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Türkiye'de Emzirmenin Teşviki ve Bebek Dostu Sağlık Kuruluşları: Programı Geliştirmek İçin Sistematik Bir Yaklaşım

Year 2019, Volume: 19 Issue: 1, 32 - 40, 22.03.2019
https://doi.org/10.17098/amj.542159

Abstract

Amaç: Türkiye’de Emzirmenin Teşviki ve Bebek Dostu Sağlık Kuruluşları Programı
(BDSK), 1991 yılında Sağlık Bakanlığı ve Birleşmiş Milletler Çocuklara Yardım
Fonu (UNICEF) işbirliği ile başlatılmıştır. 2002’den beri Program hastanelerden
birinci basamak sağlık hizmetlerine ve toplum düzeyine ilerlemiştir. Bu yazıda,
mevcut durumu değerlendirmek ve Programı canlandırmak için geliştirilen yeni
stratejileri sunmak ve böylece Programın ilerlemesine katkı sağlamak
hedeflenmektedir.

Materyal ve Metot: Sağlık
kuruluşları ve illere ait tüm veriler, Çocuk ve Ergen Sağlığı Daire
Başkanlığı’nın veri tabanından alınmıştır. Paydaş kurumlarla ve tüm bebek dostu
savunucuları ile Ulusal Emzirme Komitesi Toplantısında ve Ulusal Emzirme
Sempozyumunda Program hakkında tartışmalar gerçekleştirilmiş ve ardından
çalışma grubu tarafından Programın SWOT (güçlü yönler, zayıf yönler, fırsatlar,
tehditler) analizi yapılmıştır. Sonrasında bu analiz sonuçları kullanılarak
yeni stratejiler ve yol haritası belirlenmiştir.



Bulgular: Bebek dostu hastanelerin güncel sayısı 2017 yılı sonu itibariyle 1051’e
(tüm hastanelerin %69,42’si) ulaşmıştır. Bu hastanelerin 46’sı kadın doğum
hastanesi statüsündedir ve %93,50’si 2017 yılı sonu itibariyle bebek dostu
olarak onaylanmıştır. 2008 ve 2017 yılları arasında önceden bebek dostu unvanı
almış olan hastanelerin 120’si (%11,42) yeniden değerlendirilmiştir. 2002 ve
2013 yılları arasında 81 ilin tamamı bebek dostu unvanı almıştır. 2008 yılından
itibaren 81 ilin 61’i Bebek Dostu İl unvanını Altın Bebek Dostu İl olarak
geliştirmiş ve Aile Hekimliği Birimlerinin %95’i bebek dostu unvanı almıştır.
SWOT analizi sonuçlarına göre programın en güçlü yönü BDSK’nın devlet
tarafından güçlü bir şekilde tanınması ve desteklenmesi olarak belirlenmiştir.
Sağlık kuruluşlarında bebek dostu standartların sürdürülmesinde yaşanan
güçlükler ve bebek dostu unvanı alan hastanelerin yeterince yeniden
değerlendirilememesi çalışma grubu tarafından programın en zayıf yönleri olarak
değerlendirilmiştir.



Sonuç: Emzirmeyi etkili bir şekilde korumak, teşvik etmek ve desteklemek, ulusal
ve küresel emzirme hedeflerine erişmek için girişimlerin sağlık politikaları,
sağlık sistemleri, ev, aile, toplum gibi bir dizi ortamın kombinasyonunu
kapsayacak şekilde planlanması gereklidir.

