UNICEF in action

The Baby-Friendly Hospital Initiative

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 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. Thailand is one of 12 developing countries to take the lead in instituting the “ten steps” of baby-friendly practice in as many hospitals as possible.

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.

Please see the following list of Baby
Friendly Hospitals 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

Ten steps to successful breastfeeding Have a written breastfeeding policy that is routinely communicated to all health care staff. Train all health care staff in skills necessary to implement this policy. Inform all pregnant women about the benefits and management of breastfeeding. Help mothers initiate breastfeeding within one half-hour of birth. Show mothers how to breastfeed and maintain lactation,even if they should be separated from their infants. Give newborn infants no food or drink other than breastmilk, unless medically indicated. Practice rooming in – that is, allow mothers and infants to remain together 24 hours a day. Encourage breastfeeding on demand. Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic.

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.