WHO/UNICEF Baby-Friendly Hospital Initiative

Links to non-Federal organizations are provided solely as a service to our users. This link does not constitute an endorsement of this organization by USBC or the Federal Government, and none should be inferred. The USBC is not responsible for the content of the individual organization Web pages found at this link.

In 1992, WHO and UNICEF launched the Baby-Friendly Hospital Initiative (BFHI) in an effort to transform practices in maternity hospitals worldwide.¹ Developed by a small group of experts and built on grassroots experiences, the program focuses on the health of both infants and mothers. It facilitates breastfeeding and ensures that women in maternity care have full information and support to breastfeed their infants in an environment free of commercial influences.

The Initiative strives to achieve goals outlined by two landmark documents:

1. the 1990 Innocenti Declaration on the Protection, Promotion, and Support of Breastfeeding², and
   
   
2. the World Summit for Children — Declaration and Plan of Action.³

• appointment of a national breastfeeding coordinator,
• designation of "baby-friendly" hospitals,
• enactment of laws to enforce the International Code of Marketing of Breastmilk Substitutes, and
• establishment of "imaginative legislation" to ensure the breastfeeding rights of women employed outside the home.

BFHI has a simple but thorough approach. Hospitals are awarded "baby-friendly" status only when trained independent evaluators have verified that all hospital practices are consistent with the rigorous standards, including the "Ten Steps to Successful Breastfeeding."⁴ The Ten Steps promote exclusive breastfeeding through practices such as rooming in and helping mothers initiate breastfeeding within 30 minutes of birth. In addition, hospitals must agree not to accept free or low-cost supplies of breastmilk substitutes, feeding bottles, or pacifiers.

A valuable lesson learned from the BFHI is that hospital practices are perhaps best judged by those who have been patients of the institution under review. Therefore, the objective assessment process focuses on the experiences of a random sample of mothers who have just given birth, rather than on the reports of administrators or senior staff.⁵

The Baby-Friendly Initiative has been successful in bringing a structured program to breastfeeding support and, in less than one decade, has helped to launch baby-friendly programs in 171 countries around the world, transforming over 14,500 hospitals in 125 countries, and more are designated every year.⁵ Each designated facility represents the hard work of a retrained group of health professionals who had the courage to address routines that had long gone unquestioned, transforming them into havens of support for optimal infant feeding.

Ten Steps to Successful Breastfeeding

Based on research evidence and on mother's experiences of what made breastfeeding go well, recommendations for optimal maternity services outlined "Ten Steps to Successful Breastfeeding," co-published in 1980 by WHO and UNICEF in their join booklet entitled Protecting, Promoting and Supporting Breastfeeding: The Special Role of Maternity Services.⁴ These steps were then expanded into the Global Criteria for the Baby-Friendly Hospital Initiative in 1991.⁶ The global criteria were designed to be applicable in all settings, in industrialized as well as in developing nations, since good breastfeeding management techniques are universal. It took two years to develop a consensus on the ten steps and they have become the basis for accreditation of the BFHI health facilities. They are

1. Have a written breastfeeding policy that is regularly communicated to all health care staff;
2. Train all staff in skills necessary to implement this policy;
3. Inform all pregnant women about the benefits and management of breastfeeding;
4. Help mothers initiate breastfeeding within half an hour of birth;
5. Show mothers how to breastfeed and how to sustain lactation, even if they should be separated from their infants;
6. Feed newborn infants nothing but breastmilk, unless medically indicated, and under no circumstances provide breastmilk substitutes, feeding bottles, or pacifiers free of charge or at low cost;
7. Practice rooming-in which allows mothers and infants to remain together 24 hours a day;
8. Encourage breastfeeding on demand;
9. Give no artificial pacifiers to breastfeeding infants;
10. Help start breastfeeding support groups and refer mothers to them.

Sources

1. UNICEF. (1998) The State of the World's Children 1998. New York: Oxford University Press. [http://www.unicef.org/sowc98/sowc98.pdf] posted May, 2000.
2. WHO/UNICEF. (1990) The Innocenti Declaration on the Protection, Promotion and Support of Breastfeeding. Florence, Italy. August 1, 1990. Text of the Declaration is available.
3. UNICEF. (1990) World Summit for Children: World Declaration on the Survival, Protection and Development of Children and Plan of Action for Implementing the World Declaration. New York. September 29-30, 1990. [http://www.unicef.org/wsc/]
4. World Health Organization. (1989) Protecting, Promoting and Supporting Breastfeeding: The special role of maternity services: A Joint WHO/UNICEF Statement. Geneva, Switzerland. AND the Ten Steps can be found at the following Web site: http://www.unicef.org/newsline/tenstps.htm
5. Armstrong, Helen. (1999) "UNICEF: Lessons Learned from the Baby-Friendly Hospital Initiative" IN: Women Friendly Health Services - Experiences in Maternal Care: A Report of a WHO/UNICEF/UNFPA Workshop. Mexico City. January 26-28, 1999. [http://www.unicef.org/programme/
   health/document/mexeng.pdf]
6. UNICEF. (1992) "The Global Criteria for the WHO/UNICEF Baby-Friendly Hospital Initiative." New York.

Related information

• Baby Friendly USA
  

Home | Contact Us

This page last updated March 28, 2003