 INTRODUCTION:-

The Baby Friendly Hospital Initiative (BFHI), also known as Baby Friendly Initiative (BFI),
is a worldwide programme of the World Health Organization and UNICEF, launched in 1991
following the adoption of the “Innocenti Declaration” on breastfeeding promotion in
1990.The initiative is a global effort for improving the role of maternity services to enable
mothers to breastfeed babies for the best start in life.
Since BFHI began, more than 152 countries around the world have implemented the initiative
The Baby Friendly Hospital Initiative; breastfeeding policy promotes, supports and
encourages breastfeeding as the optimal way for a woman to feed her baby. BFHI
acknowledges that breastfeeding offers important health benefits for both the mother and
child.

 IN GLOBAL:-
CANADA
The baby friendly hospital by the world health organization (who) and UNICEF since 2008.
It is the largest hospital in Canada to receive the designation.

CHINA
China, now has more than 6,000 baby-friendly hospitals, exclusive breastfeeding in rural
areas from 29 % in 1992 to 68 % in 1994. In urban areas, the increase was from 10 % to 48
%.

CUBA
In Cuba, 56 hospitals and maternity facilities have been designated as "baby-friendly". In the
six years following the initiation of the BFHI program, the rate of exclusive breastfeeding at
four months almost tripled - from 25% in 1990 to 72 % in 1996.

SWEDEN
Sweden is considered the global leader in terms of BFHI implementation four years after the
programme was introduced in 1993, all of the then 65 maternity centres in the country had
been designated "baby-friendly"

UNITED KINGDOM
The UNICEF UK baby friendly initiative was launched in the United Kingdom in 1995.The
initiative works with the National Health Service (NHS) to ensure a high standard of care for
pregnant women and breastfeeding mothers and babies in hospitals and community health
settings.

UNITED STATES
The first hospitals verified as baby-friendly in the USA, Which was certified in September
1996. All of these early adopters were able to achieve 100% breastfeeding initiation rates. In
New York City, the Harlem hospital center was the first hospital to receive the "baby
friendly" certification granted by baby-friendly USA for the city in 2008.in 2011, New York
University Langone Medical Center became the second hospital to receive the baby-friendly
hospital designation in New York City.

 POLICY STATEMENT OF BFHI:-

 It recognises and supports the importance of creating and delivering a health care
environment in hospitals with maternity facilities, where breastfeeding is encouraged,
promoted and supported by all staff to parents.
 In that maternity facilities should follow and appropriately educate and train all staff on
the ‘Ten Steps to Successful Breastfeeding’.
 The policy recognises that all mothers have the right to receive clear and impartial
information to enable them to make a fully informed choice as to how they feed and care
for their babies after birth.
 Mothers should be supported to feed their infants in all areas of the hospital. Signs should
be displayed throughout the hospital informing all staff and parents that breastfeeding is
welcome.

 AIMS OF THE BFHI:-

1. To ensure the health benefits of breastfeeding and the potential health risks associated
with formula feeding are discussed with all women and their families as appropriate in
hospitals with maternity facilities, so they can make an informed choice about how they
will feed their babies.
2. It aims at improving the care of pregnant women, mothers and new-borns at health
facilities that provide maternity services for protecting, promoting and supporting
breastfeeding.
3. To enable Hospital staff to create an environment where more women choose to
breastfeed their babies, and are given sufficient information and support to enable them to
breastfeed exclusively for six months, and then as a part of their infant’s diet beyond the
first year of life.
4. To encourage consistent, comprehensive and evidence based breastfeeding information is
provided to parents by all health care professionals working in hospitals with maternity
facilities.
5. To adhere to the World Health Organisation Code (WHO) code of marketing of breast
milk substitutes.
The World Health Organization recommends that if a mother is unable to breastfeed,
chooses not to breastfeed, or if her baby (often premature) shows signs that it isn't getting
enough breast-milk, a healthy wet nurse or milk from a donor is a healthy alternative to
formula.

 THE TEN STEPS TO SUCCESSFUL BREASTFEEDING:-

It is the global standard by which healthcare facilities are assessed and accredited. A ‘baby
friendly’ facility is one where mother’s informed choice of feeding is encouraged, respected
and supported.

