Session 3The baby-friendly Hospital Initiative

Publication Details


At the conclusion of this session, participants will be able to:

  • Describe the history and implementation of the WHO/UNICEF Baby-friendly Hospital Initiative (BFHI) and relevant experience of participants in their institutions and country.
  • Describe the guidelines health facilities should follow related to the International Code of Marketing of Breast-milk Substitutes.
  • Describe the WHO/UNICEF Global Criteria and the Self-appraisal Tool.
  • Describe the BFHI assessment and designation process.
  • Discuss the importance of monitoring and reassessing adherence to the “10 steps”.
  • Discuss the health facility decision-maker’s role in supporting the BFHI.
  • Discuss key aspects of the Global Strategy for IYCF and BFHI’s role within it.


Total: 1 hour

Teaching methods



Video or slide show (optional)

Preparation for session

  • Work with the national breastfeeding coordinator and committee and/or WHO and UNICEF country and regional offices to prepare up-to-date information on the status of BFHI nationally, including transparencies if possible.
  • Collect examples of completed self-appraisal tools to gain a general understanding of the BFHI status of health facilities in the country. Make sure that the information on particular hospitals is kept confidential.
  • Review the Global Criteria, self-appraisal tool, and assessment and reassessment processes, in preparation for a brief presentation during the session. A copy of the revised Global Criteria and self appraisal tool is attached as Handouts 3.4 and 3.5. Information and links for downloading the revised BFHI course and assessment documents are available at the UNICEF website, http://www​​/nutrition/index_24850.html?q=printme.
  • Review the WHO/UNICEF document, Global Strategy for Infant and Young Child Feeding. Geneva, Switzerland, 2003. (http://www​​/publications​/infantfeeding/en/index.html; http://www​​/NUTRITION/global_strategy.htm). Read in particular sections 30, 31 and 34, pages 13–19, which focus on the importance of continuing to support the Baby-friendly Hospital Initiative and implementation of the Ten Steps to Successful Breastfeeding, as well as monitoring and reassessing facilities that are already designated and expanding the Initiative to include clinics, health centres, and paediatric hospitals.

Training materials



The website featuring this Course contains links to the slides and transparencies for this session in two Microsoft PowerPoint files. The slides (in colour) can be used with a laptop computer and LCD projector, if available. Alternatively, the transparencies (in black and white) can be printed out and copied on acetates and projected with an overhead projector. The transparencies are also reproduced as the first handout for this session, with 6 transparencies to a page.

Additional materials to be distributed

The following documents, which can be purchased from the World Health Organization, Geneva or the appropriate WHO regional office, should be distributed to all participants:

  • Protecting, Promoting and Supporting Breastfeeding: The Special Role of Maternity Services. A Joint WHO/UNICEF Statement. World Health Organization, Geneva, 1989.
  • The International Code of Marketing of Breast-milk Substitutes. World Health Organization, Geneva, 1981.

Suggested additional audio-visual programmes

  • Slide set or video on “Baby-friendly” in the country or region where the course is being given (optional, if available).


  • Global strategy for infant and young child feeding: The optimal duration of exclusive breastfeeding. Geneva: World Health Organization; May 1, 2001. Fifty-fourth World Health Assembly, Provisional agenda item 131, A54/INFDOC/4. ( http://www​​/EB_WHA/PDF/WHA54/ea54id4.pdf)
  • Horton S, Sanghvi T, Phillips M, Fiedler J, Perez-Escamilla Breastfeeding promotion and priority setting in health. Health Policy and Planning. 1996;11(2):156–168. [PubMed: 10158457]
  • International Baby Food Action Network. Protecting infant health: A health workers’ guide to the international code of marketing of breast-milk substitutes. 7th ed. Penang, Malaysia: IBFAN; 1993.
  • International code of marketing of breast-milk substitutes. Geneva: World Health Organization; 1981. [PubMed: 7281637]
  • Kramer MS, Kakuma R. The optimal duration of exclusive breastfeeding A systematic review. Geneva: World Health Organization; 2002. (WHO/NHD/01.08; WHO/FCH/CAH/01.23)
  • New data on the prevention of mother-to-child transmission of HIV and their policy implications Conclusions and recommendations WHO technical consultation on behalf of the UNFPA/UNICEF/WHO/UNAIDS Inter-Agency Task Team on Mother-to-Child Transmission of HIV. Geneva, 11–13 October 2000. Geneva: World Health Organization; 2001. (WHO/RHR/01.28)
  • Protecting, promoting and supporting breastfeeding: The special role of maternity services A joint WHO/UNICEF statement. Geneva: World Health Organization; 1989.
  • Report of the expert consultation on the optimal duration of exclusive breastfeeding, Geneva, Switzerland, 28–30 March 2001. Geneva: World Health Organization; 2001. (WHO/NHD/01.09; WHO/FCH/CAH/01.24)
  • Resolution WHA 3928: Infant and Young Child Feeding. Geneva: World Health Organization; 1992.
  • Resolution WHA 475: Infant and Young Child Nutrition. Geneva: World Health Organization; 1994.
  • Saadeh R, et al., editors. Breastfeeding: the technical basis and recommendations for action. Geneva: World Health Organization; 1993. (WHO/NUT/MCH/93.1)
  • The Baby-friendly Hospital Initiative: Revised, Updated and Expanded for Integrated Care, Section 1: Background and Implementation; Section 2: Strengthening and sustaining BFHI: A course for decision-makers; Section 3:Breastfeeding Promotion and Support in a Baby-friendly Hospital; a 20-hour course; Section 4:Hospital Self-Appraisal and Monitoring; Section 5: External Assessment and Reassessment. New York, New York: UNICEF; Geneva: WHO; 2008. ( http://www​​/nutrition/index_24850.html?q=printme)
  • The International Code of Marketing of Breast-milk Substitutes: Frequently Asked Questions. Geneva: World Health Organization; 2006. ( http://www​​/publications/NUTRTION​/ISBN_92_4_159429_2.htm)
  • Additional information from regional/country offices, national breastfeeding committees, local Wellstart Associates, IBFAN groups, or other sources.




BFHI is a global movement, spearheaded by WHO and UNICEF that aims to give every baby the best start in life by creating a health care environment where breastfeeding is the norm. BFHI has two main goals:

Session 3. Slides

Slide 3.1. (PDF, 24K)

Slide 3.2. (PDF, 38K)

Slide 3.3. (PDF, 38K)

Slide 3.4. (PDF, 25K)

Slide 3.5. (PDF, 25K)

Slide 3.6. (PDF, 24K)

Slide 3.7. (PDF, 32K)

Slide 3.8. (PDF, 32K)

Slide 3.9. (PDF, 32K)

Slide 3.10. (PDF, 32K)

Slide 3.11. (PDF, 32K)

Slide 3.12. (PDF, 32K)

Slide 3.13. (PDF, 27K)

Slide 3.14. (PDF, 32K)

Slide 3.15. (PDF, 32K)

Slide 3.16. (PDF, 32K)

Slide 3.17. (PDF, 32K)

Slide 3.18. (PDF, 32K)

Slide 3.19. (PDF, 33K)

Slide 3.20. (PDF, 33K)

Slide 3.21. (PDF, 31K)