WHAT IS THE BABY-FRIENDLY HOSPITAL INITIATIVE?
In 1991, the World Health Organization (WHO) collaborated with the United Nations Children’s Fund to start the global Baby-Friendly Hospital Initiative (BFHI) in response to the 1990 Innocenti Declaration on the Protection, Promotion and Support of Breastfeeding call for action. The BFHI encourages and recognizes hospitals and birthing centers that successfully implement the Ten Steps to Successful Breastfeeding and the International Code of Marketing of Breast-Milk Substitutes. To learn more, please review the Breastfeeding in Facilities Providing Maternity and Newborn Services Guideline, or review WHO Recommendations: Intrapartum Care for a Positive Childbirth Experience.
WHY IS THE BABY-FRIENDLY HOSPITAL INITIATIVE IMPORTANT?
The Baby-Friendly Hospital Initiative enhances infant feeding and maternity care practices in hospitals by providing breastfeeding education to all mothers as well as instilling the confidence and skills necessary to successfully initiate and continue breastfeeding or formula feeding their babies safely.
Research shows that mothers who give birth at Baby-Friendly hospitals and birthing centers are more likely to initiate exclusive breastfeeding and more likely to sustain breastfeeding at six months (independent of the demographic factors traditionally associated with low breastfeeding rates). In addition, compliance with the Ten Steps decreases racial, socio-cultural, and ethnic disparities in breastfeeding rates.
REVISED IMPLEMENTATION GUIDANCE FOR BFHI
In April 2018, the World Health Organization (WHO) and United Nations Children’s Fund (UNICEF) released revised implementation guidance for the Baby-Friendly Hospital Initiative (BFHI), including revisions to the Ten Steps to Successful Breastfeeding framework. BFUSA formed an expert committee to create comprehensive development, implementation, and communication plans to reflect these changes in the Ten Steps. As a result, Baby-Friendly USA released the Sixth Edition of Guidelines and Evaluation Criteria to be followed by hospitals designated after June 1, 2023.
IS THE BABY-FRIENDLY HOSPITAL INITIATIVE EFFECTIVE?
Here are a few papers that support the effectiveness of the Baby-Friendly Hospital Initiative:
- Addressing Racial Inequities in Breastfeeding in the Southern United States Anne Merewood, Kimarie Bugg, Laura Burnham, et al. Pediatrics 2019; 143 (2): e20181897.
- The Impact in the United States of the Baby-Friendly Hospital Initiative on Early Infant Health and Breastfeeding Outcomes Allison C. Munn, Susan D. Newman, Martina Mueller, Shannon M. Phillips, and Sarah N. Taylor. Breastfeed Med 2016; 11(5): 222-230.
- Evaluating the impact of the Baby-Friendly Hospital Initiative on breast-feeding rates: a multi-state analysis Summer S. Hawkins, Ariel D. Stern, Christopher F. Baum, and Matthew W. Gillman. Public Health Nutrition 2015; 18(2): 189-197.
- Effect of Maternity-Care Practices on Breastfeeding Ann M. DiGirolamo, Laurence M. Grummer-Strawn, and Sara B. Fein. Pediatrics 2008; 122: S43-S49.
- Promotion of Breastfeeding Intervention Trial (PROBIT): A Randomized Trial in the Republic of Belarus Michael S. Kramer, Beverley Chalmers, Ellen D. Hodnett, et al. JAMA. 2001; 285(4):413-420.
- Baby-Friendly Hospital Initiative Improves Breastfeeding Initiation Rates in a US Hospital Setting Barbara L. Philipp, Anne Merewood, Lisa W. Miller, Neetu Chawla, Melissa M. Murphy-Smith, Jenifer S. Gomes, Sabrina Cimo, John T. Cook. Pediatrics 2001; 108 (3): 677-681.
- Guideline: protecting, promoting and supporting breastfeeding in facilities providing maternity and newborn services World Health Organization (2017)
- Evidence for the Ten Steps to Successful Breastfeeding World Health Organization (1998).
HOW CAN DOCTORS GET INVOLVED?
ARE THERE ANY RESOURCES AVAILABLE?
There are many Baby-Friendly resources available to assist hospitals that would like to improve their maternity practices on their own or are working towards Baby-Friendly designation. We’ve listed some below.
If you work at a birthing hospital in Mississippi, you can apply to become part of the Mississippi CHAMPS program and we can help you with your Baby-Friendly goals.
BECOMING BABY-FRIENDLY: PRACTICAL SOLUTIONS TOOLKIT
The Massachusetts Department of Health and Human Services put together a Toolkit with lots of useful information about the Baby-Friendly Hospital Initiative all in one place!
BREASTFEEDING IN FACILITIES PROVIDING MATERNITY AND NEWBORN
SERVICES GUIDELINE
The World Health Organization released an evidence-based, in-depth document for breastfeeding best practices. View the guidelines now.
BABY-FRIENDLY USA PRESENTATIONS
Below are links to presentations available on the BabyFriendlyUSA.org website:
SAMPLE POLICY STATEMENT
NOTIFICATION OF BABY-FRIENDLY EXPECTATIONS
CHAMPS hospital Merit Health River Region developed a document for the nursing staff to sign after they complete the training required for Baby-Friendly. They call it the “Notification of Baby-Friendly Expectations” and shared it for others to modify for their own facilities.
It lists the Ten Steps to Successful Breastfeeding and the ways in which the hospital and nursing staff are going to work together to implement each step. This is a great way to ensure all staff is on the same page and in agreement with the improvements the hospital is making.
DATA COLLECTION TOOL
On November 30, 2012, The Joint Commission announced that the Perinatal Care core measure set would become mandatory for all hospitals with 1,100 or more births per year, effective January 1, 2014. The United States Breastfeeding Coalition created this set of guidelines to address the exclusive breast milk feeding core measure: Implementing The Joint Commission Perinatal Care Core Measure on Exclusive Breast Milk Feeding.
