9.2 The Baby Friendly Initiative
Innocenti Declaration
Some 10 years after the WHO Code was first signed a group of high-level policy-makers convened; the outcome was the release of the Innocenti Declaration. The Innocenti Declaration was endorsed by the World Health Assembly in 1991, giving it world-wide status and acceptance. It is the most concise international statement on breastfeeding and covers all three facets of protection, promotion and support.
The Innocenti Declaration set 4 targets for all governments:
- To appoint a national breastfeeding coordinator and a multi-sectoral national breastfeeding promotion committee. This target put accountability directly in the hands of each nations' government.
- That governments would have taken action to implement the International Code of Marketing of Breastmilk Substitutes.
- That maternity facilities should practice the recently published Ten Steps to Successful Breastfeeding. This came at just the right time historically. The launching of the Baby Friendly Hospital Initiative has been the most important and powerful step ever taken on behalf of breastfeeding. It has put breastfeeding on the health policy map in almost every country in the world.
- To enact imaginative legislation to protect the breastfeeding rights of working women.

Reaching the targets
The targets were ambitious and although they were not fully achieved by the projected date, great progress was made:
- 80 countries formed national breastfeeding authorities
- 19,000 hospitals became designated Baby-Friendly
- 80 countries had laws implementing the WHO Code on Marketing of Breastmilk Substitutes
- declining breastfeeding rates were reversed and exclusive breastfeeding rates increase 15% worldwide.
The Baby Friendly Initiative
Baby Friendly hospitals

A proud hospital!

Ten Steps to Successful Breastfeeding
Every facility providing maternity services and care for newborn infants should:
- Have a written breastfeeding policy that is routinely communicated to all health care staff.
- Train all health care staff in skills necessary to implement this policy.
- Inform all pregnant women about the benefits and management of breastfeeding.
- (Help mothers initiate breastfeeding within a half-hour of birth.) Place babies in skin-to-skin contact with their mothers immediately following birth for at last an hour and encourage mothers to recognize when their babies are ready to breastfeeding, offering help if needed.
- Show mothers how to breastfeed, and how to maintain lactation even if they should be separated from their infants.
- Give newborn infants no food or drink other than breastmilk unless medically indicated.
- Practise rooming-in - allow mothers and infants to remain together - 24 hours a day.
- Encourage breastfeeding on demand.
- Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants.
- Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic.
Baby Friendly communities
Community facilities who acquire the Seven-Point Plan Award are often referred to a "mother-child friendly" or "breastfeeding-friendly".

Seven-Point Plan
1. Have a written breastfeeding policy that is routinely communicated to all health-care staff.
2. Train all staff involved in the care of mothers and babies in the skills necessary to implement the policy.
3. Inform all pregnant women about the benefits and management of breastfeeding.
4. Support mothers to initiate and maintain breastfeeding.
5. Encourage exclusive and continued breastfeeding, with appropriately-timed introduction of complementary foods.
6. Provide a welcoming atmosphere for breastfeeding families.
7. Promote cooperation between health-care staff, breastfeeding support groups and the local community.
Source: 2001 UNICEF/BFI UK
Does Baby Friendly Work?
- UNICEF, in 1999, reported widespread increases in rates of breastfeeding in urban areas, reductions in respiratory infections and diarrhea in infants, and savings in terms of both costs and staff time when BFHI is implemented.
- USA - Baby-Friendly designated hospitals have elevated rates of breastfeeding initiation and exclusivity. Elevated rates persist regardless of demographic factors that are traditionally linked with low breastfeeding rates. 1
- China - after 2 years of implementation of the Ten Steps, exclusive breastfeeding rates doubled in rural areas and improved from 10% to 47% in urban areas.
- Cuba - exclusive breastfeeding rates increased from 25% in 1990 to 72% in 1996. 2
- Scotland - babies born in a Baby-Friendly accredited hospital were 28% more likely to be exclusively breastfed at 7 days of postnatal age than those born in other maternity units. 3
- UK - in a 2 year period of mandatory BFI training of health visitors and nursery nurses resulted in a 1.57 times increased likelihood of an infant being breastfed at 8 weeks. 4
- New Zealand - Exclusive breastfeeding rates at discharge from hospital increased from 55.6% (2001) to 84.4% (2011). 96.1% of New Zealand hospitals now hold BFHI accreditation.5
Becoming accredited

Workbook Activity 9.4
Complete Activity 9.4 in your workbook.

Poster Promotion
Display the posters in strategic areas in your workplace.
What should I remember?

- The significance of the landmark Innocenti Declaration on the protection, promotion and support of breastfeeding.
- An understanding of the purpose of the Baby-Friendly Initiative.
- The application of each of the Ten Steps or Seven Points to my work practice.
Self-test quiz
Match an item from the column on the left with an item from the column on the right. Click on an item in one column, then on its matching response from the other column
Notes
- # Merewood A et al. (2005) Breastfeeding Rates in US Baby-Friendly Hospitals: Results of a National Survey
- # Philipp BL et al. (2004) The Baby-Friendly way: the best breastfeeding start.
- # Broadfoot M (2005) The Baby Friendly Hospital Initiative and breast feeding rates in Scotland
- # Ingram J et al. (2011) The effects of baby-friendly iniatiative training on breastfeeding rates and the breastfeeding attitudes, knowledge and self-efficacy of community health care staff.
- # Martis R et al. (2013) The New Zealand/aotearoa baby-friendly hospital initiative implementation journey: piki ake te tihi--strive for excellence.