STEP 1: HAVE A WRITTEN BREASTFEEDING POLICY THAT IS

ROUTINELY COMMUNICATED TO ALL HEALTH CARE STAFF
1. The breastfeeding policy is to be communicated to all health care staff in contact with
pregnant women and mothers. All staff will be able to access a copy of the Baby Friendly
Hospital Initiative breastfeeding policy.
2. All new staff will be orientated on how to locate the Baby Friendly
Hospital Initiative breastfeeding policy and provided with a copy of the Information flyer at
orientation.
3. The information flyer should be displayed in all areas throughout the hospital.

STEP 2: TRAIN ALL HEALTH CARE STAFF IN THE SKILLS

NECESSARY TO IMPLEMENT THIS POLICY
1. Health professionals have a responsibility to support breastfeeding women and assist and
educate them to overcome related breastfeeding problems.
2. All professional and support staff who have contact with pregnant women and mothers will
be trained in breastfeeding management at a level appropriate to their professional group.
3. All clerical and ancillary staff will be orientated to the policy and receive training to enable
them to refer breastfeeding queries appropriately.
4. The responsibility for providing training lies with designated personnel who will record
training attendance.
5. Written curricula clearly covering all ten steps to successful breastfeeding will be available
for staff training.

STEP 3: INFORM ALL PREGNANT WOMEN ABOUT THE BENEFITS

AND MANAGEMENT OF BREASTFEEDING
1. It is the responsibility of professional staff to ensure that all pregnant women are aware of
the benefits of breastfeeding and the potential health risks of formula feeding.
2. All pregnant women should be given the opportunity to discuss infant feeding on a one-to-
one basis with a health professional.
3. The physiological basis of breastfeeding should be clearly and simply explained to all
pregnant women, together with evidence-based management practices, which have proven to
protect breastfeeding and reduce common problems. The aim should be to give women
confidence in their ability to breastfeed.
4. All materials and teaching should reflect WHO/UNICEF baby friendly best practice
standards.

STEP 4: PLACE BABIES SKIN TO SKIN CONTACT WITH THEIR

MOTHERS IMMEDIATELY FOLLOWING BIRTH FOR AT LEAST AN
HOUR AND ENCOURAGE MOTHERS TO RECOGNISE WHEN
THEIR BABIES ARE READY TO BREASTFEED, OFFERING HELP IF
NEEDED
1. All mothers are encouraged to hold their babies with skin to skin contact as soon as
possible after birth in an unhurried environment, regardless of their intended feeding method.
2. In the case of caesarean section births mothers and babies should remain together
whenever possible, only being interrupted for medical reasons.
3. If skin to skin contact is interrupted for clinical reasons, it should be commenced/resumed
as soon as mother and baby are able.
4. All women are encouraged to offer the first breastfeed when the mother and baby are
ready. Help from a midwife will be available if needed.

STEP 5: SHOW MOTHERS HOW TO BREASTFEED AND HOW TO

MAINTAIN LACTATION EVEN IF THEY ARE SEPARATED FROM
THEIR INFANTS
1. All breastfeeding mothers will be offered further assistance with breastfeeding during their
hospital stay if required. The transfer of care for mothers and babies to community child
health nurses will follow standard procedure in the form of written communication to ensure
a seamless transition.
2. Midwives and health professionals should ensure that mothers are offered the support
necessary to acquire the skills of positioning their baby to ensure effective attachment for
successful breastfeeding. They should be able to explain the necessary technique to the
mother, thereby helping her acquire this skill for herself.
3. All breastfeeding mothers will be shown how to hand express their milk.
4. It is the responsibility of those health professionals caring for both mother and baby to
ensure the mother is given help and encouragement to express milk and maintain lactation
during periods of separation from her baby.
5. Mothers who are separated from their babies are encouraged to express milk at least six to
eight times in a 24 hour period. They are shown how to express by hand and pump.

