Overview

The Baby-friendly Hospital Initiative (BFHI) is a global effort launched by WHO and UNICEF to implement practices that protect, promote and support breastfeeding. It was launched in 1991 in response to the Innocenti Declaration. The global BFHI materials have been revised, updated and expanded for integrated care. The materials reflect new research and experience, reinforce the International Code of Marketing of Breast-milk Substitutes, support mothers who are not breastfeeding, provide modules on HIV and infant feeding and mother-friendly care, and give more guidance for monitoring and reassessment.

Contents

• Preface for the 2009 BFHI materials: Revised, Updated and Expanded for Integrated Care
• Section 1. BACKGROUND AND IMPLEMENTATION
  • 1.1. COUNTRY LEVEL IMPLEMENTATION
    • Background Rationale for Revisions
    • Getting Started
    • Five Steps in Implementing BFHI at the Country Level
    • National Criteria for Baby-friendly Community Designation
    • Section 1.1 - Annex 1 Five Steps in Implementing BFHI at the Country Level: Suggested Inputs and Outputs
    • Section 1.1 - Annex 2 Suggested questions for a rapid baseline country assessment, to include literature review and key informant interviews
    • Section 1.1 - Annex 3 Excerpts from recent WHO, UNICEF, and other global publications and releases
    • Section 1.1 - Annex 4 The contribution of Breastfeeding and Complementary Feeding to achieving the Millennium Development Goals
  • 1.2. HOSPITAL LEVEL IMPLEMENTATION
    • Breastfeeding rates
    • Supplies of breast-milk substitutes
    • Support for non-breastfeeding mothers
    • Mother-friendly care
    • HIV and infant feeding
    • The Baby-friendly Hospital designation process
    • Section 1.2: Annex 1 Applying the Ten Steps in facilities settings with high HIV prevalence
  • 1.3. THE GLOBAL CRITERIA FOR THE BFHI
    • Criteria for the 10 Steps and other components
    • Section 1.3 - Annex 1 Acceptable medical reasons for use of breast-milk substitutes
  • 1.4. COMPLIANCE WITH THE INTERNATIONAL CODE OF MARKETING OF BREAST-MILK SUBSTITUTES
    • What is the Code?
    • How is the Code relevant to the Baby-friendly Hospital Initiative?
    • Which products fall under the scope of the Code?
    • What does the Code say?
    • Who is a “health worker” for the purposes of the Code?
    • What are a health worker’s responsibilities under the Code?
    • Does the Code ban all free and low-cost supplies of infant formula and other breast-milk substitutes (including follow-on formula) in health facilities?
    • Should free supplies be donated for pre-term and low birth weight infants? Some argue that these infants need early supplementation, and therefore free supplies should be permitted
    • Should free supplies be donated for infants of HIV-positive mothers who have chosen to formula feed?
    • Should the prohibition extend to Maternal Child Health, primary health, and rural clinics?
    • Why not permit free supplies in paediatric wards, since older infants may already be using feeding bottles?
    • Is there a working definition for “low-cost” supplies?
    • Is the Code still relevant in view of the HIV pandemic and the increased need for formula?
  • 1.5. BABY-FRIENDLY EXPANSION AND INTEGRATION POSSIBILITIES
    • Baby-friendly communities: Creating Step Ten
    • BFHI and Prevention of Mother-to-Child Transmission (PMTCT) of HIV/AIDS
    • Mother-baby-friendly facilities
    • Baby-friendly neonatal intensive care and paediatric units
    • Baby-friendly physician’s office: Optimizing care for infants and children
    • Baby-friendly complementary feeding
    • Mother-baby friendly health care - everywhere!
