Baby-Friendly Hospital Initiative. Protecting, promoting, and supporting breastfeeding in the twenty-first century

Pediatr Clin North Am. 2001 Apr;48(2):475-83. doi: 10.1016/s0031-3955(08)70039-7.


The BFHI is a global UNICEF/WHO-sponsored effort to promote breastfeeding by ensuring that all women are provided with sound information regarding their infant feeding choices and that those who elect to breastfeed their infants are given physiologically sound, evidence-based advice and skilled assistance prenatally and as they begin nursing their infants during their postpartum hospital or birth center stay. The initiative is based on ten policy or procedure statements, The Ten Steps, which were jointly developed and published in 1989 by the sponsoring agencies in consultation with international experts. In 1990, the Ten Steps were accepted as the central theme of the Innocenti Declaration and, later that year, endorsed at the World Summit on Children. In 1992, UNICEF and WHO launched a major international campaign to encourage all hospitals with maternity services to accept the Ten Steps as basic maternity and newborn infant care policies and procedures. These Ten Steps were reviewed briefly in this article. Official designation as Baby Friendly requires a careful assessment completed by a trained external team to confirm that the institution is truly carrying out all Ten Steps and conforming to the International Code of Marketing of Breastmilk Substitutes. During the 8 years since the initiative began, more than 15,000 hospitals in 136 countries have been designated as Baby Friendly. Twenty-seven of these officially designated institutions are in the United States, where the campaign has been active only since 1996. The BFHI is considered one of the most successful international efforts ever performed to protect, promote, and support breastfeeding. Although it does not ensure that mothers will aspire to or achieve the widely accepted goal of approximately 6 months of exclusive breastfeeding, it helps mothers to initiate exclusive nursing, an essential step in the right direction.

Publication types

  • Review

MeSH terms

  • Breast Feeding* / psychology
  • Breast Feeding* / statistics & numerical data
  • Evidence-Based Medicine
  • Forecasting
  • Health Priorities*
  • Health Promotion / organization & administration*
  • Hospital Administration*
  • Humans
  • Infant, Newborn
  • Mothers / education
  • Mothers / psychology
  • Organizational Policy
  • Patient Education as Topic / methods
  • Personnel, Hospital / education
  • Personnel, Hospital / psychology
  • Social Support*
  • United Nations*