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Are you interested in establishing a Baby-friendly Hospital ? Do you have questions about the Code ? Or do you have experiences you would like to share with others ?

Please send your questions, ideas or answers to: mlabbok@unicef.org

Guidelines for submission - Keep your message brief and include the word 'Message Board' in the Subject header.

Note: Communications specific to the numerous technical issues concerning prevention of vertical transmission (mother to child transmission) of HIV/AIDS would appropriately be addressed to pmtct@list.unaids.org

Q. Our country is redrafting the Ten Steps of the BFHI in accord with our culture. Is this acceptable to UNICEF and WHO?

A. Drafting policy for support of a national breastfeeding programming is the right of every country and state. We encourage creative and culturally appropriate implementation of the Innocenti Operational targets.

However, the Ten Steps to Successful Breastfeeding, per se, were developed using a prolonged and inclusive process; they were carefully phrased to be applicable and feasible any maternity setting. Published in the 1989 WHO/UNICEF Joint Statement on Protecting, Promoting and Supporting Breastfeeding, they continue to represent a universal standard by which over 15,000 maternity facilities in 136 countries have been assessed. The Ten Steps are the minimum package of hospital and maternity facility practices required to become certified Baby-Friendly, and are considered a non-negotiable standard of practice.

Over the years there have been many requests to change the Ten Steps, however, the suggested changes have tended to perpetuate practices that work against easy and exclusive breastfeeding. Additional Steps may be added by national authorities, if they do not alter, replace or weaken any of the basic Ten Steps.

Q. BFHI Step Four says to initiate breastfeeding in half an hour, but doesn't recent research show many newborns are not yet ready?

A. The establishment of breastfeeding is a process that cannot be defined by a single contact of baby and breast. Swedish and Zambian studies, and clinical experience in many countries, show that newborns of mothers who receive no medications during labor and delivery will approach and suckle the breast spontaneously if they are unwrapped and in continuous full skin-to-skin contact with the mother from a few minutes after birth.

The average time for such an infant to attach and suckle without aid is about 55 minutes after birth, and almost all will suckle within two hours. If aided, many will have a successful first latch-on even sooner.

Evidence-based new practices do not hurry the newborn to the breast, but provide peaceful, warm skin-to-skin contact without pushing ahead of the infant's instinctive progress to the first suckling. However, more help may be needed by the infant when the mother has received substantial medications or in other special conditions. Whether a normal newborn is allowed time to attach spontaneously, or is helped to take the breast for the first time, the process of initiating breastfeeding should begin within thirty minutes of the birth.

Q. I am interested in Baby-friendly certifiication for the hospital where I work. What are my first steps ?

A. Please contact - Your local UNICEF office, National Committees or local Breastfeeding committee or authority for instructions and training materials. If you still have questions please write again !

Q. I have a small kiosk and a commercial representative has approached me to advertise their artifical feeding product using a large picture of a happy baby. I want to be supportive of Code of marketing. Should I display this poster?

A. Advertising directly to mothers is prohibited under the articles of the Code. For more information read the Code.


Do you have an International Infant feeding related event coming up? Please let us know and we will post relevant events.

La Leche League International

18th International Breastfeeding Conference
"Strength Through Diversity; Creating one Breastfeeding World"
July 3-6, 2003 in San Francisco, California, USA.
If you are interested in attending, please visit website at http://www.lalecheleague.org/03conf/03conf.html.

Those attending the conference may contribute poster presentations. Posters will consist of visually interesting charts, graphs, photographs, or text describing a particular project, research or innovative program on the protection, support or promotion of breastfeeding.

Interested participants are asked to submit a 250 word abstract describing their poster/project by February 15, 2003 via email to rmagalhaes@llli.org, post to Rebecca Magalhaes,1400 N. Meacham Road, Schaumburg, IL 60173-4808; or or through the Online Abstract Form available at the website.


New and Noteworthy.

The Academy of Breastfeeding Medicine (ABM) is a worldwide organization of physicians dedicated to the promotion, protection and support of breastfeeding and human lactation. Their mission is to unite into one association members of the various medical specialties with this common purpose. It strives to promote physician education, expand knowledge in both breastfeeding science and human lactation, facilitate optimal breastfeeding practices and encourage the exchange of information among organizations.

The ABM fully supports the WHO International Code of Marketing of Breastmilk Substitutes and thus refuses support or endorsement of companies which are not Code-compliant.

To widen the Academy's presence in the international community of physicians, the Chair of its International Committee invites communications from all physicians interested in supporting its mission.


José J. Gorrín-Peralta, MD, MPH, FACOG
Professor and Director
Maternal and Child Health Program
UPR Graduate School of Public Health
San Juan, PR 00936-5067
Tel/Fax 787-759-6546
Email: jgorrin@rcm.upr.edu