What is a baby-friendly hospital?

The Baby-Friendly Hospital Initiative (BFHI) is a global program that was launched by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) in 1991 to encourage and recognize hospitals and birthing centers that offer an optimal level of care for infant feeding and mother/baby bonding. It recognizes and awards birthing facilities who successfully implement the Ten Steps to Successful Breastfeeding (i) and the International Code of Marketing of Breast-milk Substitutes (ii). The BFHI assists hospitals in giving all mothers the information, confidence, and skills necessary to successfully initiate and continue breastfeeding their babies or feeding formula safely, and gives special recognition to hospitals that have done so.


Becoming a Baby-Friendly facility is a comprehensive, detailed and thorough journey toward excellence in providing evidence-based, maternity care with the goal of achieving optimal infant feeding outcomes and mother/baby bonding. It compels facilities to examine, challenge and modify longstanding policies and procedures. It requires training and skill building among all levels of staff. It entails implementing audit processes to assure quality in all aspects of maternity care operations. The journey is exciting, challenging, and worth it! It creates opportunities to develop high performance work teams and build leadership skills among staff, promotes employee pride, enhances patient satisfaction and improves health outcomes.”


i.The Ten Steps to Successful Breastfeeding, Protecting, Promoting and Supporting Breast-feeding: The Special Role of Maternity Services. Geneva: WHO, 1989.


ii. International Code of Marketing of Breast-milk Substitutes. Geneva: WHO, 1981.



Virginia's Baby-Friendly Hospitals are:


Culpeper Regional Hospital received their designation as a Baby Friendly Hospital in December 2008 They were the first in the state of Virginia to earn this distinction.


Fort Belvoir Community Hospital received their accreditation in July 2014


Centra Virginia Baptist Hospital, 3300 Rivermont Avenue, Lynchburg, VA 24503 in May 2015


Virginia Commonwealth Univerisity Medical Center both received their certifications in May 2015


University of Virginia Health System earned their recognition in August 2015


LewisGale Hospital-Montgomery, 3700 S. Main Street, Blacksburg, VA 24060 in October 2015


Inova Alexandria Hospital, 4320 Seminary Road, Alexandria, VA 22304, in September 2015

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Ten Steps to successful breastfeeding

The Ten Steps to Successful Breastfeeding


[WHO_NHD_99.2_cov] The Ten Steps to Successful Breastfeeding were developed by a team of global experts and consist of evidence-based practices that have been shown to increase breastfeeding initiation and duration. Baby-Friendly hospitals and birthing facilities must adhere to the Ten Steps to receive, and retain, a Baby-Friendly designation.


The Ten Steps to Successful Breastfeeding are:


  1. Have a written breastfeeding policy that is routinely communicated to all health care staff.
  2. Train all health care staff in the 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 hour of birth.
  5. Show mothers how to breastfeed and how to maintain lactation, even if they are separated from their infants.
  6. Give infants no food or drink other than breast-milk, unless medically indicated.
  7. Practice rooming in – allow mothers and infants to remain together 24 hours a day.
  8. Encourage breastfeeding on demand.
  9. Give no pacifiers or artificial nipples to breastfeeding infants.
  10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or birth center.


Ten Steps are endorsed and promoted by the major maternal and child health authorities in the United States, including:


American Academy of Family Physicians
American Academy of Nurses
American Academy of Pediatrics
American College of Nurse-Midwives
Academy of Breastfeeding Medicine
Academy of Nutrition and Dietetics
Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN)
Centers for Disease Control and Prevention (CDC)
National WIC Association
U.S. Breastfeeding Committee (USBC)
U.S. Preventive Services Task Force
U.S. Surgeon General

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international code of marketing breastmilk substitutes

One of the tenets of the Baby-Friendly Hospital Initiative is that the marketing of breast-milk substitutes, including infant formula, discourages mothers from initiating and/or exclusively breastfeeding their infants. The International Code on Marketing Breast-milk Substitutes, adopted by the WHO in 1981, recommends restrictions on the marketing of breast-milk substitutes, infant feeding bottles, and teats. Hospitals and birthing centers wishing to attain Baby-Friendly designation must abide by the provisions of the International Code on Marketing Breast-milk Substitutes.


Significant provisions of this code prevent hospitals and birthing centers from accepting free or low-cost infant formula, providing free samples of infant formula to families, or advertising breast-milk substitutes. Provisions of the International Code on Marketing Breast-milk Substitutes require:


  1. No advertising of breast milk substitutes to families
  2. No free samples or supplies in the health care system.
  3. No promotion of products through health care facilities, including no free or low-cost formula.
  4. No contact between marketing personnel and mothers.
  5. No gifts or personal samples to health workers.
  6. No words or pictures idealizing artificial feeding, including pictures of infants, on the labels or product.
  7. Information to health workers should be scientific and factual only.
  8. All information on artificial feeding, including labels, should explain the benefits of breastfeeding and the costs and hazards associated with artificial feeding.
  9. Unsuitable products should not be promoted for babies.
  10. All products should be of high quality and take account of the climate and storage conditions of the country where they are used.


The entire International Code on Marketing Breastmilk Substitutes document is available in PDF download here.

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Baby-Friendly Hospitals: Laws Across the 50 States

The ChangeLab Solutions webinar, Baby-Friendly Hospitals: Laws Across the 50 States, presents the results of our systematic review of baby-friendly hospital laws in the United States. This webinar includes an overview of baby-friendly hospital requirements and the 10 Steps to Successful Breastfeeding, a brief description of the legal research methods used, and a discussion of what we found. Participants will learn about data that can help advance policy by clearly showing how state laws differ. 

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