Baby Friendly Hospital Initiative

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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[1][2] following the adoption of the Innocenti Declaration on breastfeeding promotion in 1990.[3] 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. It aims at improving the care of pregnant women, mothers and newborns at health facilities that provide maternity services for protecting, promoting and supporting breastfeeding, in accordance with the International Code of Marketing of Breastmilk Substitutes.[4]

UNICEF, the World Health Organization, and many national government health agencies recommend that babies are breastfed exclusively for their first six months of life. Studies have shown that breastfed babies are less likely to suffer from serious illnesses, including gastroenteritis, asthma, eczema, and respiratory and ear infections.[5][6][7][8] Adults who were breastfed as babies may be less likely to develop risk factors for heart disease such as obesity and high blood pressure. There are benefits for mothers too: women who don't breastfeed have increased risk of developing heart disease, hypertension, diabetes, high cholesterol, breast cancer, ovarian cancer and hip fractures in later life.[9][10][11] The BFHI aims to increase the numbers of babies who are exclusively breastfed worldwide, a goal which the WHO estimates could contribute to avoiding over a million child deaths each year, and potentially many premature maternal deaths as well.[12][13][14]


The criteria for a hospital's Baby Friendly accreditation include:

  1. Have a written breastfeeding policy that is routinely communicated to all health care staff.
  2. Train all health care staff in skills necessary to implement this policy.
  3. Inform all pregnant women about the benefits and management of breastfeeding.
  4. Help mothers initiate breastfeeding within one half-hour of birth.
  5. Show mothers how to breastfeed and maintain lactation, even if they should be separated from their infants.
  6. Give newborn infants no food or drink other than breastmilk, not even sips of water, unless medically indicated.
  7. Practice rooming in - that is, allow mothers and infants to remain together 24 hours a day.
  8. Encourage breastfeeding on demand.
  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 them on discharge from the hospital or clinic.

The program also restricts use by the hospital of free formula or other infant care aids provided by formula companies and recommends that when formula is medically needed, it should be given in a small cup or spoon, rather than a bottle and should only be used to supplement breastfeeding.

Since the program's inception, approximately 15,000 facilities in more than 152 countries have been inspected and accredited as "Baby-Friendly."[1][2]

Recommended alternatives[edit]

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.[15] A special formula is manufactured for premature babies, although the World Health Organization recommends it only if breast-milk is medically not an option such as if a premature baby has to be fed formula through a tube to maintain a healthy weight.[15] The World Health Organization advocates the importance of a baby being close to its mother whenever possible even if the mother does not breastfeed.[16]

Regional schemes[edit]


In Canada, the provinces of Quebec and New Brunswick have mandated the implementation of the BFHI. In 2012, the Ministry of Health and Long Term Care in Ontario added BFI status to their progress indicators for Public Health Units thus requiring all Public Health Units in Ontario to begin implementation of BFI.[17] Other provinces and territories are implementing strategies at regional and local levels.[18] As of 2008, 18 health care facilities (9 hospitals & birthing centres and 9 community health services) had been designated "Baby-Friendly" across the country.[19] The B.C. Women’s Hospital and Health Centre has been recognized as a breast-feeding and “baby-friendly” hospital by the World Health Organization (WHO) and UNICEF since 2008. It is the largest hospital in Canada to receive the designation.[20]


China, now has more than 6,000 Baby-Friendly Hospitals, exclusive breastfeeding in rural areas rose from 29 per cent in 1992 to 68 per cent in 1994; in urban areas, the increase was from 10 per cent to 48 per cent.[1]


In Cuba, 49 of the country's 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 per cent in 1990 to 72 per cent in 1996.[1]

Hong Kong[edit]

In Hong Kong several hospitals have shown interest in being designated Baby Friendly. However, only Queen Elizabeth Hospital has advanced past the Award of Level 2 Participation stage and is well on its way to receiving BFHI accreditation.[21]


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".[22]


In 2014 78.60% of babies were born in BFHI hospitals. Between 2001 and 2013, the increase in certified hospitals was from 38 to 176.[23]

United Kingdom[edit]

The UNICEF UK Baby Friendly Initiative was launched in the United Kingdom in 1995.[24] 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. The Baby Friendly Initiative accredits health-care facilities that adopt internationally recognised best practice standards for breastfeeding.[25] During each stage of accreditation, the Initiative provides support as facilities implement standards relating to policies and procedures, staff education, effective auditing, educating pregnant women and mothers, and other relevant areas.

