this lecture is one of my lectures for the lactation specialist diploma students at Benha University it involves simple and easy explanation of the health facilities practices that is needed to support breast feeding the objectives for this lecture involves the following items: Health facility practices to support breast feeding WHO Guidelines for National implementation of BFHI (Baby-friendly Hospital Initiative) at national level Ten steps to successful breastfeeding implemented by WHO & UNICEF organizations

1. Health facility
practices to
support breast
feeding
By
Dr. Ahmed Mohamed Amin Nasef
Assistant lecturer in Obstetrics & Gynecology
department
Benha University

2. Objectives
• Health facility practices to support
breast feeding
• WHO Guidelines for National
implementation of BFHI (Baby-friendly
Hospital Initiative) at national level
• Ten steps to successful breastfeeding
implemented by WHO & UNICEF
organizations

3. Health Facility Practices for
Protecting Breastfeeding

4. The ten steps of the Baby-friendly Hospital Initiative (BFHI) for Protecting,
Promoting and Supporting Breastfeeding have been revised by WHO/UNICEF in
2018 and mandates in step 1 that every facility caring for mothers and babies
must fully comply by the full articles of the International Code of marketing of
HBM substitutes and the WHO subsequent relevant resolutions that protect
breastfeeding

5. WHO Guidelines for National implementation of
BFHI (Baby-friendly Hospital Initiative) at
national level

6. WHO Guidelines for National implementation
of BFHI at national level
Should be implemented by (the country national program)
The following are the summary of these guidelines:
• Appropriate care to protect, promote, and support breastfeeding is the responsibility of every facility
providing maternity and newborn services. This includes private facilities, as well as public ones, and large as
well as small facilities
• Countries need to establish national standards for the protection, promotion and support for breastfeeding
in all facilities providing maternity and newborn services, based on the updated Ten Steps to Successful
Breastfeeding and global criteria
• The Baby-friendly Hospital Initiative must be integrated with other initiatives for maternal and newborn
health, health-care improvement, health-systems strengthening and quality assurance

7. WHO Guidelines for National implementation
of BFHI
• To ensure that health-care providers have the competencies to implement the BFHI, this topic needs
to be integrated into pre-service training curricula. In addition, in-service training needs to be
provided when competencies are not yet met
• Public recognition of facilities that implement the Ten Steps and comply with the global criteria is one
way to incentivize quality improvement. Several other incentives exist, ranging from compliance with
national facility standards to performance-based financing
• Regular internal monitoring is a crucial element of both quality improvement and ongoing quality
assurance
• External assessment is a valuable tool for validating the quality of maternity and newborn services.
External assessments should be sufficiently streamlined into existing mechanisms that can be
implemented sustainably

8. Ten steps to
successful
breastfeeding

9. Ten steps to successful breastfeeding
Ten steps were implemented by the WHO & UNICEF organizations
Ten steps to successful breastfeeding (revised 2018)
The Ten Steps summarize a package of policies and procedures that facilities providing maternity and
newborn services should implement to support breastfeeding. WHO has called upon all facilities
providing maternity and newborn services worldwide to implement the Ten Steps
They are divided into 2 groups:
• Critical management procedures
Includes step 1 and 2
• Key clinical practices
Includes the other remaining 8 steps

10. Step 1
a. Comply fully with the International Code of
Marketing of Breast-milk Substitutes and relevant
World Health Assembly resolutions
b. Have a written infant feeding policy that is
routinely communicated to staff and parents
c. Establish ongoing monitoring and data-
management systems

11. Step 2
Ensure that staff have sufficient knowledge,
competence and skills to support breastfeeding

12. Step 3
Discuss the importance and
management of breastfeeding
with pregnant women and their
families

13. Step 4
Facilitate immediate and uninterrupted skin-to-skin
contact and support mothers to initiate
breastfeeding as soon as possible after birth

14. Step 5
Support mothers to initiate and maintain
breastfeeding and manage common difficulties

15. Step 6
Do not provide breastfed newborns any food or
fluids other than breast milk (HBM), unless
medically indicated

16. Step 7
Enable mothers and their infants to remain
together and to practice rooming-in 24 hours a day

17. Step 8
Support mothers to recognize and respond to their
infants’ cues for feeding

18. Step 9
Counsel mothers on the use and risks
of feeding bottles, teats and pacifiers

19. Step 10
Coordinate discharge so that parents and their
infants have timely access to ongoing support and
care