Implementing Baby-Friendly Community and Health Services in Europe: a cross-country context analysis from the JA PreventNCD

The first 1000 days of life represent a critical window for health and a key priority for the prevention of noncommunicable diseases. Breastfeeding is recognised as the biological norm and one of the most impactful, cost-effective, and equitable public health interventions. However, breastfeeding rates in Europe remain among the lowest globally, reflecting systemic barriers and insufficient continuity of care after hospital discharge. The Baby-Friendly Community Health Services model extends the WHO/UNICEF Baby-Friendly Initiative standards to community settings. This study aimed to map the implementation of Baby-Friendly standards in community and primary health care settings across selected European countries. A cross-country descriptive context analysis was conducted within Task 6.5 of the Joint Action PreventNCD across seven European countries: Italy, Slovenia, Norway, Greece, Spain, Lithuania, and Ukraine. Data were collected through a structured, standardised questionnaire completed by national key informants and analysed using descriptive statistics. Qualitative comments were reviewed descriptively to contextualise cross-country findings. All countries reported national breastfeeding recommendations, including exclusive breastfeeding for the first six months. However, only three countries reported national guidelines integrating Baby-Friendly standards into community health services. A national coordinating body was present in all countries, although governance and funding mechanisms varied. Antenatal and postnatal services were available free of charge, but organisational and professional roles showed substantial heterogeneity. Although most countries reported a formal Baby-Friendly Community Health Services designation system, implementation remained heterogeneous and population coverage varied widely. Barriers described were staff resistance, insufficient added value perception, limited funding, and political commitment. Limited data were available on breastfeeding prevalence and on inequalities in breastfeeding outcomes across population groups, including differences by socioeconomic status, e.g. education, and ethnicity, or geographic area. Important gaps remain in the implementation of Baby-Friendly standards at community level. Strengthening governance, capacity building, and monitoring is essential to ensure continuity of breastfeeding support after hospital discharge and throughout the first 1000 days of life, thereby strengthening this key public health intervention for noncommunicable disease prevention.