The Ten Steps were presented to the world in the 1989 as the WHO/UNICEF Joint Statement on the Protection, Promotion and Support
of Breastfeeding: The special role of the Maternity Services. The Innocenti Declaration in 1990 called upon the world to fully implement the Ten Steps in all maternities by 1995.
Twenty years later, more than 152 countries have Baby-friendly hospitals. They have implemented the Ten Steps, and, with the
addition of relevant parts of the International Code of Marketing of Breast-milk Substitutes they have also helped to resist the promotion of commercial infant formula to health care practitioners and the public.
TEN STEPS TO SUCCESSFUL BREASTFEEDING
Every facility providing maternity services and care for newborn infants should:
1. Have a written breastfeeding policy 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 initiate breastfeeding within a half-hour of birth.
5. Show mothers how to breastfeed, and how to maintain lactation even if they should be separated from their infants.
6. Give newborn infants no food or drink other than breast milk unless medically indicated.
7. Practise rooming in – 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
10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic.
PROGRESS TO DATE ON BFHI AND THE TEN STEPS
Achievements: Today, more than 20,000 maternity facilities worldwide report ever having achieved Baby-friendly status. The BFHI increases exclusive breastfeeding at the local, national and global levels. Increased breastfeeding has been a key factor contributing to recent declines in
child mortality (UNICEF 2009).
The Revised Baby-friendly practices include suggested sets of ten steps for programs beyond the hospital, in other health settings and in the community.
Where the Ten Steps are in place in hospital, communitybased support adds to their effectiveness. But, where there are few steps in place in the hospital, other breastfeeding efforts are less effective.
Challenges Remaining: Unfortunately, we hear reports of lack of commitment, deteriorating hospital practices, and inadequate training of health workers to counsel mothers, even as the evidence of the
potential benefits of the Ten Steps grows.
Therefore, it is time to revitalise implementation of the Ten Steps in hospitals, in other health care settings, and in communities and to return our path to the Baby-friendly Way!