Breastfeeding Medicine

Physicians blogging about breastfeeding

How will you celebrate the Ten Steps?

with 4 comments

This summer, the World Alliance for Breastfeeding Action is celebrating the Ten Steps for World Breastfeeding Week. Less than 3% of US hospitals have implemented these maternity care guidelines, but globally, the Ten Steps have transformed care for mothers and infants, empowering mothers to achieve optimal infant feeding.

The Ten Steps comprise the criteria for the Baby Friendly Hospital Initiative, a World Health Organization program that recognizes birth facilities that provide high quality breastfeeding care. Worldwide, 20,000 maternity centers have adopted the Ten Steps since Wellstart and UNICEF executive director James Grant coined the term “Baby Friendly Hospital Award” in 1991.

In many parts of the world, maternity support for breastfeeding has translated into marked improvements in child health. From Unicef:

In the first two years of BFHI implementation at the Central Hospital of Libreville in Gabon, cases of neonatal diarrhoea fell by 15 per cent, diarrhoeal dehydration declined by 14 per cent and mortality fell by 8 per cent.

Nations from Romania to Fiji have embraced the Ten Steps — but we still have a long way to go. According to UNICEF, suboptimal breastfeeding accounts for 1.4 million deaths annually for children under 5 — and there is strong evidence that mothers who give birth in Baby Friendly facilities are more likely to achieve optimal breastfeeding. In other words, the Ten Steps save children’s lives.

In the US, recent studies show that mothers who birth in hospital that implement more of the Ten Steps are far more likely to achieve their breastfeeding goals. Conversely, women who birth in “baby hostile” facilities that implement none of the Ten Steps are far more likely to fail. In one study, one in three mothers who experienced none of the steps weaned earlier than she had planned. In another study of first-time mothers who planned to exclusively breastfeed, 86 percent failed to achieve their goals if they delivered in a “no steps” hospital. To date, just 92 US hospitals have achieved Baby Friendly Certification.

For World Breastfeeding Week, we have an ideal opportunity to advocate for Baby Friendly care for all mothers and infants. Here are the WBW objectives:

  • To increase attention to the contribution of the Ten Steps to exclusive breastfeeding.
  • To revitalise activities within health systems, and among healthcare providers and communities to support women to achieve their breastfeeding intentions.
  • To inform people everywhere that protection, promotion and support of breastfeeding is a mother’s right, a child’s right, and a human right.
  • To enable women and all who care about human rights to fight for healthcare systems which support breastfeeding.
  • To ensure that health workers who care for mothers and babies are adequately trained to counsel and support them in optimal infant feeding.

You can read more about the Ten Steps and the WBW celebration on the World Breastfeeding Week web site.

On this blog, ABM will be celebrating the Ten Steps with ABM physicians blogging about each of the steps, why they matter to mothers, and how we can transform maternity care so that every mother can meet her breastfeeding goals.

How are you planning to celebrate WBW in your community? And how can ABM help?

Alison Stuebe, MD, MSc, is a maternal-fetal medicine physician, breastfeeding researcher, and assistant professor of Obstetrics and Gynecology at the University of North Carolina School of Medicine.

Posts on this blog reflect the opinions of individual ABM members, not the organization as a whole.

Written by astuebe

May 25, 2010 at 8:54 pm

4 Responses

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  1. There needs to be a little correction in this note about the BFHI. Wellstart International did indeed work with UNICEF and WHO on developing the original Ten Steps and eventually creating the initial assessment and 18 hour training course for BFHI. Wellstart also trained the first wave of international BFHI assessor/trainers that began the process in 1992. However, The credit for the term “Baby Friendly Hospital” should go exclusively to James Grant, the Executive Director of UNICEF at the time.

    Audrey Naylor

    June 2, 2010 at 12:03 pm

  2. I want to share that I had two completely different experiences with my two sons, who were born in two different hospitals. My first was born at March Birch, in San Diego, who likes to brag that they give births to the most babies in San Diego. After my personal experience there, I call it the “baby factory” because after they get that baby out, they’re useless to the mom and the newborn. I had a very hard time getting my son to latch and his bilirubin levels were borderline because of that. I had a c-section and I had little colustrum coming out and no clue how to get more (=pump). I requested a lactation consultant every day, but they told me she was very busy and I’d only see her before I was dismissed, and that every nurse was trained to help with breastfeeding! I was also told that there was nothing wrong with formula feeding so I shouldn’t beat myself up… Because of my son not doing well, I stayed there 5 days! When I left, I was given a diaper bag sponsored by Similac, with several formula samples inside. It took A LOT of personal perseverence to get my son to latch properly, but it eventually worked, thanks to the help of a wonderful lactation consultant.

    For my second, I was ready and considered myself a pro. I was ready to pump if the baby didn’t latch. I gave birth at Kaiser Permanente Medical Center in San Diego. There, I got a daily visit from the lactation consultant (3 days total), and when I left, I was given a bag with NO formula samples, but a booklet on breastfeeding, as well as a cloth to cover myself, and a cold pack to keep my pumped milk cold. I thought it was the best gift any mom should be given!

    Keep on posting and promoting this issue. Many moms just don’t get the support they need to breastfeed.

    Perfecting Motherhood

    June 12, 2010 at 12:36 am



    July 1, 2010 at 3:03 am

  4. we have a short documentary to promote breastfeeding. how can we get a copy to you? we are from nairobi kenya


    July 17, 2010 at 2:44 am

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