal interviews and infant breastfeeding rates were the primary outcomes of the study. In total, 741 healthy postpartum women from the experimental and control group were interviewed: 383 and 358, respectively. Interviews were conducted over 5 months, from May to July 2004. In addition, an assessment of levels and trends in breastfeeding for the period of 1998 to 2003 was made for the area served by the BFHs and the NBFHs., Findings: Analyses of the questionnaires completed by the mothers found a positive effect of BFH practice on a number of parameters, such as an increased rate of in-hospital exclusive breastfeeding, mothers' decisions concerning planned duration of breastfeeding, mothers' and babies' health, and maternal knowledge about the necessary measures in BFHs. Mothers appreciated baby-friendly changes, such as rooming-in, breastfeeding on baby's demand, and taking care of their babies by themselves. The successful initiation of breastfeeding in the BFHs was shown to favor the promotion of breastfeeding among 1-year-old babies in the experimental areas. However, there were some shortcomings in the BFHs: frequent use of labor anesthesia; insufficient placing of newborns on the mother's abdomen, rooming-in, and initiating breastfeeding immediately; and a short length of "skin-to-skin" contact (<30 minutes). The women in BFHs also observed the use of feeding bottles and dummies, and experienced some problems with breast health., Conclusions: BFH practices can increase breastfeeding rates as well as maternal satisfaction. However, shortcomings in the training and support for mothers, and limited help of the medical personnel were noted. It is recommended that BFHs pay attention to maintaining adherence to the criteria of the 10 steps of the Baby-Friendly Hospital Initiative. Since 2003 to control the implementation of the Baby Friendly Initiative principles and sustain the progress in the hospitals designated as Baby Friendly reassessment of maternity hospitals is held in Russia in conformity with the requirements of WHO and UNICEF.