The document summarizes the WHO/UNICEF Baby-Friendly Hospital Initiative, which aims to make hospitals and birthing centers centers of breastfeeding support. It outlines the 10 steps of the initiative, including establishing written breastfeeding policies, training staff, rooming-in, and not providing breastmilk substitutes. Implementing these steps could save 1.5 million lives annually by promoting exclusive breastfeeding for the first six months. The document also describes the process for facilities to become Baby-Friendly designated through a self-appraisal and external assessment against global criteria.

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The Ten Steps of the WHO/UNICEF
Baby-Friendly™
Hospital Initiative
Launched in 1991, by
UNICEF and the World Health Organization
To ensure that all hospitals, maternity facilities and
communities become
Centers of Breastfeeding Support

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The Baby Friendly - 10 Steps
 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.

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The Baby Friendly - 10 Steps
 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 nipples or pacifiers (soothers) to
breastfeeding infants.
 Foster the establishment of breastfeeding support groups
and refer mothers to them on discharge from the hospital or
clinic.

4. 4
BFHI 10-Steps based on Research
If every baby were exclusively breastfed from
Birth for 6 months,
an estimated 1.5 million lives world-wide
would be saved each year.
Babies and Mother’s lives would be enhanced with
implementing the 10-Steps because:

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 Immediate postpartum breastfeeding helps Mother/Child
bonding
 Breastmilk Alone is the perfect food for Baby’s first 6-months
 Nutrients, antibodies, Hormones, Antioxidants, other factors
 Stimulates immune system – response to diseases & vaccination
 Protects from diarrhea and acute respiratory infections
 Health and emotional benefits for Mother
 Sense of empowerment and satisfaction
 Decreased blood loss postpartum
 Delayed return to fertility
 Decreased risk of breast and ovarian cancer
 Provides social/economic benefits to the Family
 Environment Benefits
BFHI 10-Steps based on Research
Why Breastfeed?
an abbreviated list

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WHY The BFHI Initiative?
Hospital, Maternity Units,
Birthing Centers
 Set a Powerful Example for New Mothers
(and Fathers)
 Can provide a “Good Start” to Breastfeeding
basics
 First Influence of the benefits of Breastfeeding
 Can instill Confidence and Empowerment to
Mothers (and Fathers) to continue Breastfeeding

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 In L&D provide information on how medical intervention
and labour interventions can affect newborns ability to
breastfeed
 Facilitate breastfeeding as soon as possible after birth
 Provide continuous skin-to-skin contact
 for at least the first 2 hours after birth or
 until after the first breastfeeding
 before routine tests – weighing & measuring
 allow some medical tests to be performed while on the breast
 Confirm that parents know to respond to early feeding
readiness cues
 Help mother choose a comfortable position
How Facilities can
Support Exclusive Breastfeeding
Promoting BFHI

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 Facilitate unrestricted breastfeeding 8-12 times per 24 hours
 Ensure breastfeeding “culture” is sustained
 Refuse to accept, market, distribute or promote breastmilk
substitutes, bottles and artificial nipples
 Empower (educate) women to breastfeed their children
exclusively for six months and to continue breastfeeding with
complementary food, well into the second year and beyond
Some of the 24 Recommendations of the International Lactation Consultant Assn document
“Evidence-based guidelines for breastfeeding management during the first fourteen days.” www.guideline.gov
How Facilities can
Support Exclusive Breastfeeding
Promoting BFHI
Correct positioning (infant)
Signs of correct latch-on (infant)
Signs (in Mother and Infant) of milk transfer
 Observe:

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 Baby-Friendly™ designation is an International
Standard
 Baby-Friendly™ maternity services have passed
external assessment according to the Global BFHI
Criteria.
 Is not appropriately applied to other medical services,
community activities, workplaces or commercial
products.
 'breastfeeding-friendly', 'mother-child friendly' or
'pro-breastfeeding' may be used for any other
complementary efforts to help mothers to breastfeed.
Baby-Friendly™ Defined

10. 10
Breastfeeding Committee for Canada
(BCC)
is the National Authority
for implementing the WHO/UNICEF
Baby-Friendly™ Hospital Initiative (BFHI)
in Canada
WHO/UNICEF BFHI™ in Canada

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How a Hospital,
Maternity Facility,
Birthing Center Becomes WHO/UNICEF Baby-Friendly™:
WHO/UNICEF BFHI™ in Canada
1. Self-Appraisal process
Form multidisciplinary committee
Complete BFHI Self-Appraisal Tool
Decision: Doesn’t Meet or Meets
2.  Recognizes need to improve
Plan strategies to address weakness areas
May contact Provincial/Territorial Committee for advice
4.  Recognizes need to improve
Plan actions to improve weak areas
When standards met , submit request to P/T Committee
3. BFHI Pre-Assessment
P/T Committee Reviews (the Approved)
Tool and breastfeeding handouts
5. External Assessment Using
BFHI Global Criteria
Breastfeeding Committee for Canada to
arrange External Assessment by 2-4 BFHI
Assessors (takes 2 – 4 days)
6.  Submit Action Plan & timetable to
meet criteria
A Certificate of Commitment is issued
P/T Committee (or BCC) provides advice up to 4 years
 Meets Baby-Friendly Hospital 
Certificate Awarded By BCC and the P/T Committee
7. Re-Assessment Every 5 years
 to Retain Baby-Friendly Criteria 

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References
 UNICEF Global Action www.unicef.ca
BREASTFEEDING AND THE BABY-FRIENDLY INITIATIVE
http://www.unicef.org/programme/breastfeeding/baby.htm
 CURRENT STATUS OF BABY-FRIENDLY HOSPITAL INITIATIVE List of Baby-Friendly
Hospitals
http://www.unicef.org/programme/breastfeeding/assets/statusbfhi.pdf
 Annex 1, Evaluating adequacy of Support for breast-feeding in maternity
hospitals, wards and clinics, Infant Feeding The Physiological Basis,
Supplement to Volume 67, 1989 of the Bulleting of the WHO
 BREASTFEEDING COMMITTEE FOR CANADA Breastfeeding Position
Statement, How a Hospital, Maternity Facility, Birthing Center Becomes
WHO/UNICEF Baby-Friendly™:
http://www.geocities.com/hotsprings/falls/1136/webdoc30.htm
 The Mother-friendly Childbirth Initiative, 10 questions to Ask, CIMS
(Coalition for Improving Maternity Services)
http://www.motherfriendly.org/resources/10Q/
 Take an interactive quiz
http://www.unicef.ca/eng/travail/breastFeeding/index.html

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How we can contribute
Support
 World Breastfeeding Week is celebrated every
year, on the anniversary of the Innocenti
Declaration. ( Aug 1- 7 ) UNICEF supports World
Breastfeeding Week
Help facilities work towards a BFHI designation
 Canada’s only Baby-Friendly Hospital is Brome-
Missisquoi-Perkins Hospital in Cowansville,
Quebec. Designated in July 1st, 1999 (as of March 2002)
Thankyoufor listening!
Kairan Athwal and Sylviate Boekhorst