Becoming baby-friendly in Spain: a quality-improvement process

Aim: To describe the implementation process and effect of a quality-improvement intervention aimed at achieving compliance with the Baby-friendly Hospital Initiative (BFHI). Methods: We conducted a prospective study of the development and evaluation of a quality-improvement intervention at the Yecla Hospital, Spain. A random sample of 1273 infants born in the hospital was followed up in primary care centres between 1997 and 2005. The study interventions were process-oriented training, audit and feedback, quality-improvement cycles and provision of breastfeeding support resources. The main outcome measures were changes in compliance with the Global Criteria for the BFHI and breastfeeding rates before, during and after the intervention. Results: Compliance with the Global Criteria increased progressively, and in 2004 all criteria were met. The median duration of breastfeeding went up gradually from the start of the intervention. The likelihood of being breastfed at different ages among infants born in 2005 was between 45% [odds ratio (OR) 0.55; 95% confidence interval (CI) 0.38-0.79] and 86% (OR 0.14; 95% CI 0.09-0.20) higher than among infants born in 1997. Conclusion: Quality-improvement interventions based on participation, training, audit and feedback of information, and provision of resources are useful for the implementation of the BFHI, which is associated with a significant increase in breastfeeding rates.