BFUSA Releases Updated BFHI Guidelines and Evaluation Criteria

Published On: July 21, 2021|Tags: |

Baby-Friendly USA is excited to announce the release of the updated Guidelines and Evaluation Criteria (GEC) 6th edition, for the United States, which will apply to all Baby-Friendly designation assessment letters received on or after June 1, 2023. The Interim GEC, which has been the basis for assessments since February 1, 2020, will remain in effect until that time.


The GEC gives meaning and specific definition to each of the Ten Steps to Successful Breastfeeding for implementation in the US. As indicated by its title, this document includes both the Guidelines facilities need to follow and the Evaluation Criteria that clearly spell out the minimum standards that a facility must achieve in order to become Baby-Friendly designated. It is the most important tool hospitals use to guide their work through the Baby-Friendly designation process.

The release of the updated document represents the culmination of three years of work by BFUSA to bring the GEC for the US fully into alignment with the Implementation Guidance released by WHO and UNICEF in 2018, as well as their Competency Verification Toolkit released in 2020. BFUSA also took this opportunity to address some other important issues.

What’s New

The updated GEC has been given a fresh new look and is a more robust document than its predecessor with more detailed information to support each practice. Beyond these general changes, the guidelines are new in four important respects:

Communications – The updated guidelines emphasize meaningful conversations and shared decision-making between providers and families around evidence-based practices. The key components of these meaningful conversations are captured in the acronym ENCOURAGES: Empathize, Non-judgmental, Confirm, Open-ended questions, Use competent skills, Responsive care, Affirm, Give evidence-based information, Empower, and S These critical concepts are woven throughout the updated GEC document, and are also included in several of the Evaluation Criteria.

Competency – A completely new approach for Step 2 places a strong emphasis on competency verification with targeted training to address identified gaps in knowledge and skills, instead of the current one-size-fits-all program of 20 hours of training on specific topics. Also, the description of each of the Ten Steps includes a new section called “Performance Indicators Indicating Competency,” which provides detailed information about the competencies staff and providers must possess in order to properly support that step.

Equity – One of the foundational goals of the BFHI is to ensure the consistent application of evidence-base best practice standards for every mother and baby in all care settings. The updated GEC sharpens the focus on inclusion, cultural humility, and equity, while highlighting the importance of collecting data by race and ethnicity.

Safety – Above all else, the updated guidelines highlight the importance of safety. The descriptions for each of the Ten Steps also includes a new section called “Safe implementation of Practice,” which provides detailed information about the safe ways to implement evidence-based practices, as well as the missteps that must be avoided to ensure no patient harm is experienced.

The updated GEC also provides facilities a compilation of guidance for each of the Ten Steps, which consists of documents, policies, and/or protocols from recognized national or international authorities. These resources offer information pertaining to important issues facilities should address as they consider the best way to implement a practice.

“This is a momentous occasion for the healthcare providers throughout the US who are committed to upholding the highest standards of infant feeding care – and the families, individuals, mothers and babies they support,” said Trish MacEnroe, BFUSA’s former CEO and the leader of the effort to launch the updated GEC in the US.

“I want to offer my heartfelt thank you to everyone who helped bring us to this important moment,” said Eileen FitzPatrick, BFUSA’s new CEO. “I’m so pleased to be associated with so many caring professionals who are committed to ensuring evidence-based practices are implemented consistently and compassionately every day in birthing facilities throughout the country.”

>> Go to the Updated GEC

Like this article? Share it!

Archives by Month