References

  • Section on Breastfeeding. Breastfeeding and the use of human milk. Pediatrics 2012; 129(3): e827-41.
  • Lawrence RA. Breastfeeding-a public health issue, not just a matter of choice. Breastfeed Med 2012; 7(2): 67-8.
  • Sankar MJ, Sinha B, Chowdhury R, et al. Optimal breastfeeding practices and infant and child mortality: a systematic review and meta-analysis. Acta Paediatr 2015; 104 (467):3-13.
  • Victora CG, Bahl R, Barros AJ, et al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet 2016; 387 (10017): 475-90.
  • Innocenti declaration on the protection, promotion and support of breastfeeding. UNICEF, 1990. Available from: http://www.unicef.org/programme/breastfeeding/innocenti.htm. Accessed February 19, 2019.
  • Implementation guidance: protecting, promoting and supporting breastfeeding in facilities providing maternity and newborn services – the revised Baby-friendly Hospital Initiative. Geneva: World Health Organization; 2018.
  • International Code of Marketing of Breast-Milk Substitutes. Geneva: World Health Organization 1981. Available from: http://www.who.int/nutrition/publications/infantfeeding/9241541601/en/. Accessed February 19, 2019.
  • Global strategy for infant and young child feeding. Geneva: World Health Organization 2003. Available from: http://www.who.int/nutrition/publications/infantfeeding/9241562218/en/. Accessed February 19, 2019.
  • Infant and young child feeding. Model chapter for textbooks for medical students and allied health professionals. Geneva: World Health Organization 2009. Available from: http://www.who.int/maternal_child_adolescent/documents/9789241597494/en/. Accessed February 19, 2019.
  • Guideline: protecting, promoting and supporting breastfeeding in facilities providing maternity and newborn services. Geneva: World Health Organization; 2017.
  • Yalçın SS (editor). Dünyada ve Türkiye’de Bebek Dostu Girişimi. In: Emzirme Danışmanlığı Eğitimci Kitabı. Birinci baskı, Ankara: Sağlık Bakanlığı; 2018:19-30.
  • Turkey Health Transformation Program Assessment Report 2003-2011. Ministry of Health of Turkey 2012. Available from: https://sbu.saglik.gov.tr/Ekutuphane/Yayin/452. Accessed February 19, 2019.
  • Health Statistics Yearbook 2016. Ankara: Ministry of Health 2017. Available from: https://dosyasb.saglik.gov.tr/Eklenti/13160,sy2016enpdf.pdf?0. Accessed February 19, 2019.
  • Strategic Plan 2013-2017. Ankara: Ministry of Health of Turkey 2012. Available from: http://sbu.saglik.gov.tr/Ekutuphane/Yayin/454. Accessed February 19, 2019.
  • Marketing of breast-milk substitutes: national implementation of the international code, status report 2018. Geneva: World Health Organization; 2018.
  • Baby-Friendly Hospital Initiative. Revised, Updated and Expanded for Integrated Care, Section 5. External Assessment and Reassessment. Geneva: World Health Organization 2009.
  • Hacettepe University Institute of Population Studies. Turkey Demographic and Health Surveys; 1993, 1998, 2003, 2008, 2013. Available from: http://www.hips.hacettepe.edu.tr/eng/publicitions.shtml. Accessed February 19, 2019.
  • Baby-Friendly Hospital Initiative. Revised, Updated and Expanded for Integrated Care, Section 1. Background and Implementation. Geneva: World Health Organization 2009. Available from: http://www.who.int/nutrition/publications/infantfeeding/bfhi_trainingcourse/en/. Accessed February 19, 2019.
  • Semenic S, Childerhose JE, Lauzière J, Groleau D. Barriers, facilitators, and recommendations related to implementing the Baby-Friendly Initiative (BFI): an integrative review. J Hum Lact 2012; 28: 317-34.
  • Baby-Friendly Hospital Initiative. Revised, Updated and Expanded for Integrated Care, Section 3. Background and Implementation. Geneva: World Health Organization 2009. Available from: http://www.who.int/nutrition/publications/infantfeeding/bfhi_trainingcourse/en/. Accessed February 19, 2019.
  • Haddad L, Achadi E, Bendech MA, et al. Global Nutrition Report, Actions and Accountability to Accelerate the World’s Progress on Nutrition. J Nutr 2015; 145: 663-71.
  • Rowe-Murray HJ, Fisher JR. Baby friendly hospital practices: cesarean section is a persistent barrier to early initiation of breastfeeding. Birth 2002; 29(2): 124-31.
  • Agostoni C, Decsi T, Fewtrell M, et al. Complementary feeding: a commentary by the ESPGHAN Committee on Nutrition. J Pediatr Gastroenterol and Nutr 2008; 46 (1): 99- 110.
  • EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA), Scientific Opinion on the appropriate age for introduction of complementary feeding of infants. EFSA Journal 2009; 7(12): 1423 (38 pp.). Available from: http://onlinelibrary.wiley.com/doi/10.2903/j.efsa.2009.1423/epdf. Accessed February 19, 2019.
  • Fewtrell M, Bronsky J, Campoy C, et al. Complementary Feeding: A Position Paper by the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) Committee on Nutrition. J Pediatr Gastroenterol and Nutr 2017;64(1):119-32.
  • Bagci Bosi AT, Eriksen KG, Sobko T, Wijnhoven TM, Breda J. Breastfeeding practices and policies in WHO European Region Member States. Public Health Nutr 2016; 19(4): 753-64.
  • Pérez-Escamilla R, Martinez JL, Segura-Pérez S. Impact of the Baby-friendly Hospital Initiative on breastfeeding and child health outcomes: a systematic review. Matern Child Nutr 2016; 12(3): 402-17.
  • Saadeh RJ. The Baby-Friendly Hospital Initiative 20 years on: facts, progress, and the way forward. J Hum Lact 2012; 28(3): 272-5.
  • Bettinelli ME, Chapin EM, Cattaneo A. Establishing the Baby-Friendly Community Initiative in Italy: development, strategy, and implementation. J Hum Lact 2012; 28(3): 297-303.
  • Casanovas C, Saadeh R. Scaling up protection, promotion, and support of breastfeeding at the community level. Food Nutr Bull 2009; 30(2 Suppl): 230-5.
  • Sinha B, Chowdhury R, Sankar MJ, et al. Interventions to improve breastfeeding outcomes: a systematic review and meta-analysis. Acta Paediatr 2015; 104(467): 114-34.

