Monitoring the implementation of the Baby-friendly Hospital Initiative in the Americas


The Baby-friendly Hospital Initiative (BFHI) was launched in 1991 by the World Health Organization (WHO) and  UNICEF. The BFHI helps health care facilities providing maternity and newborn care implement the Ten Steps to Successful Breastfeeding, a package of policies and procedures that the facilities should implement to support breastfeeding. Studies have shown that adherence to the Ten Steps positively impacts breastfeeding initiation and duration and short-term, medium-term, and long-term breastfeeding outcomes. The Pan American Health Organization (PAHO/WHO) recommends that health facilities implement measures to protect, promote and support breastfeeding starting in the period of antenatal care up to when mothers and newborns are discharged.

In 2009 an updated version of the BFHI package was released by WHO and UNICEF. The 2018 Implementation Guidance outlines nine key responsibilities of a national BFHI program, listed below:

  1. Establish or strengthen a national breastfeeding coordination body.
  2. Integrate the Ten Steps into relevant national policy documents and professional standards of care.
  3. Ensure the competency of health professionals and managers in implementing the Ten Steps.
  4. Utilize external assessment systems to regularly evaluate adherence to the Ten Steps.
  5. Develop and implement incentives for compliance and/or sanctions for non-compliance with the Ten Steps.
  6. Provide technical assistance to facilities that are making changes to adopt the Ten Steps.
  7. Monitor implementation of the initiative.
  8. Advocate for the BFHI to relevant audiences.
  9. Identify and allocate sufficient resources to ensure the ongoing funding of the initiative.

The tool for monitoring the implementation of the BFHI in the Americas presents information on the status of implementation of the nine key responsibilities of the national BFHI program in countries and territories of the Americas.

The information presented in this tool has been collected by the regional nutrition program, NCD Risk Factors and Nutrition Unit, Department of Noncommunicable Diseases and Mental Health, PAHO from the following sources:

  • Global nutrition policy review 2016-2017: country progress in creating enabling policy environments for promoting healthy diets and nutrition. Geneva: World Health Organization; 2018.
  • Network meeting in Brazil during the Breastfeeding and Complementary Feeding Congress.
  • Information collected from BFHI Network members in 2018, 2019, 2020 and 2021
  • Verification exercise with countries - 2021 - 2022