Baby-Friendly Hospital Initiative:

The first few hours and days of a new-borns life are a critical window for establishing lactation and providing mothers with the support they need to breastfeed successfully.

WHO and UNICEF launched the Baby-Friendly Hospital Initiative (BFHI) in 1992 to motivate facilities providing maternity and newborn services to implement the Ten Steps to Successful Breastfeeding In 2015 WHO and UNICEF embarked on a process to re-evaluate and reinvigorate the BFHI program.

A systematic literature review was commissioned to examine the evidence for each of the Ten Steps. It is reported that there is substantial evidence that implementing the Ten Steps considerably improves breastfeeding rates. Following this review, the Ten Steps were revised since they were launched in 1989. The theme of each step has not changed, but the wording is in line with the evidence-based guidelines and global public health policy.

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The ten steps are sub-divided into programmatic areas such as:

  1. The institutional procedures necessary to ensure that care is delivered consistently and ethically
  2. Standards for individual care of mothers and infants (critical clinical practices) are upheld.
  3. Complete application of the International Code of Marketing of Breastmilk Substitutes and relevant World Health Assembly Resolutions (9 the Code) including ongoing, periodic monitoring and adherence to the clinical practices have been incooperated into step1.
  4. The guidance further focuses on integrating the ten steps fully into the health care system, such as:
  • Establishing or strengthening a national coordinating body.
  • Integrating the ten steps into national policies and standards.
  • Building the capacity of health care professionals using external assessment in competencies.
  • Advocating for long-lasting changes in clinical practices and adequate resources.
  • Providing technical assistance on Code implementation, monitoring, and enforcement.

The Ten Steps summarize a package of policies and procedures that facilities providing maternity and newborn services should implement to support breastfeeding. With these basic Ten Steps, appropriately implemented, we can significantly improve breastfeeding rates around the world and give children the best possible start in life.

Breastfeeding is vital to a child’s lifelong health and reduces costs for health facilities, families, and governments. Breastfeeding within the first hour of birth protects newborn babies from infections and saves lives. Infants are at greater risk of death due to diarrhoea and other infections when they are only partially breastfed or not breastfed at all. Breastfeeding also improves IQ, school readiness and attendance, and is associated with higher income in adult life. It also reduces the risk of breast cancer in the mother. “Breastfeeding saves lives. Its benefits help keep babies healthy in their first days and last well into adulthood,” says UNICEF Executive Director Henrietta H. Fore. 

The practical guidance encourages new mothers to breastfeed and informs health workers how best to support breastfeeding. The implementation guidance for BFHI emphasizes strategies to scale up to universal coverage and ensure sustainability over time. The guidance focuses on integrating the program more fully in the healthcare system to ensure that all facilities in a country implement the Ten Steps. Governments are called upon to fulfill the critical responsibilities through a national BFHI program:


Critical management procedures:


1a. Comply fully with the International Code of Marketing of Breast-milk Substitutes and relevant World Health Assembly resolutions.

1b. Have a written infant feeding policy that is routinely communicated to staff and parents.

1c. Establish ongoing monitoring and data-management systems.

  1. Ensure that staff has sufficient knowledge, competence, and skills to support breastfeeding.

Key clinical practices:

  1. Discuss the importance and management of breastfeeding with pregnant women and their families.
  2. Facilitate immediate and uninterrupted skin-to-skin contact and support mothers to initiate breastfeeding as soon as possible after birth.
  3. Support mothers to initiate and maintain breastfeeding and manage common difficulties.
  4. Do not provide breastfed new-borns any food or fluids other than breastmilk unless medically indicated.
  5. Enable mothers and their infants to remain together and to practice rooming-in 24 hours a day.
  6. Support mothers to recognize and respond to their infants’ cues for feeding.
  7. Counsel mothers on the use and risks of feeding bottles, teats, and pacifiers.
  8. Coordinate discharge so that parents and their infants have timely access to ongoing support and care.

WHO Director-General Dr. Tedros Adhanom Ghebreyesus says that in many hospitals and communities around the world, whether a child can be breastfed or not can make the difference between life and death and whether a child will develop to reach their full potential.

“Hospitals are not there to cure the ill. They are there to promote life and ensure people can thrive and live their lives to their full potential,” says Dr. Tedros. “As part of every country’s drive to achieve universal health coverage, there is no better or more crucial place to start than by ensuring the Ten Steps to Successful Breastfeeding are the standard for care of mothers and their babies.”

The new guidance describes practical steps countries should take to protect, promote and support breastfeeding in facilities providing maternity and newborn services. They provide the immediate health system platform to help mothers initiate breastfeeding within the first hour and breastfeed exclusively for six months.

It describes how hospitals should have a written breastfeeding policy, staff competencies, and antenatal and post-birth care, including breastfeeding support for mothers. It also recommends limited use of breastmilk substitutes, rooming-in, responsive feeding, educating parents on the use and risks of bottles and pacifiers, and support when mothers and babies are discharged from the hospital.

WHO/UNICEF have developed new documents to assist in the implementation of BFHI:


2. https://www.who.int/teams/nutrition-and-food-safety/food-and-nutrition-actions-in-health-systems/ten-steps-to-successful-breastfeeding

3. https://www.unicef.org/documents/baby-friendly-hospital-initiative

4. WHO Competency Verification Toolkit

5. WHO Protecting, Promoting and Supporting Breastfeeding

6. WHO Training Course for Maternity Staff

7. https://www.globalbreastfeedingcollective.org/ten-steps-successful-breastfeeding

8. https://www.healthynewbornnetwork.org/resource/ten-steps-to-successful-breastfeeding-revised-2018/

9. https://www.babymilkaction.org/archives/17039

10. https://www.youtube.com/watch?v=mNr7V0F_Tlk