Latest research on the status of the Baby-friendly Hospital Initiative (BFHI) worldwide: Are we still making progress?

Background/Purpose: The Ten Steps for Successful Breastfeeding are the basis for the UNICEF/WHO Baby-friendly Hospital Initiative (BFHI) launched in 1991, however, global oversight and support ended by 2002. Nonetheless, UNICEF updated and revised the BFHI materials in 2006, published by WHO in 2009/10. The purpose of this study is to assess current status worldwide and to explore uptake and influence of the new materials. Methods: At the request of WABA, and in collaboration with UNICEF, official contacts from the 2006/7 update, as well as personal and informal contacts, were approached. Data included number of hospitals ever-certified, presence of a government breastfeeding oversight committee, use of the new materials, and uptake of the new maternity and HIV materials. Findings: With data from 66 countries (33.3%), the number of hospitals ever-certified continues to increase to 21,293, representing about 27% of all maternities worldwide: 8% of those in industrialized countries and 31% of those in less developed settings. Only 13 countries report an active government committee, but about half reported beginning to use the new materials: 14 report using the maternity care, and 11 report using the new HIV module. Discussion/Conclusions: The continued growth is testimony to the acceptance of the effectiveness of the Ten Steps, and to the dedication of health leadership to preserve the effort, despite lack of global oversight and diminished resources. The previously requested HIV module is being implemented slightly less frequently than the unsolicited maternity materials.