‘Are they taunting us?’ That was the response of one IFA member, when she learned the theme of this year’s WHO World Patient Safety Day. I admit that I had to read the theme twice myself to believe it:
‘Safe care for every newborn and every child’.
To those of us negatively impacted by World Health Organization (WHO) guidance on newborn feeding, the idea of a WHO ‘Patient Safety Day’ is galling in itself. This year’s theme stretches credulity.
When my daughter was born in an NHS hospital after a long labour, I was excessively sleep deprived, but I had been advised that breastfeeding was best. Following healthcare advice, I had not brought formula to hospital and no discussion of other options was on offer.
For two and a half distressing days, I received breastfeeding support at every feed. My baby never latched well. So, I was given tiny syringes with which to feed her extra colostrum and these drops were documented as ‘feeds’. I know from the feed chart I was given to fill in that she received 6 ml in her first 48 hours. I doubt she got much, if anything, from the breast.
But this was fine, according to staff, who manipulated my breasts and did all manner of different things to make breastfeeding work (it never did). It was only when I finally raised concerns before being discharged on the third day that another option, a breast pump, was mentioned reluctantly. Formula was not mentioned. It was like it didn’t exist.
Back home I pumped and my mental health declined. Our baby would not by then take much from a bottle. Less than 24 hours after we had been discharged, a midwife visited. She found our baby had lost 13% of her birthweight, was jaundiced and dehydrated and needed urgent care.
In Paediatrics A&E, staff explained that our newborn daughter had not been getting enough to eat from exclusive breastfeeding. This made no sense. On the other side of the hospital, where we had been until yesterday, staff believed exclusive breastfeeding was always possible, formula needn’t be mentioned and that everything was always fine if you kept breastfeeding.
What had happened? I didn’t know yet, but I sensed that it had not been a mistake, a one-off or the fault of individual staff. I would learn that my baby’s care was entirely in line with policies followed in the maternity unit. In short, these are the policies of the so-called Baby Friendly Initiative .
The Baby Friendly Initiative is an accreditation scheme aimed at promoting breastfeeding that hospitals sign up to. Even if hospitals aren’t accredited yet, they all follow this guidance, which is endorsed by the DHSC, NHSE and NICE (The National Institute for Health and Care Excellence). A breastfeeding programme in hospitals meets the government’s agenda on infant feeding, which is to promote exclusive breastfeeding and increase breastfeeding rates.
The Baby Friendly Initiative is the reason why I had not been told about formula in antenatal classes. It is why I was encouraged to keep trying to exclusively breastfeed. And it is why formula was never mentioned on the postnatal ward when my daughter was struggling to feed. I would later discover that we were far from alone in our bad experience of this model of care.
So where does the World Health Organization fit in to all of this? The World Health Organization is a ‘global partner’ in the Baby Friendly Initiative. It founded the programme with UNICEF back in the early 1990s. For some years before that, the two organisations had been behind the development of recommendations to promote exclusive breastfeeding and to reduce the use of formula.
And why is the British government promoting exclusive breastfeeding to all women in 2025, even though there is no evidence it improves UK health and the majority of families bottle feed? You’ve guessed it: advice from the World Health Organization!
Emergency formula supplementation rescued my daughter (recommended by non-‘Baby Friendly’ clinicians – the irony). It also meant I could finally sleep as my husband could feed the baby. I pumped for a while and then fully formula fed, which suited us well. The whole ordeal had an ongoing negative impact on my mental health, but I think I avoided a worse crisis by getting sleep when I did. My daughter, thankfully, does not seem to have been impacted by her period of under feeding.
Tragically, others are not so lucky. The Fed is Best Foundation in the US was co-founded by a doctor whose own son experienced brain injury as a result of such a period of insufficient intake. Though the Fed is Best Foundation share data from the US of the harms of policies to promote exclusive breastfeeding, similar data are available here, it’s just that no one seems to know how to make sense of them.
Since 2017, the Nuffield Trust has been publishing reports that show time and again increases in infant readmissions to hospital in the early days of life for complications of insufficient intake, just like my daughter’s. Readmissions for jaundice more than doubled in the ten-year period (2006–16) of the first of these Nuffield Trust reports.
And what was also happening from the mid 2000s onwards? That’s right, the period of the biggest expansion of the WHO/UNICEF Baby Friendly Initiative in UK hospitals. That time also saw the formalising of the government’s commitment to promote exclusive breastfeeding, indeed making it a ‘public health priority’, following WHO advice.
Correlation does not imply causation. However it seems reasonable to ask whether a policy to ‘give newborns no food or drink except breastmilk unless medically necessary’ and to encourage hospitals to reduce the amount of formula supplementation they give babies might be a factor in increasing numbers of newborns not getting enough to eat and experiencing complications.
And the withholding of formula is only one of the WHO/UNICEF infant feeding policies that has been associated with newborn harm. Baby Friendly also promotes the practice of skin-to-skin contact to promote breastfeeding, which has been implicated in the deaths of a small number of UK babies from sudden unexpected postnatal collapse (SUPC).
Rooming-in, another ‘Baby Friendly’ policy, which means mothers are left to care for their newborn for the duration of their hospital stay, no matter their own condition, has been linked to increases in newborn falls and collapses in hospitals in the US and tragic cases elsewhere.
But when the UK’s Healthcare Safety Investigation Branch (HSIB) set out to investigate the deaths of the babies from SUPC in skin-to-skin contact, they did not question the policy of skin-to-skin itself. In fact, they invited Baby Friendly on board! And when Nuffield Trust considered the reasons for increased newborn readmissions, they theorised that factors such as the short length of the postnatal hospital stay might be to blame. No one is apparently willing to look at the role of national and global infant feeding policies in these infant complications.
Perhaps it is just too difficult to acknowledge that breastfeeding, a lovely idea, might often be insufficient and causing complications in some newborns. And perhaps it is too hard for organisations, governments and individuals who have promoted exclusive breastfeeding to accept that the policies they supported may well have done more harm than good. And perhaps it is hard for all of us to accept, because of what it means for all of our healthcare, that the World Health Organization can get things as spectacularly wrong as they have done with infant feeding. But no one is above scrutiny or being held accountable, and that includes the WHO, whose approach to newborn care should be the first thing looked at this World Patient Safety Day.
Sue Haddon
World Patient Safety Day takes place on Wednesday 17 September 2025.
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