Breastfeeding Initiation and Birth Setting Practices: A Review of the Literature

Della A. Forster, RN, RM, PhD; Helen L. McLachlan, RN, RM, PhD


J Midwifery Womens Health. 2007;52(3):273-280. 

In This Article

Baby-Friendly Hospital Initiative (BFHI)

A global initiative to promote breastfeeding is the Baby-Friendly Hospital Initiative (BFHI). This WHO/United Nations Children's Fund (UNICEF) initiative commenced in 1991 in an attempt to ensure that where possible, babies are born in an environment that protects, supports, and promotes breastfeeding.[9] There is a rigorous system in place to accredit hospitals as "Baby-Friendly." Maternity providers have to demonstrate 80% compliance with each of the BFHI "Ten Steps to Successful Breastfeeding" ( Table 1 ),[10] and the process is repeated at predefined intervals to maintain accreditation. The Ten Steps summarise the maternity care practices recommended to provide optimal breastfeeding support for women.[9] As of April 2006, 53 hospitals and birth centres in the United States were accredited as Baby-Friendly.[11]


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