  • 1.6. RESOURCES, REFERENCES AND WEBSITES
    • UNICEF
    • WHO
    • OTHER ORGANIZATIONS: POLICIES, BACKGROUND AND PROTOCOLS
    • OTHER SOURCES
    • JOURNAL REFERENCE SITES
• Section 2. STRENGTHENING AND SUSTAINING THE BABY-FRIENDLY HOSPITAL INITIATIVE: A COURSE FOR DECISION-MAKERS
  • Course guide
    • Background
    • Course description
    • Course preparation
    • Course site
    • Course materials
    • Initial course activities
    • Evaluation and reporting
    • Follow-up
    • Annex A Sample agendas for the Decision-makers Course
    • Annex B Strengthening and sustaining the Baby-friendly Hospital Initiative: A course for decision-makers
    • Annex C Course for decision-makers photo slide inventory
  • Session 1. The national infant feeding situation
    • Duration
    • Teaching methods
    • Preparation for session
    • Training materials
    • References
    • Outline
    • Session 1 Handouts
    • Session 1 Slides
    • Session 1 Transparencies
  • Session 2. Benefits of breastfeeding
    • Duration
    • Teaching methods
    • Preparation for session
    • Training materials
    • References
    • Outline
    • Summaries of research studies presented during Session 2
    • Session 2 Handouts
    • Session 2 Slides
    • Session 2 Transparencies
  • Session 3. The baby-friendly Hospital Initiative
    • Duration
    • Teaching methods
    • Preparation for session
    • Training materials
    • References
    • Outline
    • Session 3 Handouts
    • Session 3 Slides
    • Session 3 Transparencies
  • Session 4. The scientific basis for the “Ten steps to successful breastfeeding”
    • Duration
    • Teaching methods
    • Preparation for session
    • Training materials
    • References
    • Outline
    • Summaries of research studies presented during Session 4
    • Session 4 Handouts
    • Session 4 Slides
    • Session 4 Transparencies
  • Session 4. The scientific basis for the “Ten steps to successful breastfeeding” for settings with high HIV prevalence
    • Duration
    • Teaching methods
    • Preparation for session
    • Training materials
    • References
    • Outline
    • Summaries of research studies presented during Session 4
    • Session 4 Handouts
    • Session 4 Slides
    • Session 4 Transparencies
  • Session 5. Becoming “Baby-friendly”
    • Duration
    • Teaching methods
    • Preparation for session
    • Training materials
    • References
    • Outline
    • Session 5 Handouts
    • Session 5 Slides
    • Session 5 Transparencies
  • Session 5. Becoming “baby-friendly” in settings with high HIV prevalence
    • Duration
    • Teaching methods
    • Preparation for session
    • Training materials
    • References
    • Outline
    • Session 5 Handouts
    • Session 5 Slides
    • Session 5 Transparencies
  • Session 6. Costs and savings
    • Duration
    • Teaching methods
    • Preparation for session
    • Training materials
    • References
    • Outline
    • Summaries of research studies presented during Session 6
    • Session 6 Handouts
    • Session 6 Slides
    • Session 6 Transparencies
  • Session 7. Appraising policies and practices
    • Duration
    • Teaching methods
    • Preparation for session
    • Training materials
    • References
    • Outline
  • Session 8. Developing action plans
    • Duration
    • Teaching methods
    • Preparation for session
    • Training materials
    • References
    • Outline
    • Session 8 Handouts
    • Session 8 Slides
    • Session 8 Transparencies
• Section 3. BREASTFEEDING PROMOTION AND SUPPORT IN A BABY-FRIENDLY HOSPITAL: A 20-HOUR COURSE FOR MATERNITY STAFF
  • 3.1. GUIDELINES FOR COURSE FACILITATORS
    • Course objectives
    • Length of the course
    • Preparing for the course
    • Course materials
    • Presentation of the course
    • HIV and infant feeding
    • Annex 1 Course Planning Checklist
    • Annex 2 Example of a Course Timetable – held over 3 days
    • Annex 3 Resources for further information
    • Annex 4 Instructions to make a cloth breast model
    • Annex 5 Assessment of Learning Tools
    • Annex 6 Picture credits
    • Annex 7 Notes for an orientation session for non-clinical staff
  • 3.2. SESSION OUTLINES
