The Baby-Friendly Hospital Initiative

Helping to establish breastfeeding is an important aspect of the care provided by a birthing facility. Numerous studies have shown that maternity care practices significantly impact the initiation and duration of breastfeeding.^1,2 The Baby-Friendly^® (United Nations Children's Fund [UNICEF], New York, NY) Hospital Initiative (BFHI) provides the framework to assist facilities with making the institutional changes necessary to assist mothers with achieving their breastfeeding goals. The BFHI is a quality improvement, recognition, and award program that celebrates birthing facilities that successfully implement the World Health Organization (WHO)/UNICEF's Ten Steps to Successful Breastfeeding. The Ten Steps were developed by a team of global experts and consist of evidence-based practices that have been shown to increase breastfeeding initiation and duration. ³ They are endorsed and promoted by the major maternal and child health authorities in the United States.

The BFHI is a global program sponsored by WHO and UNICEF. A national authority is established for each country. Baby-Friendly USA, Inc., a not-for-profit, 501(c)(3) organization, is recognized by UNICEF/WHO as the national authority in the United States.

The BFHI is growing in popularity in the United States, perhaps because of a broader recognition of the importance of breastfeeding and the role of the birthing facility in helping to establish lactation, increased funding opportunities targeted to improving breastfeeding rates, increased state and local focus on improving maternity care practices, the new Joint Commission perinatal core measures including exclusive breastmilk feeding, and the Center for Disease Control and Prevention's facility-specific Maternity Practices in Infant Nutrition and Care reports.

To achieve designation, facilities must thoroughly evaluate their current practices and, where necessary, adopt new policies and procedures that incorporate all Ten Steps to Successful Breastfeeding. The process entails registering with Baby-Friendly USA, Inc., completing all of the requirements, and ultimately demonstrating during an on-site assessment that they have correctly integrated all Ten Steps to Successful Breastfeeding into their practice for healthy newborns. To assist facilities with self-evaluation and planning for incorporating all necessary changes, Baby-Friendly USA has implemented a process called “4-D Pathway to Baby-Friendly Designation.” This new method incorporates all of the high standards set by the team of global experts, while breaking down the process into manageable and achievable tasks. The 4-D Pathway ensures that the principles of the BFHI are fully implemented in a logical and efficient manner. There are four phases to the 4-D Pathway—Discovery, Development, Dissemination, and Designation:

Discovery Phase. Facilities engage in a process to discover the benefits and process for qualifying for the Baby-Friendly designation.

The Baby-Friendly designation is conferred for 5 years. Once designated, facilities are expected to maintain the high standards of care that they work hard to achieve. Under the 4-D Pathway, they are required to complete annual quality assurance projects for two steps each year. The steps are assigned by Baby-Friendly USA, Inc. At the end of 5 years, the facility must undergo another on-site assessment.

For more information visit www.babyfriendlyusa.org or write to info@babyfriendlyusa.org.