10 Steps and International Code
The Ten Steps to Successful Breastfeeding
The Ten Steps to Successful Breastfeeding were developed by a team of global experts and consist of evidence-based practices that have been shown to increase breastfeeding initiation and duration. Baby-Friendly hospitals and birthing facilities must adhere to the Ten Steps to receive, and retain, a Baby-Friendly designation.
The Ten Steps to Successful Breastfeeding are:
- Have a written breastfeeding policy that is routinely communicated to all health care staff.
- Train all health care staff in the skills necessary to implement this policy.
- Inform all pregnant women about the benefits and management of breastfeeding.
- Help mothers initiate breastfeeding within one hour of birth.
- Show mothers how to breastfeed and how to maintain lactation, even if they are separated from their infants.
- Give infants no food or drink other than breast-milk, unless medically indicated.
- Practice rooming in - allow mothers and infants to remain together 24 hours a day.
- Encourage breastfeeding on demand.
- Give no pacifiers or artificial nipples to breastfeeding infants.
- Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or birth center.
The Ten Steps are endorsed and promoted by the major maternal and child health authorities in the United States, including:
- American Academy of Family Physicians
- American Academy of Nursing
- American Academy of Pediatrics
- American College of Nurse-Midwives
- American College of Obstetricians and Gynecologists
- Academy of Breastfeeding Medicine
- Academy of Nutrition and Dietetics
- Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN)
- Centers for Disease Control and Prevention (CDC)
- National WIC Association
- U.S. Breastfeeding Committee (USBC)
- U.S. Preventive Services Task Force
- U.S. Surgeon General
The International Code of Marketing of Breast-Milk Substitutes
One of the tenets of the Baby-Friendly Hospital Initiative is that the marketing of breast-milk substitutes, including infant formula, discourages mothers from initiating and/or exclusively breastfeeding their infants. The International Code of Marketing of Breast-Milk Substitutes, adopted by the WHO in 1981, recommends restrictions on the marketing of breast-milk substitutes, infant feeding bottles, and teats. Hospitals and birthing centers wishing to attain Baby-Friendly designation must abide by the provisions of the International Code of Marketing of Breast-Milk Substitutes.
Significant provisions of this code prevent hospitals and birthing centers from accepting free or low-cost infant formula, providing free samples of infant formula to families, or advertising breast-milk substitutes. Provisions of the International Code of Marketing of Breast-Milk Substitutes require:
- No advertising of breast-milk substitutes to families
- No free samples or supplies in the health care system.
- No promotion of products through health care facilities, including no free or low-cost formula.
- No contact between marketing personnel and mothers.
- No gifts or personal samples to health workers.
- No words or pictures idealizing artificial feeding, including pictures of infants, on the labels or product.
- Information to health workers should be scientific and factual only.
- All information on artificial feeding, including labels, should explain the benefits of breastfeeding and the costs and hazards associated with artificial feeding.
- Unsuitable products should not be promoted for babies.
- All products should be of high quality and take account of the climate and storage conditions of the country where they are used.
The entire International Code of Marketing of Breast-Milk Substitutes document is available at:www.who.int/nutrition/publications/code_english.pdf