    • WELCOME SESSION
      • Time
      • Materials
      • Welcome participants to the course
      • Describe course methods and timetable
    • Session 1. THE BABY-FRIENDLY HOSPITAL INITIATIVE: A PART OF THE GLOBAL STRATEGY
      • Session Objectives
      • Materials
      • Further reading for facilitators
      • 1 Global Strategy for Infant and Young Child Feeding
      • 2 Baby-friendly Hospital Initiative
      • 3 BFHI is important in areas of high HIV prevalence
      • 4 How this course can assist this health facility
      • 5 How the Global Strategy fits with other activities
      • Session 1 Summary
    • Session 2. COMMUNICATION SKILLS
      • Session Objectives
      • Materials
      • Preparation for the demonstrations
      • Further reading for facilitators
      • 1 Communication skills
      • 2 Practice communication skills
      • Session 2 Summary
      • Session 2 Demonstrations
    • Session 3. PROMOTING BREASTFEEDING DURING PREGNANCY – STEP 3
      • Session Objectives
      • Materials
      • Further reading for facilitators
      • Introduction
      • 1 Discussion of breastfeeding with pregnant women
      • 2 Antenatal breast and nipple preparation
      • 3 Women who need extra attention
      • 4 Antenatal discussion with women who are HIV-positive
      • 5 Discuss breastfeeding with a pregnant woman
      • Session 3 Summary
    • Session 4. PROTECTING BREASTFEEDING
      • Session Objectives
      • Materials
      • Further reading for facilitators
      • Introduction
      • 1 The effect of marketing on infant feeding practices
      • 2 The International Code of Marketing of Breast-milk Substitutes
      • 3 How health workers can protect families from marketing
      • 4 Donations in emergency situations
      • 5 How to respond to marketing practices
      • Session 4 Summary
    • Session 5. BIRTH PRACTICES AND BREASTFEEDING - STEP 4
      • Session Objectives
      • Materials
      • Further Reading for Facilitators
      • 1 Labour and birth practices to support early breastfeeding
      • 2 Importance of early contact
      • 3 Helping to initiate breastfeeding
      • 4 Ways to support breastfeeding after a Caesarean section
      • 5 BFHI practices and women who are not breastfeeding
      • Session 5 Summary
    • Session 6. HOW MILK GETS FROM BREAST TO BABY
      • Session Objectives
      • Materials
      • Further reading for facilitators
      • Introduction
      • 1 Parts of the breast involved in lactation
      • 2 Breast milk production
      • 3 The baby’s role in milk transfer
      • 4 Breast care
      • Session 6 Summary
    • Session 7. HELPING WITH A BREASTFEED - STEP 5
      • Session Objectives
      • Materials
      • Further reading for facilitators
      • Preparation for the demonstration
      • 1 Positioning for breastfeeding
      • 2 How to assess a breastfeed
      • 3 Recognise signs of positioning and attachment
      • 4 Help a mother to learn to position and attach her baby
      • 5 When to assist with breastfeeding
      • 6 Practice in a small group helping a ‘mother’
      • 7 Baby who has difficulty attaching to the breast
      • Session 7 Summary
    • Session 8. PRACTICES THAT ASSIST BREASTFEEDING – STEPS 6, 7, 8 AND 9
      • Session Objectives
      • Materials
      • Further Reading for facilitators
      • 1 Rooming-in
      • 2 Baby-led feeding
      • 3 Ways to wake a sleepy baby and to settle a crying baby
      • 4 Avoid unnecessary supplements
      • 5 Avoid bottles and teats
      • 6 Discussion – removing barriers to early breastfeeding
      • Session 8 Summary
    • Session 9. MILK SUPPLY
      • Session Objectives
      • Materials
      • Further reading for facilitators
      • 1 Concerns about “Not enough milk”
      • 2 Normal growth patterns of babies
      • 3 Improving milk intake and milk production
      • 4 Discuss a case study
      • Session 9 Summary
    • Session 10. INFANTS WITH SPECIAL NEEDS
      • Session Objectives
      • Materials
      • Further reading for facilitators
      • 1 Breastfeeding infants who are preterm, low birth weight or ill
      • 2 Breastfeeding more than one baby
