The Guidelines and Evaluation Criteria

BFUSA’s Guidelines and Evaluation Criteria give meaning and specific definition to each of the Ten Steps. It is the most important tool hospitals will use to guide their work through the Baby-Friendly designation process.

The most recently updated “Interim Guidelines and Evaluation Criteria for Facilities Seeking Baby-Friendly Designation” (effective at onsite assessments taking place February 1, 2020 through December 31, 2022) is available for download in the box to the right.

As indicated by its title, this document includes both the Guidelines facilities would need to follow to achieve full Baby-Friendly status and Evaluation Criteria that clearly spell out the minimum standards that a facility must achieve in order to become Baby-Friendly designated.

  • GUIDELINES: These are the standards of care that facilities should strive to achieve for all patients.
  • EVALUATION CRITERIA:  These are the minimum standards that a facility must achieve to become Baby-Friendly designated.
The Baby-Friendly Hospital Initiative Interim Guidelines & Evaluation Criteria
Download Interim Version (PDF)
Download 2016 V2 Edition (PDF)
Summary of Changes from 2016 V2 to Interim Version (PDF)

Guideline Tenets

The Guidelines and Evaluation Criteria and the assessment and accreditation processes are predicated on the following tenets:

  1. Well-constructed, comprehensive policies effectively guide staff to deliver evidence-based care.
  2. Well-trained staff provide current, evidence-based care.
  3. Monitoring of practice is required to assure adherence to policy.
  4. Breastfeeding has been recognized by scientific authorities as the optimal method of infant feeding and should be promoted as the norm within all maternal and child health care facilities.
  5. The most sound and effective procedural approaches to supporting breastfeeding and human lactation in the birthing environment that have been documented in the scientific literature to date should be followed by the health facility.
  6. The health care delivery environment should be neither restrictive nor punitive and should facilitate informed health care decisions on the part of the mother and her family.
  7. The health care delivery environment should be sensitive to cultural and social diversity.
  8. The mother and her family should be protected within the health care setting from false or misleading product promotion and/or advertising which interferes with or undermines informed choices regarding infant health care practices.
  9. When a mother has chosen not to breastfeed, when supplementation of breastfeeding is medically indicated, or when supplementation is chosen by the breastfeeding mother (after appropriate counseling and education), it is crucial that safe and appropriate methods of formula mixing, handling, storage, and feeding are taught to the parents.
  10. Recognition as a Baby-Friendly institution should have both national and international credibility and prestige, so that it is marketable to the community, increases demand, and thereby improves motivation among facilities to participate in the Initiative.
  11. Participation of any facility in the U.S. BFHI is entirely voluntary and is available to any institution providing birthing services. Each participating facility assumes full responsibility for assuring that its implementation of the BFHI is consistent with all of its safety protocols.

Implementation Dates

Baby-Friendly USA has prepared and published dates for implementing the revised Guidelines and Criteria, to provide clarity and ample time for facilities to comply:

  • Facilities seeking designation: All facilities with on-site assessments taking place after February 1, 2020 will be assessed using the Interim edition.