The Baby-Friendly Hospital Initiative

Our story begins in 1991 when the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) launched the Baby-Friendly Hospital Initiative (BFHI), a global program to encourage the broad-scale implementation of the Ten Steps to Successful Breastfeeding and the International Code of Marketing of Breast-milk Substitutes. The BFHI assists hospitals in giving mothers the information, confidence, and skills necessary to successfully initiate and continue breastfeeding their babies and gives special recognition to hospitals that have done so.  In cases where patients have a medical indication or have made an informed decision to use formula, the safe preparation and feeding of formula is provided to mothers.

The WHO and UNICEF administer the BFHI program internationally and work with the national authority in each country which confers the Baby-Friendly® designation in their nation. More than 20,000 maternity facilities in 150 countries around the world have earned the Baby-Friendly designation.

In 2007, less than 3% of United States births occurred in approximately 60 Baby-Friendly designated facilities. Those numbers have risen to approximately 25% of births in roughly 600 Baby-Friendly designated facilities. Baby-Friendly hospitals and birthing centers can be found in all 50 states, the District of Columbia, and the Commonwealth of Puerto Rico.

The BFHI has enabled tremendous progress in lactation support. Since its inception over two decades ago, we have seen maternity wards transform from places historically infused with enormous influence from formula companies and maternity care and infant feeding practices that undermined breastfeeding, to environments in which evidenced-based care is provided, education is free from commercial interests, and mothers are supported in reaching their infant feeding goals.

These changes have contributed to a significant increase in breastfeeding rates in the US. Over the past 15 years, while the percentage of facilities in the US that are Baby-Friendly designated increased from less than 5% to more than 20%, the percentage of babies “ever breastfed” increased from 74% to 82%, according to data from the CDC (see chart below left). Since 1996, when the first hospital in the United States was designated Baby-Friendly, nearly 10 million babies have been born in Baby-Friendly designated facilities in the US (see chart below right).


Baby-Friendly USA, Inc.

Baby-Friendly USA, Inc. (BFUSA) is the accrediting body and national authority for the BFHI in the United States. In this capacity, BFUSA is responsible for coordinating and conducting all activities necessary to confer the prestigious Baby-Friendly® designation and to ensure the widespread adoption of the BFHI in the United States. We do this by:

  1. Refining and upholding the standards/criteria for successfully implementing the Ten Steps to Successful Breastfeeding in the US;
  2. Assessing and accrediting birthing facilities that meet those standards and follow the International Code of Marketing of Breast-milk Substitutes; and
  3. Generating widespread understanding of and enthusiasm for best practice infant feeding care.

BFUSA was incorporated as a non-profit 501(c)(3) organization in August 1997.

Our Philosophy

These are the basic tenets of BFUSA’s philosophy and approach:

1.  Human milk fed through direct breastfeeding is the optimal way for human infants to be nurtured and nourished.

There is no question that breastfeeding is the optimal feeding and caring method for the health of both the baby and the mother. An abundance of scientific evidence concludes that mothers and babies who breastfeed experience improved health outcomes and lower risks for certain diseases. Breastfeeding is the natural biological conclusion to pregnancy and an important mechanism in the natural development of the infant.

2.  The precious first days in the birth facility should be protected as a time of bonding and support not influenced by commercial interests.

Hospitals and birthing centers wield enormous influence over the first days of life and play a critical role in determining breastfeeding success. Before the Baby-Friendly Hospital Initiative began to take hold across the US, commercial interests significantly influenced infant feeding practices in ways that undermined breastfeeding. Baby-Friendly facilities are centers of support in which evidenced-based care is provided, education is free from commercial interests, all infant feeding options are possible, and individual preferences are respected.

3.  Every mother should be informed about the importance of breastfeeding and respected to make her own decision.

We aim to ensure that every mother is fully informed of the importance of breastfeeding and receives the help she needs to achieve her breastfeeding goals. We respect that breastfeeding is not possible for some families in certain situations, that supplementation is sometimes medically appropriate, and that some mothers will decide not to breastfeed. Every mother has the right to evidence-based information, free from commercial interests to help her decide how to feed her baby and should be equally supported and treated with dignity and respect for her infant feeding decision.