Introduction & Background

Origin: Launched globally by WHO and UNICEF in 1991, following the Innocenti Declaration of 1990.
Core Objective: To protect, promote, and support breastfeeding in facilities providing maternity and newborn services.
Recent Update: Revitalized in 2018 by WHO/UNICEF to emphasize sustainability, scaling up, and integration into broader healthcare quality standards.

Core Components & The "Ten Steps" (WHO/UNICEF 2018 Update)

The foundation of the BFHI is the "Ten Steps to Successful Breastfeeding." The 2018 update divided these into two distinct categories:

1. Hospital Policies:

1a. Comply fully with the International Code of Marketing of Breast-milk Substitutes and relevant World Health Assembly resolutions.
1b. Have a written infant feeding policy that is routinely communicated to staff and parents.
1c. Establish ongoing monitoring and data-management systems.

2. Staff Competency:

Ensure that staff have sufficient knowledge, competence, and skills to support breastfeeding through mandatory, standardized training.

3. Antenatal Care:

Discuss the importance and management of breastfeeding with pregnant women and their families.

4. Care Right After Birth:

Facilitate immediate and uninterrupted skin-to-skin contact.
Support mothers to initiate breastfeeding as soon as possible after birth (ideally within 1 hour for normal deliveries).

5. Support Mothers with Breastfeeding:

Support mothers to initiate and maintain breastfeeding and manage common difficulties (e.g., proper positioning, attachment, and hand expression of breast milk).

6. Supplementing:

Do not provide breastfed newborns any food or fluids other than breast milk, unless medically indicated.

7. Rooming-in:

Enable mothers and their infants to remain together and practice rooming-in 24 hours a day (promoting zero separation).

8. Responsive Feeding:

Support mothers to recognize and respond to their infants' cues for feeding (also known as feeding on demand).

9. Counseling on Bottles, Teats, and Pacifiers:

10. Discharge and Ongoing Support:

Coordinate discharge so that parents and their infants have timely access to ongoing support and care (e.g., linking them to community peer support groups or lactation clinics).

BFHI-India: Spearheaded by the Breastfeeding Promotion Network of India (BPNI) in collaboration with the Indian Academy of Pediatrics (IAP) and other healthcare associations.
The IMS Act: In India, absolute, 100% compliance with the Infant Milk Substitutes, Feeding Bottles and Infant Foods (IMS) Act is a non-negotiable legal prerequisite for BFHI certification.
Integration with National Health Programs:
- MAA (Mothers' Absolute Affection) Programme: A flagship government initiative focusing heavily on early initiation and exclusive breastfeeding.
- LaQshya Initiative: Focuses on quality improvement in labor rooms and maternity operating theaters, mandating skin-to-skin contact and early breastfeeding initiation.
- Lactation Management Centres: Establishment of human milk banks aligned with BFHI protocols to support vulnerable newborns.

Self-Appraisal: The hospital reviews its own practices using standardized WHO/UNICEF or national BFHI-India toolkits.
External Assessment: Conducted by trained external assessors who evaluate policies, test staff knowledge, and interview mothers about their experiences.
Certification: Awarded only upon scoring >80% in all steps and demonstrating full compliance with the IMS Act. The "Baby Friendly" status requires periodic re-assessment to be maintained.

Infant Health: Significant increase in early initiation and exclusive breastfeeding rates at 6 months; marked reduction in neonatal morbidity, specifically related to diarrheal diseases, respiratory infections, and necrotizing enterocolitis (NEC).
Maternal Health: Enhances maternal-infant bonding, decreases the incidence of postpartum hemorrhage (due to oxytocin release from early suckling), and delays the return of fertility (lactational amenorrhea).