STEP 6: GIVE NEW-BORN INFANTS NO FOOD OR DRINK OTHER

THAN BREAST MILK, UNLESS MEDICALLY INDICATED
1. For the first six months, breastfed babies should receive no water or formula except in
cases of medical indication or fully informed parental choice. In hospital no water or formula
will be given to a breastfed baby unless prescribed by a medical practitioner.
2. Every effort will be made to encourage mothers to express breast milk, for
supplementation, if extra fluids or calories are required.
3. Parents must be consulted if formula is recommended and the reasons discussed in full.
Any formula prescribed must be recorded in the baby’s hospital notes or health record along
with the reason for supplementation and accompanied by a consent signed by the parent.
4. Parents who request formula should be made aware of the possible health implications and
the negative effect such action may have on breastfeeding to enable them to make a fully
informed choice. This discussion should be recorded in the health records/ consent form.
5. All mothers should be encouraged to breastfeed exclusively for at least six months and
continue breastfeeding for at least the first year of life. All weaning information should
reflect this ideal.
6. Data on infant feeding showing prevalence of both exclusive and partial breastfeeding
should be collected during their hospital stay and on discharge and transferred to community
child health staff.

STEP 7: PRACTICE ROOMING-IN, ALLOW MOTHERS AND

INFANTS TO REMAIN TOGETHER 24 HOURS A DAY
1. Mothers will assume primary responsibility for the care of their babies.
2. Separation of mother and baby while in hospital will occur only when the health of either
the mother or her baby prevents care being offered in the postnatal areas.
3. If the facility has a well-baby area/ treatment room it should not be used to routinely care
for babies.
4. Babies should not be routinely separated from their mothers at night. This applies to babies
who are formula fed as well as those babies who are breastfed.
Mothers who have delivered by caesarean section should be given appropriate care but the
policy of keeping mother and baby together will apply.
5. Mothers will be encouraged to continue to keep their babies near them when they are at
home, so they can learn how to interpret their baby’s needs and feeding cues.

STEP 8: ENCOURAGE BREASTFEEDING ON DEMAND

1. Feeding according to need is encouraged for all babies unless clinically contraindicated.
Hospital procedures should not interfere with this principle.
2. Mothers should be encouraged to continue to practise baby-led feeding throughout the time
they are breastfeeding. The importance of night-time feeding for milk production should be
explained to mothers.

STEP 9: GIVE NO ARTIFICIAL TEATS OR DUMMIES TO

BREASTFEEDING INFANTS
1. Artificial teats or dummies are not recommended for healthy term babies during the
establishment of breastfeeding. Parents wishing to use them should be advised of the possible
detrimental effects on breastfeeding to allow them to make a fully informed choice. The
information given and the parents’ decision should be documented in the appropriate health
record.
2. Nipple shields will not be recommended without full assessment by an experienced
midwife or lactation consultant. Any mother using a nipple shield must have its use fully
explained. A mother should be given information to assess when the baby is able to feed
without the shield.
 STEP 10: FOSTER THE ESTABLISHMENT OF BREASTFEEDING
SUPPORT GROUPS AND REFERS MOTHERS TO THEM ON
DISCHARGE
1. All breastfeeding mothers will be provided with contact details of health professionals who
can support them with breastfeeding, including community midwives, community child
health nurses, certified lactation consultants and
2. Telephone numbers (or other means of contact) for community child health nurses,
voluntary breastfeeding counsellors and support groups will be issued to all mothers and be
routinely displayed in all areas relevant to maternity and child health. A National 24 hour
toll-free breastfeeding helpline has been established by the Federal Government.
3. Contact details of professional and voluntary support should be regularly updated by
hospital staff to ensure correct information is given to mothers.
4. Representatives from breastfeeding support groups will be invited to continue further
development of the breastfeeding policy through involvement in appropriate meetings.

 BENEFITS OF BFHI
 Cost benefits.
 Hospitals get a public recognition.
 Hospital gets information, education and communication (IEC) material for distribution
to the mothers and the health workers.
 Gradually, will have an impact on the reduction in infant malnutrition and better child
survival in the areas catered by those hospitals.
 Greater acceptance and promotion of breast feeding and increase the rate of
breastfeeding.

 CONCLUSION:-
BFHI is a joint World Health Organisation (WHO) and United Children’s Fund (UNICEF)
project. The aim is to give every baby the best start in life by creating a health care
environment where breastfeeding is the norm and practices known to promote the health and
well-being of all babies and their mothers are followed.

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