WHO/UNICEF Ten Steps to Successful Breastfeeding

The Baby Friendly Hospital Initiative (BFHI) is a global campaign of the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF), which recognises that implementing best practice in health services is crucial to the success of breastfeeding programmes.

Best practice is represented by The Ten Steps to Successful Breastfeeding (The Ten Steps), which were first published in Protecting, Promoting and Supporting Breastfeeding: The Special Role of Maternity Services - a joint WHO/UNICEF Statement in 1989.  See below for information on the proposed revision of the Ten Steps.

According to The Ten Steps, every facility providing maternity services and care for new born infants should:

  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 a half-hour of birth (this step is now interpreted as: Place babies in skin-to-skin contact with their mothers immediately following birth for at least an hour. Encourage mothers to recognise when their babies are ready to breastfeed, offering help if needed)
  5. show mothers how to breastfeed, and how to maintain lactation even if they should be separated from their infants
  6. give new born infants of breastfeeding mothers no food or drink other than breastmilk, unless medically indicated
  7. practise rooming-in - allow mothers and infants to remain together 24 hours a day
  8. encourage breastfeeding on demand
  9. give no artificial teats of 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

Endorsement of the WHO International Code of Marketing of Breastmilk Substitutes and subsequent World Health Assembly (WHA) resolutions is a prerequisite for designation of Baby Friendly even though it is not included as one of The Ten Steps.

As a result, the BFHI has two main goals:

  • to encourage and facilitate the transformation of hospital facilities in accordance with the WHO/UNICEF Ten Steps to Successful Breastfeeding
  • to end the practice of distribution of free and low-cost supplies of breastmilk substitutes to hospitals and health care facilities in accordance with the International Code of Marketing of Breastmilk Substitutes and subsequent relevant WHA Resolutions

Revision of The Ten Steps - February 2018