      • 3 Prevention and management of common clinical concerns
      • 4 Medical reasons for food other than breast milk
      • Session 10 Summary
    • Session 11. IF BABY CANNOT FEED AT THE BREAST – STEP 5
      • Session Objectives
      • Materials
      • Further reading for facilitators
      • 1 Learning to hand express
      • 2 Pair practice learning to hand express
      • 3 Use of milk from another mother
      • 4 Feeding expressed breast milk to the baby
      • Session 11 Summary
    • Session 12. BREAST AND NIPPLE CONDITIONS
      • Session Objectives
      • Materials
      • Further reading for facilitators
      • 1 Examination of the mother’s breasts and nipples
      • 2 Engorgement, blocked ducts and mastitis
      • 3 Sore Nipples
      • 4 Small group work
      • Session 12 Summary
    • Session 13. MATERNAL HEALTH CONCERNS
      • Session Objectives
      • Materials
      • Further Reading for facilitators
      • 1 Nutritional needs of breastfeeding women
      • 2 How breastfeeding helps to space pregnancies
      • 3 Breastfeeding management when the mother is ill
      • 4 Medications and breastfeeding
      • Session 13 Summary
      • Breastfeeding and Mother’s Medication - Summary
      • Continue breastfeeding
    • Session 14. ON-GOING SUPPORT FOR MOTHERS – STEP 10
      • Session Objectives
      • Materials and Preparation
      • Further reading for facilitators
      • 1 Preparing a mother for discharge
      • 2 Follow-up and support after discharge
      • 3 Protecting breastfeeding for employed women
      • 4 Sustaining continued breastfeeding for 2 years or longer
      • 5 Group support - class activity
      • Session 14 Summary
    • Session 15. MAKING YOUR HOSPITAL BABY-FRIENDLY
      • Session Objectives
      • Materials
      • Further reading for facilitators
      • 1 What Baby-friendly practices mean
      • 2 The process of Baby-friendly Assessment
      • 3 Including BFHI in existing programmes
      • Session 15 Summary
      • Optional Activity: Assess a Policy
      • Optional activity – Planning for Change
    • CLOSING SESSION
      • Session Time
      • Preparation for session
      • Session Outline
    • CLINICAL PRACTICE 1– OBSERVING AND ASSISTING BREASTFEEDING
      • Session Objectives
      • Materials
      • Preparation for Clinical Practice
      • 1 Explain the clinical practice
      • 2 Conduct the clinical practice
      • 3 Discuss the clinical practice
    • CLINICAL PRACTICE 2- TALKING WITH A PREGNANT WOMAN
      • Session Objectives
      • Materials
      • Preparation for Clinical Practice
      • 1 Explain the clinical practice
      • 2 Conduct the clinical practice
      • 3 Discuss the clinical practice
    • CLINICAL PRACTICE 3 – OBSERVING HAND EXPRESSION AND CUP FEEDING
      • Session Objectives
      • Session time
      • Materials
      • Preparation for the clinical practice
      • 1 Explain the clinical practice – hand expression
      • 2 Conduct the clinical practice – hand expression
      • 3 Discuss the clinical practice – hand expression
      • 4 Clinical practice – cup feeding demonstration
    • Appendix 1 Acceptable medical reasons for use of breast-milk substitutes
    • Appendix 2 Knowledge Checks
  • 3.3. PowerPoint Slides for the course
• Section 4. HOSPITAL SELF-APPRAISAL AND MONITORING
  • 4.1. THE HOSPITAL SELF-APPRAISAL TOOL
    • Using the hospital self-appraisal tool to assess policies and practices
    • Analysing the Self-Appraisal Results
    • Action
    • Preparing for the external assessment
    • Annex 1 Hospital breastfeeding/infant feeding policy checklist
    • Annex 2 The International Code of Marketing of Breast-milk Substitutes
    • Annex 3 HIV and infant feeding recommendations
    • Annex 4 Acceptable medical reasons for use of breast-milk substitutes
  • 4.2. GUIDELINES AND TOOLS FOR MONITORING BABY-FRIENDLY HOSPITALS
    • Guide to Developing a National Process for BFHI Monitoring
    • Annex 1 Infant Feeding Record and Report
    • Annex 2 Staff Training Record and Report
    • Annex 3 BFHI monitoring tool
    • Annex 4 The BFHI Reassessment Tool and its possible use for monitoring

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