Breastfeeding Promotion and Baby-Friendly Health Facilities in Turkey: A Systematic Approach to Scale up the Program

Year 2019, Volume: 19 Issue: 1, 32 - 40, 22.03.2019
https://doi.org/10.17098/amj.542159

Abstract

Objectives: In Turkey, Breastfeeding Promotion and Baby-Friendly
Health Facilities Program (BFHF) was launched in 1991 with the collaboration of
the Ministry of Health (MoH) and United Nations International Children’s
Emergency Fund (UNICEF). Since 2002, the program has been extended from
hospitals to the primary health care services and the community level. This
paper aims to present the current status of BFHF and development of new
strategies to revitalize the program and thus, to contribute to the progress.

Materials and Methods: All
information about health facilities and provinces was collected from the
database of the Child and Adolescent Health Department. Discussions about
Initiative with stakeholder institutions and baby-friendly advocates took place
in the National Breastfeeding Committee Meeting and in Annual Breastfeeding
Symposium. Then a SWOT (strengths, weaknesses, opportunities, threats) analysis
of the Program was performed by the working group. Using this analysis results,
new strategies and course of action were identified.

Results: The current number of
baby-friendly hospitals has reached a total of 1051(69.42% of all hospitals).
Of those, 46 were maternity hospitals, which were 93.50% approved as
baby-friendly at the end of 2017. Between 2008 and 2017, 120 (%11.42) of those
pre-certified hospitals were reassessed. Between 2002 and 2013, all 81
provinces have been designated Baby-Friendly Provinces. Since 2008, 61 of the
81 provinces have been designated Golden Baby-Friendly Provinces and 95% of
Family Medicine Units have been certified as baby-friendly. According to the
SWOT analysis result, the main strength of the program was strong recognition
and support of the BFHF by the government. The difficulties in maintaining of
baby-friendly standards in health facilities and inadequate reassessment of
pre-certified facilities were determined as the main weaknesses of the BFHF by
the working group.

Conclusion: To protect, promote and
support breastfeeding effectively and to reach the national and global
breastfeeding goals, interventions should be planned in a combination of
settings by concurrently involving health policies, health systems, home,
family and the community. 

