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The Baby-Friendly Hospital Initiative

© UNICEF/HQ92-0380/Lemoyne
A father watches as his wife breastfeeds their new baby in the maternity ward of the Singburi Hospital, in the town of the same name. Fathers are encouraged to learn about the benefits and become active supporters of breastfeeding.

Hospitals and maternity units set a powerful example for new mothers. The Baby-Friendly Hospital Initiative ( BFHI ), launched in 1991, is an effort by UNICEF and the World Health Organization to ensure that all maternities,whether free standing or in a hospital, become centers of breastfeeding support.

A maternity facility can be designated 'baby-friendly' when it does not accept free or low-cost breastmilk substitutes, feeding bottles or teats, and has implemented 10 specific steps to support successful breastfeeding.

The process is currently controlled by national breastfeeding authorities, using Global Criteria that can be applied to maternity care in every country. Implementation guides for the BFHI have been developed by UNICEF and WHO.

FHI Part II provides the Global Criteria and outlines how to transform hospital practices. Part IV and Part VI help to verify the ending of free and low-cost supplies of breastmilk substitutes. Additional BFHI Parts, including questionnaires used by external teams to assess facilities before Baby-Friendly designation, may be requested when appropriate from the breastfeeding authority of each country.

A list of Baby Friendly Hospitals is available on a country by country basis. In areas where hospitals have achieved baby-friendly status, more mothers are breastfeeding their infants, and child health improves as a consequence.

Since the BFHI began, more than 15,000 facilities in 134 countries have been awarded Baby-Friendly status. In many areas where hospitals have been designated Baby-Friendly, more mothers are breastfeeding their infants, and child health has improved. News of the BFHI accomplishments and articles about effective breastfeeding programmes have been published for ten years in UNICEF's BFHI News.

New knowledge about breastfeeding and its management has been provided through publication of four training courses, and through recommendation of selected Breastfeeding Papers of the Month.

Success Stories 

In Cuba, where 49 of the country's 56 hospitals and maternity facilities are baby-friendly, the rate of exclusive breastfeeding at four mounths almost tripled in six years - from 25 per cent in 1990 to 72 per cent in 1996.

In the first two years of BFHI implementation at the Central Hospital of Libreville in Gabon, cases of neonatal diarrhoea fell by 15 per cent, diarrhoeal dehydration declined by 14 per cent and mortality fell by 8 per cent.

In China, which now has more than 6,000 Baby-Friendly Hospitals, exclusive breastfeeding in rural areas rose from 29 per cent in 1992 to 68 per cent in 1994; in urban areas, the increase was from 10 per cent to 48 per cent.

The Catholic University of Chile, Santiago, initiated one of the first baby-friendly hospitals. As a result, initiation of breastfeeding within the first two hours increased. With a strong Step 10, a monthly clinic, exclusive breastfeeding at 6 months increased from approximately 20% to over 60%.

The internationally defined term 'Baby-Friendly' may be used only by maternity services that have passed external assessment according to the Global Criteria for the BFHI. The term "Baby-Friendly" is not appropriately applied to other medical services, community activities, workplaces or commercial products. Descriptions such as 'breastfeeding-friendly', 'mother-child friendly' or 'pro-breastfeeding' may be used for such other complementary efforts to help mothers to breastfeed.



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. Help mothers initiate breastfeeding within one half-hour of birth.

5. Show mothers how to breastfeed and 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. Practice rooming in - that is, 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.

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