Gender-just reductions in greenhouse gas emissions in maternity care services through the ‘baby- friendly hospital initiative’: a scoping review

BACKGROUND: The use of commercial milk formula (CMF) in facilities providing maternity and newborn services disrupts establishment of breastfeeding and adds to greenhouse gas (GHG) emissions. We identified evidence on GHG emissions in these services and explored implications for a gender-just transition to GHG emissions reductions by scaling-up the Baby-Friendly Hospital Initiative (BFHI) to reduce CMF use. METHODS: We performed a scoping review and narrative synthesis on three interrelated topics: 1) GHG emissions impact of CMF use in maternity services, 2) gender-just transitions in agrifood systems away from dairy production, and 3) BFHI's influence on CMF use at hospital discharge. RESULTS: Searches retrieved 280 articles across three topics, with 51 meeting inclusion criteria. For topic 1, there was limited focus on GHG impacts or CMF use, with just one study primarily addressing the impacts of CMF use for food waste. Topic 2 included 14 studies showing that gender disparities and structural inequalities hinder effective gender mainstreaming and climate change adaptation in agriculture such as dairying, while none cited gendered effects on producers of reducing dairy use from transitioning to more sustainable health services. For topic 3, 36 studies indicated that BFHI reduced CMF supplementation, and increased breastfeeding. CONCLUSION AND IMPLICATION: This study highlights a significant evidence gap regarding carbon footprints of facilities providing maternity and newborn services. Given the GHG emissions associated with CMF, absence of evidence of harmful impacts on female dairy farmers, and under-investment in women's competencies as maternity care professionals, facilities seeking to reduce their carbon footprint should implement gender-just strategies such as BFHI which minimize unnecessary CMF use and increase investments in breastfeeding support and training of mostly female maternity services staff.