In 1998, its principles were extended to cover the work of community health-care services with the Seven Point Plan for the Promotion, Protection and Support of Breastfeeding in Community Health Care Settings.[25] In 2005, it introduced an accreditation programme for university departments responsible for midwifery, health visitor and public health nurse education. This ensures that newly qualified midwives and health visitors are equipped with the basic knowledge and skills they need to support breastfeeding effectively. The program's emphasis on applying the standards in post-natal and education settings makes it unique amongst the various Baby Friendly programmes in other countries.[citation needed]

There are now 52 Baby Friendly-accredited maternity hospitals in the UK and ten accredited community health-care providers.[citation needed] It has been estimated that if all babies were breastfed, over £35m would be saved by the NHS in England and Wales each year in treating gastroenteritis alone.[26] Despite this, breastfeeding rates in the UK are amongst the lowest in Europe: 78 per cent of babies born in the UK are breastfed at birth, falling to 63 per cent at one week. Only one in five babies still receives breastmilk at six months.[27] In 2009, the Department of Health awarded a total of £4 million to 40 Primary Care Trusts in areas with low rates of breastfeeding to support them in seeking Baby Friendly accreditation.[citation needed]

By the end of 2013 the success of the initiative in Scotland meant that 90% of Scottish mothers now give birth in a UNICEF-accredited Baby Friendly hospital. This compares with 30% of mothers in England, 58% for Wales and 57% in Northern Ireland.[28]

United States[edit]

The first hospitals verified as Baby-Friendly in the USA were on the Pacific coast. Among the earliest, if not the first US hospital to receive this designation was Evergreen Hospital Medical Center, in Kirkland, WA, which was certified in September 1996. All of these early adopters were able to achieve 100% breastfeeding initiation rates.[29] 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.[30] In 2011, New York University Langone Medical Center became the second hospital to receive the Baby-Friendly Hospital designation in New York City.[31]


