Series L, Number 14
Issues in World Health

CONTENTS

Home (Key Points)

Breastfeeding Gains and Goals
Table 1. Breastfeeding Practices Improving
Web Table 1. Early Initiation of Breastfeeding Over Time
Web Table 2. Exclusive Breastfeeding Over Time
Web Table 3. Breastfeeding at Two Years
Table 2. Breastfeeding Common but Not Usually Optimal
Web Figure 1. Most Infants Breastfed Initially
Web Figure 2. Levels of Breastfeeding Vary Widely

Comprehensive Strategies Needed

Spotlight: Madagascar’s Comprehensive Approach Improves Breastfeeding

Breastfeeding Increases Women’s Contraceptive Options
Table 3. When Breastfeeding Mothers Can Begin a Family Planning Method After Childbirth Compared with Mothers Not Breastfeeding

Centerspread: Breastfeeding Is Best
Figure 1. Better Breastfeeding Reduces Diarrhea

Women with HIV Face Crucial Breastfeeding Decisions
Figure 2. Estimated Risk of HIV Infection in Infants and Young Children

Bibliography

Credits

• Counseling Aid: When Can a Woman Use LAM?
• Counseling Aid: HIV and Infant Feeding Counseling Flow Chart

• Box: Taking Ten Steps to Successful Breastfeeding
• Table: When Breastfeeding Mothers Can Begin a Family Planning Method

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Taking Ten Steps to Successful Breastfeeding

The Ten Steps to Successful Breastfeeding are the foundation of the WHO/UNICEF 1991 Baby-Friendly Hospital Initiative. They summarize the maternity care practices that support a woman's choice to breastfeed and enable women to breastfeed successfully. For a maternal health care facility to be considered Baby-Friendly, it should:

1. Have a written policy on breastfeeding that is routinely communicated to all health care staff.
2. Train all health care staff in skills necessary to implement this policy.
3. Inform all pregnant women about the benefits and management of breastfeeding.
4. Help mothers start breastfeeding within one hour of giving birth.
5. Show mothers how to breastfeed and maintain lactation, even if they are separated from their infants for a time.
6. Give newborn infants no food or drink other than breastmilk, unless medically indicated.
7. Practice rooming-in-that is, allow mothers and infants to remain together 24 hours a day.
8. Encourage breastfeeding on demand.
9. Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants.
10. Foster the establishment of breastfeeding support groups and refer new mothers to them on discharge from the hospital or clinic.

To become a Baby-Friendly facility, staff first identify and correct practices that hinder breastfeeding. The facility is then assessed by a WHO/UNICEF trained evaluator to see if it has met international standards for maternity care and can thus achieve Baby-Friendly Hospital status.

In areas of high HIV prevalence, training and assessment criteria can include elements related to HIV. These elements help facilities to develop policies and procedures concerning HIV and to train staff on HIV and infant feeding, HIV testing and counseling, and preventing mother-to-child transmission of HIV.

WHO and UNICEF are revising and updating guidance for Baby-Friendly Hospital activities. The new guidance is expected some time in 2006.

Sources: WHO 1990 (270) and UNICEF 2004 (235)