References

  • Section on Breastfeeding. Breastfeeding and the use of human milk. Pediatrics 2012; 129(3): e827-41.
  • Lawrence RA. Breastfeeding-a public health issue, not just a matter of choice. Breastfeed Med 2012; 7(2): 67-8.
  • Sankar MJ, Sinha B, Chowdhury R, et al. Optimal breastfeeding practices and infant and child mortality: a systematic review and meta-analysis. Acta Paediatr 2015; 104 (467):3-13.
  • Victora CG, Bahl R, Barros AJ, et al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet 2016; 387 (10017): 475-90.
  • Innocenti declaration on the protection, promotion and support of breastfeeding. UNICEF, 1990. Available from: http://www.unicef.org/programme/breastfeeding/innocenti.htm. Accessed February 19, 2019.
  • Implementation guidance: protecting, promoting and supporting breastfeeding in facilities providing maternity and newborn services – the revised Baby-friendly Hospital Initiative. Geneva: World Health Organization; 2018.
  • International Code of Marketing of Breast-Milk Substitutes. Geneva: World Health Organization 1981. Available from: http://www.who.int/nutrition/publications/infantfeeding/9241541601/en/. Accessed February 19, 2019.
  • Global strategy for infant and young child feeding. Geneva: World Health Organization 2003. Available from: http://www.who.int/nutrition/publications/infantfeeding/9241562218/en/. Accessed February 19, 2019.
  • Infant and young child feeding. Model chapter for textbooks for medical students and allied health professionals. Geneva: World Health Organization 2009. Available from: http://www.who.int/maternal_child_adolescent/documents/9789241597494/en/. Accessed February 19, 2019.
  • Guideline: protecting, promoting and supporting breastfeeding in facilities providing maternity and newborn services. Geneva: World Health Organization; 2017.
  • Yalçın SS (editor). Dünyada ve Türkiye’de Bebek Dostu Girişimi. In: Emzirme Danışmanlığı Eğitimci Kitabı. Birinci baskı, Ankara: Sağlık Bakanlığı; 2018:19-30.
  • Turkey Health Transformation Program Assessment Report 2003-2011. Ministry of Health of Turkey 2012. Available from: https://sbu.saglik.gov.tr/Ekutuphane/Yayin/452. Accessed February 19, 2019.
  • Health Statistics Yearbook 2016. Ankara: Ministry of Health 2017. Available from: https://dosyasb.saglik.gov.tr/Eklenti/13160,sy2016enpdf.pdf?0. Accessed February 19, 2019.
  • Strategic Plan 2013-2017. Ankara: Ministry of Health of Turkey 2012. Available from: http://sbu.saglik.gov.tr/Ekutuphane/Yayin/454. Accessed February 19, 2019.
  • Marketing of breast-milk substitutes: national implementation of the international code, status report 2018. Geneva: World Health Organization; 2018.
  • Baby-Friendly Hospital Initiative. Revised, Updated and Expanded for Integrated Care, Section 5. External Assessment and Reassessment. Geneva: World Health Organization 2009.
  • Hacettepe University Institute of Population Studies. Turkey Demographic and Health Surveys; 1993, 1998, 2003, 2008, 2013. Available from: http://www.hips.hacettepe.edu.tr/eng/publicitions.shtml. Accessed February 19, 2019.
  • Baby-Friendly Hospital Initiative. Revised, Updated and Expanded for Integrated Care, Section 1. Background and Implementation. Geneva: World Health Organization 2009. Available from: http://www.who.int/nutrition/publications/infantfeeding/bfhi_trainingcourse/en/. Accessed February 19, 2019.
  • Semenic S, Childerhose JE, Lauzière J, Groleau D. Barriers, facilitators, and recommendations related to implementing the Baby-Friendly Initiative (BFI): an integrative review. J Hum Lact 2012; 28: 317-34.
  • Baby-Friendly Hospital Initiative. Revised, Updated and Expanded for Integrated Care, Section 3. Background and Implementation. Geneva: World Health Organization 2009. Available from: http://www.who.int/nutrition/publications/infantfeeding/bfhi_trainingcourse/en/. Accessed February 19, 2019.
  • Haddad L, Achadi E, Bendech MA, et al. Global Nutrition Report, Actions and Accountability to Accelerate the World’s Progress on Nutrition. J Nutr 2015; 145: 663-71.
  • Rowe-Murray HJ, Fisher JR. Baby friendly hospital practices: cesarean section is a persistent barrier to early initiation of breastfeeding. Birth 2002; 29(2): 124-31.
  • Agostoni C, Decsi T, Fewtrell M, et al. Complementary feeding: a commentary by the ESPGHAN Committee on Nutrition. J Pediatr Gastroenterol and Nutr 2008; 46 (1): 99- 110.
  • EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA), Scientific Opinion on the appropriate age for introduction of complementary feeding of infants. EFSA Journal 2009; 7(12): 1423 (38 pp.). Available from: http://onlinelibrary.wiley.com/doi/10.2903/j.efsa.2009.1423/epdf. Accessed February 19, 2019.
  • Fewtrell M, Bronsky J, Campoy C, et al. Complementary Feeding: A Position Paper by the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) Committee on Nutrition. J Pediatr Gastroenterol and Nutr 2017;64(1):119-32.
  • Bagci Bosi AT, Eriksen KG, Sobko T, Wijnhoven TM, Breda J. Breastfeeding practices and policies in WHO European Region Member States. Public Health Nutr 2016; 19(4): 753-64.
  • Pérez-Escamilla R, Martinez JL, Segura-Pérez S. Impact of the Baby-friendly Hospital Initiative on breastfeeding and child health outcomes: a systematic review. Matern Child Nutr 2016; 12(3): 402-17.
  • Saadeh RJ. The Baby-Friendly Hospital Initiative 20 years on: facts, progress, and the way forward. J Hum Lact 2012; 28(3): 272-5.
  • Bettinelli ME, Chapin EM, Cattaneo A. Establishing the Baby-Friendly Community Initiative in Italy: development, strategy, and implementation. J Hum Lact 2012; 28(3): 297-303.
  • Casanovas C, Saadeh R. Scaling up protection, promotion, and support of breastfeeding at the community level. Food Nutr Bull 2009; 30(2 Suppl): 230-5.
  • Sinha B, Chowdhury R, Sankar MJ, et al. Interventions to improve breastfeeding outcomes: a systematic review and meta-analysis. Acta Paediatr 2015; 104(467): 114-34.
There are 31 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Research Articles
Authors

