This program is delivered to mothers of newborn infants and intends to impact mothers and babies.

The Baby-Friendly Hospital Initiative (BFHI) is designed to champion, encourage, and help sustain breastfeeding at health care centers that provide maternity services in order to increase the well-being of mothers and their children.

A randomized controlled trial found that mothers in the BFHI program, compared to mothers in control groups, reported higher rates of exclusive breastfeeding at 3 and 6 months; any breastfeeding at all ages up to 12 months; exclusive breastfeeding of the subsequent child for at least 3 months; and the duration of any breastfeeding of the subsequent child.  Infants in the program experienced lower rates of gastrointestinal infections and atopic eczema. Observational studies conducted by research groups around the world have shown that BFHI participation is associated with increases in breastfeeding initiation, exclusivity, and duration and improvement in health outcomes in newborns; however, most studies lack a rigorous design and/or assess important short-term effects rather than longer-term program effects.  Evidence supporting each program step is summarized in Evidence for Ten Steps to Successful Breastfeeding, which is accessible online at https://www.who.int/nutrition/publications/evidence_ten_step_eng.pdf

BFHI represents a worldwide endeavor initiated by the World Health Organization (WHO) and United Nations Children's Fund (UNICEF) to promote breastfeeding in health care facilities.  Participating health care facilities must be accredited to offer the BFHI program and are referred to as baby-friendly.  These facilities comply with the WHO/UNICEF Ten Steps to Successful Breastfeeding guidelines:

1. Have a written breastfeeding policy that is routinely communicated to all health care staff.
2. Train staff to have the knowledge and skills to support breastfeeding.
3. Inform all pregnant women about the benefits and management of breastfeeding.
4. Help mothers initiate breastfeeding as soon as possible after birth and facilitate immediate skin-to-skin contact.
5. Show mothers how to breastfeed and how to maintain lactation even if separated from their infants.
6. Give newborn infants no food or drink other than breastmilk, unless medically indicated.
7. Practice rooming-in, which allows mothers and infants to remain together 24 hours a day.
8. Help mothers to recognize and respond to their infants' cues for feeding.
9. Give no artificial teats or pacifiers, also called dummies or soothers, to breastfeeding infants.
10. Foster the establishment of breastfeeding support groups and refer mothers to these groups on discharge from the hospital or clinic.

The World Health Organization and the United Nations Children's Fund launched the BFHI in 1991. Since then, more than 20,000 maternity facilties in 150 countries, including over 600 hospitals and birthing centers in all 50 states and the District of Columbia in the United States, have received BFHI accreditation.  Weed Army Community Hospital in Ft. Irwin, California, and Naval Hospital Jacksonville in Jacksonville, Florida, are baby-friendly military hospitals. Since 1996, more than 6.5 million babies have been born in BFHI designated faciities in the United States.

The U.S. accrediting body, Baby-Friendly U.S.A., Inc., has created a four-phase training process, Discovery, Development, Dissemination, and Designation, to be completed by facilities seeking accreditation. Each phase may require up to 1 year to complete.  U.S. hospitals typically pay $0, $4,425 $4,500, and $4,800 for each phase, respectively.  Freestanding birth centers and small hospitals are charged smaller phase fees, and facilities that require over 1 year for phase completion pay larger phase fees. To achieve a Baby Friendly designation, facilities are required to verify policies, curriculum, action plans, quality improvement projects, staff training, and competency and complete a readiness interview and an on-site survey. Upon successful completion of this process, as determined by an onsite assessment, the facility will be granted a license to use the Baby-Friendly certification mark. Please use details in the Contact section for more information.

Considerations for implementing this program include acquiring buy-in from hospital administration and maternity care staff, securing funding for the accreditation training and assessment processes and annual designation fees, and identifying highly motivated individuals to oversee the facility accreditation process (e.g., develop a work plan, implement policy changes, manage staff training, collect data) and annual quality improvement efforts.

The Clearinghouse can help address these considerations. Please call 1-877-382-9185 or email Clearinghouse@psu.edu

If you are interested in implementing BFHI, the Clearinghouse is interested in helping you!
Please call 1-877-382-9185 or email Clearinghouse@psu.edu

Implementation time varies by site and depends on the number of women and infants receiving maternity care.

An assessment fee is required for accreditation and varies by site depending on assessor travel expenses.  Once accredited, all facilities pay an Annual Designated Facility Fee of $1,600. Additional costs include staff and provider training, purchasing breast milk substitutes, bottles, nipples, pacifiers, and other infant feeding supplies.

To move BFHI to the Effective category on the Clearinghouse Continuum of Evidence at least one external evaluation must be conducted that demonstrates sustained, positive outcomes.  This study must be conducted independently of the program developer.

The Clearinghouse can help you develop an evaluation plan to ensure the program components are meeting your goals. Please call 1-877-382-9185 or email Clearinghouse@psu.edu

Contact the Clearinghouse with any questions regarding this program.
Phone: 1-877-382-9185 Email: Clearinghouse@psu.edu

You may also contact Baby-Friendly U.S.A., Inc., by mail 125 Wolf Rd, Suite 402, Albany, NY 12205, phone 1-518-621-7982, fax 1-518-621-7983, or visit https://www.babyfriendlyusa.org/about/contact/

https://www.who.int/activities/promoting-baby-friendly-hospitals and https://www.babyfriendlyusa.org/

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