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J Perinatol. 2018 Jun;38(6):623-632. doi: 10.1038/s41372-018-0068-0. Epub 2018 Feb 7.

The Baby Friendly Hospital Initiative and the ten steps for successful breastfeeding. a critical review of the literature.

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Division of Neonatology, Department of Pediatrics, University of Kentucky, Lexington, KY, 40506, USA.
Neonatal Intensive Care Unit Medical Director, Rush Foundation Hospital, Meridian, MS, 39301, USA.


There is no doubt regarding the multiple benefits of breastfeeding for infants and society in general. Therefore, the World Health Organization (WHO) in a conjoint effort with United Nations International Children's Emergency Fund (UNICEF) developed the "Ten Steps to Successful Breastfeeding" in 1992, which became the backbone of the Baby Friendly Hospital Initiative (BFHI). Following this development, many hospitals and countries intensified their position towards creating a "breastfeeding oriented" practice. Over the past two decades, the interest increased in the BFHI and the Ten Steps. However, alongside the implementation of the initiative, extensive research continues to evaluate the benefits and dangers of the suggested practices. Hence, it is our intention to make a critical evaluation of the current BFHI and the Ten Steps recommendations in consideration of the importance of providing an evidence-based breastfeeding supported environment for our mothers and infants.


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