Nilgün Çaylan

Melek Kılıç This is me

Burcu Kayhan Tetik This is me

Ceren Armut This is me

Başak Tezel This is me

Publication Date March 22, 2019
Published in Issue Year 2019 Volume: 19 Issue: 1

Cite

APA Çaylan, N., Kılıç, M., Kayhan Tetik, B., Armut, C., et al. (2019). Breastfeeding Promotion and Baby-Friendly Health Facilities in Turkey: A Systematic Approach to Scale up the Program. Ankara Medical Journal, 19(1), 32-40. https://doi.org/10.17098/amj.542159
AMA Çaylan N, Kılıç M, Kayhan Tetik B, Armut C, Tezel B. Breastfeeding Promotion and Baby-Friendly Health Facilities in Turkey: A Systematic Approach to Scale up the Program. Ankara Med J. March 2019;19(1):32-40. doi:10.17098/amj.542159
Chicago Çaylan, Nilgün, Melek Kılıç, Burcu Kayhan Tetik, Ceren Armut, and Başak Tezel. “Breastfeeding Promotion and Baby-Friendly Health Facilities in Turkey: A Systematic Approach to Scale up the Program”. Ankara Medical Journal 19, no. 1 (March 2019): 32-40. https://doi.org/10.17098/amj.542159.
EndNote Çaylan N, Kılıç M, Kayhan Tetik B, Armut C, Tezel B (March 1, 2019) Breastfeeding Promotion and Baby-Friendly Health Facilities in Turkey: A Systematic Approach to Scale up the Program. Ankara Medical Journal 19 1 32–40.
IEEE N. Çaylan, M. Kılıç, B. Kayhan Tetik, C. Armut, and B. Tezel, “Breastfeeding Promotion and Baby-Friendly Health Facilities in Turkey: A Systematic Approach to Scale up the Program”, Ankara Med J, vol. 19, no. 1, pp. 32–40, 2019, doi: 10.17098/amj.542159.
ISNAD Çaylan, Nilgün et al. “Breastfeeding Promotion and Baby-Friendly Health Facilities in Turkey: A Systematic Approach to Scale up the Program”. Ankara Medical Journal 19/1 (March 2019), 32-40. https://doi.org/10.17098/amj.542159.
JAMA Çaylan N, Kılıç M, Kayhan Tetik B, Armut C, Tezel B. Breastfeeding Promotion and Baby-Friendly Health Facilities in Turkey: A Systematic Approach to Scale up the Program. Ankara Med J. 2019;19:32–40.
MLA Çaylan, Nilgün et al. “Breastfeeding Promotion and Baby-Friendly Health Facilities in Turkey: A Systematic Approach to Scale up the Program”. Ankara Medical Journal, vol. 19, no. 1, 2019, pp. 32-40, doi:10.17098/amj.542159.
Vancouver Çaylan N, Kılıç M, Kayhan Tetik B, Armut C, Tezel B. Breastfeeding Promotion and Baby-Friendly Health Facilities in Turkey: A Systematic Approach to Scale up the Program. Ankara Med J. 2019;19(1):32-40.