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2.0 The Baby Friendly Initiative

In 1989 the Ten Steps to Successful Breastfeeding were set out in the joint World Health Organization and UNICEF statement "Protecting, promoting and supporting breastfeeding: the special role of maternity services". Two years later world leaders met in Italy where the Innocenti Declaration was drafted and endorsed by the World Health Assembly, giving it world-wide status and acceptance.

There were 4 targets set:

This came at just the right time historically and resulted in the launching of the Baby Friendly Hospital Initiative, which has been the most important and powerful step ever taken to protect the health of the World's children. It has put breastfeeding on the health policy map in almost every country in the world.

The Steps

The Baby Friendly Hospital Initiative (BFHI) was launched by WHO and UNICEF in June 1991 at a meeting of the International Pediatric Association. The goal is to promote the adoption of the Ten Steps to Successful Breastfeeding in hospitals worldwide. It is designed to remove hospital barriers to breastfeeding by creating a supportive environment with trained and knowledgeable health workers. Adherence to the WHO Code on the Marketing of Breast-milk Substitutes is also a requirement of the Initiative.

The Ten Steps to Successful Breastfeeding

  1. Have a written breastfeeding policy that is routinely communicated to all health care staff.
  2. Train all health care staff in skills necessary to implement this policy.
  3. Inform all pregnant women about the benefits and management of breastfeeding.
  4. Place babies in skin-to-skin contact with their mothers immediately following birth for at least an hour. Encourage mothers to recognize when their babies are ready to breastfeed and offer help if needed.
    (Replaced: 'Help mothers initiate breastfeeding within a half-hour of birth' in 2009).
  5. Show mothers how to breastfeed, and how to maintain lactation even if they should be separated from their infants.
  6. Give newborn infants no food or drink other than breastmilk unless medically indicated.
  7. Practise rooming in - allow mothers and infants to remain together - 24 hours a day.
  8. Encourage breastfeeding on demand.
  9. Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants.
  10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic.

To continue the best practices initiated in the hospital situation, and to provide supportive care to the mother in the community the Seven-point Plan for Sustaining Breastfeeding in the Community was launched in the United Kingdom in 1998 and subsequently modified and adopted by many other countries.

The Seven-point Plan to Promote, Protect and Support Breastfeeding in the Community*

  1. Have a written breastfeeding policy that is routinely communicated to all healthcare 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 co-operation between healthcare staff, breastfeeding support groups and the local community.
* Various countries have altered the wording of some of these points slightly.

Integrated Ten Steps (Breastfeeding Committee for Canada)

In 2011 the Breastfeeding Committee for Canada developed and adopted the Integrated Ten Steps & WHO Code Practice Outcome Indicators for Hospitals and Community Health Services.

  1. Have a written breastfeeding policy that is routinely communicated to all healthcare staff.
  2. Ensure all health care providers have the knowledge and skills necessary to implement the breastfeeding policy.
  3. Inform all pregnant women about the importance and process of breastfeeding.
  4. Place babies in skin-to-skin contact with their mothers immediately following birth for at least an hour. Encourage mothers to recognize when their babies are ready to breastfeed and offer help if needed.
  5. Assist mothers to breastfeed and maintain lactation should they face challenges including separation from their infants.
  6. Infants are not offered food or drink other than human milk for the first 6 months, unless medically indicated.
  7. Facilitate 24 hour rooming-in for all mothers: mothers and infants remain together.
  8. Encourage baby-led or cue-based breastfeeding.
    Encourage sustained breastfeeding beyond six months with appropriate introduction of complementary foods.
  9. Support mothers to feed and care for their breastfeeding babies without the use of artificial teats or pacifiers (dummies or soothers).
  10. Provide a seamless transition between the services provided by the hospital, community health services and peer support programs.

What should I remember?

  • the two international organisations that together launched the Baby Friendly Hospitals Initiative
  • what the Ten Steps for Successful Breastfeeding, and subsequently the 7-Point Plan for Breastfeeding in the Community, was designed to achieve