Baby Friendly Hospital Initiative (BFHI)

Introduction & Background

Origin: Launched globally by WHO and UNICEF in 1991, following the Innocenti Declaration of 1990.
Core Objective: To protect, promote, and support breastfeeding in facilities providing maternity and newborn services.
Recent Update: Revitalized in 2018 by WHO/UNICEF to emphasize sustainability, scaling up, and integration into broader healthcare quality standards.

The foundation of the BFHI is the “Ten Steps to Successful Breastfeeding.” The 2018 update divided these into two distinct categories:

1. Hospital Policies:

1a. Comply fully with the International Code of Marketing of Breast-milk Substitutes and relevant World Health Assembly resolutions.
1b. Have a written infant feeding policy that is routinely communicated to staff and parents.
1c. Establish ongoing monitoring and data-management systems. 2. Staff Competency:
Ensure that staff have sufficient knowledge, competence, and skills to support breastfeeding through mandatory, standardized training.

3. Antenatal Care:

Discuss the importance and management of breastfeeding with pregnant women and their families. 4. Care Right After Birth:
Facilitate immediate and uninterrupted skin-to-skin contact.
Support mothers to initiate breastfeeding as soon as possible after birth (ideally within 1 hour for normal deliveries). 5. Support Mothers with Breastfeeding:
Support mothers to initiate and maintain breastfeeding and manage common difficulties (e.g., proper positioning, attachment, and hand expression of breast milk). 6. Supplementing:
Do not provide breastfed newborns any food or fluids other than breast milk, unless medically indicated. 7. Rooming-in:
Enable mothers and their infants to remain together and practice rooming-in 24 hours a day (promoting zero separation). 8. Responsive Feeding:
Support mothers to recognize and respond to their infants’ cues for feeding (also known as feeding on demand). 9. Counseling on Bottles, Teats, and Pacifiers:
Counsel mothers on the use and risks of feeding bottles, teats, and pacifiers. 10. Discharge and Ongoing Support:
Coordinate discharge so that parents and their infants have timely access to ongoing support and care (e.g., linking them to community peer support groups or lactation clinics).

BFHI-India: Spearheaded by the Breastfeeding Promotion Network of India (BPNI) in collaboration with the Indian Academy of Pediatrics (IAP) and other healthcare associations.
The IMS Act: In India, absolute, 100% compliance with the Infant Milk Substitutes, Feeding Bottles and Infant Foods (IMS) Act is a non-negotiable legal prerequisite for BFHI certification.
Integration with National Health Programs:
- MAA (Mothers’ Absolute Affection) Programme: A flagship government initiative focusing heavily on early initiation and exclusive breastfeeding.
- LaQshya Initiative: Focuses on quality improvement in labor rooms and maternity operating theaters, mandating skin-to-skin contact and early breastfeeding initiation.
- Lactation Management Centres: Establishment of human milk banks aligned with BFHI protocols to support vulnerable newborns.

Self-Appraisal: The hospital reviews its own practices using standardized WHO/UNICEF or national BFHI-India toolkits.
External Assessment: Conducted by trained external assessors who evaluate policies, test staff knowledge, and interview mothers about their experiences.
Certification: Awarded only upon scoring >80% in all steps and demonstrating full compliance with the IMS Act. The “Baby Friendly” status requires periodic re-assessment to be maintained.

Infant Health: Significant increase in early initiation and exclusive breastfeeding rates at 6 months; marked reduction in neonatal morbidity, specifically related to diarrheal diseases, respiratory infections, and necrotizing enterocolitis (NEC).
Maternal Health: Enhances maternal-infant bonding, decreases the incidence of postpartum hemorrhage (due to oxytocin release from early suckling), and delays the return of fertility (lactational amenorrhea).