  1. ^ a b c d UNICEF. The Baby-Friendly Hospital Initiative. Accessed 4 August 2011.
  2. ^ a b World Health Organization. Baby-friendly Hospital Initiative. Accessed 4 August 2011.
  3. ^ UNICEF. INNOCENTI DECLARATION on the Protection, Promotion and Support of Breastfeeding. Adopted at the WHO/UNICEF meeting on "Breastfeeding in the 1990s: A Global Initiative", held at the Spedale degli Innocenti, Florence, Italy, 30 July-1 August 1990.
  4. ^ "Breastfeeding Initiation at BFI Hospitals". Sacred Heart University. Retrieved 2016-07-26. 
  5. ^ "Breastfeeding and Maternal and Infant Health Outcomes in Developed Countries". Agency for Healthcare Research & Quality. 2012-12-06. Retrieved 2013-09-01. 
  6. ^ Greer, F. R.; Sicherer, S. H.; Burks, A. W. (1 January 2008). "Effects of Early Nutritional Interventions on the Development of Atopic Disease in Infants and Children: The Role of Maternal Dietary Restriction, Breastfeeding, Timing of Introduction of Complementary Foods, and Hydrolyzed Formulas". Pediatrics. 121 (1): 183–191. PMID 18166574. doi:10.1542/peds.2007-3022. 
  7. ^ Mahr, Todd A. (November 1, 2008). "Effect of Breastfeeding on Lung Function in Childhood and Modulation by Maternal Asthma and Atopy". Pediatrics. 122: S176–S177. doi:10.1542/peds.2008-2139H. 
  8. ^ "The effect of breastfeeding duration on lung function at age 10 years: a prospective birth cohort study". Thorax. 64: 62–66. 10 November 2008. doi:10.1136/thx.2008.101543. 
  9. ^ Rich-Edwards JW, Stampfer MJ, Manson JE, Rosner B, Hu FB, Michels KB, Willett WC (1 September 2004). "Breastfeeding during infancy and the risk of cardiovascular disease in adulthood". Epidemiology. 15 (5): 550–556. PMID 15308954. doi:10.1097/ 
  10. ^ Richard M. Martin, David Gunnell and George Davey Smith (2005). "Breastfeeding in Infancy and Blood Pressure in Later Life: Systematic Review and Meta-Analysis". American Journal of Epidemiology. 161 (1): 15–26. doi:10.1093/aje/kwh338. 
  11. ^ "World Cancer Research Fund" (PDF). UK Baby Friendly Initiative. UNICEF. 2007. Retrieved 2013-09-01. 
  12. ^ World Health Organization. 10 facts on breastfeeding, accessed 20 April 2011.
  13. ^ Schwarz, E. B.; Ray, R. M.; Stuebe, A. M.; Allison, M. A.; Ness, R. B.; Freiberg, M. S.; Cauley, J. A. (2009). "Duration of lactation and risk factors for maternal cardiovascular disease". Obstetrics & Gynecology. 113 (5): 974–82. PMC 2714700Freely accessible. PMID 19384111. doi:10.1097/ 
  14. ^ Bartick, M. C.; Stuebe, A. M.; Schwarz, E. B.; Luongo, C; Reinhold, A. G.; Foster, E. M. (2013). "Cost analysis of maternal disease associated with suboptimal breastfeeding". Obstetrics & Gynecology. 122 (1): 111–9. PMID 23743465. doi:10.1097/AOG.0b013e318297a047. 
  15. ^ a b "What if a baby is born preterm and cannot breastfeed?". World Health Organisation. Retrieved 8 July 2014. 
  16. ^ "Feeding in exceptionally difficult circumstances". World Health Organisation. Retrieved 8 July 2014. 
  17. ^ Technical Document:Public Health Accountability Agreement Indicators 2011-13 Ministry of Health and Long-Term Care Public Health Division Health Promotion Division
  18. ^ Breastfeeding Committee for Canada. BFI in Canada. Accessed 2 August 2011.
  19. ^ New Brunswick Department of Health. New Brunswick Provincial Report of the Baby-Friendly Self-Assessment Survey. March 2008.
  20. ^ "B.C. Women's Hospital recognized as 'baby-friendly'". Archived from the original on 2015-09-24. 
  21. ^ "Healthcare Facilities". Retrieved 3 April 2016. 
  22. ^ Hofvander Y. "Breastfeeding and the Baby Friendly Hospitals Initiative (BFHI): Organization, response and outcome in Sweden and other countries." Acta Paediatrica, 94(8): 1012–1016, August 2005. doi:10.1111/j.1651-2227.2005.tb02038.x
  23. ^ "The Gender Dimension of the MDGs in R. O. C. (Taiwan)". Retrieved 24 March 2016. 
  24. ^ "About Baby Friendly: All about us: History of Baby Friendly in the UK". UNICEF UK. Archived from the original on 12 September 2014. Retrieved 24 August 2014. 
  25. ^ a b UNICEF UK. What is the Baby Friendly Initiative? Archived 2011-07-27 at the Wayback Machine. Accessed 4 August 2011.
  26. ^ "Local Authority Approach" (PDF). UK Baby Friendly Initiative. UNICEF. Retrieved 2013-09-01. 
  27. ^ "Infant Feeding Survey - 2005, Early results". Health & Social Care Information Centre. 2006-05-19. Retrieved 2013-09-01. 
  28. ^ "More Scottish women give birth in UNICEF UK accredited hospitals than in rest of UK, leading to more mothers successfully starting to breastfeed their babies" (Press release). UNICEF. 27 November 2013. Retrieved 7 July 2014. 
  29. ^ Merewood A, Mehta SD, Chamberlain LB, Philipp BL, Bauchner H (September 2005). "Breastfeeding Rates in US Baby-Friendly Hospitals: Results of a National Survey" (PDF). Pediatrics. 116 (3): 628–634. PMID 16140702. doi:10.1542/peds.2004-1636. 
  30. ^ "Baby-Friendly Harlem Hospital". HHC Today. July 2008. Archived from the original on 2013-12-03. Retrieved 2013-09-01. 
  31. ^ "NYU Langone Medical Center Awarded Official Baby-Friendly USA Designation". NYU Langone Medical Center. 2011. Retrieved 2013-09-01. 

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