Statement from Trish MacEnroe Regarding Revised BFHI Guidance

Published On: April 20, 2018|Tags: , , |

Dear Colleagues,

By now I expect you have heard the news that, after several months of thoughtful and productive discussion, the World Health Organization (WHO) and United Nations Children’s Fund (UNICEF) have released the revised implementation guidance for the Baby-Friendly Hospital Initiative (BFHI), including revisions to the Ten Steps to Successful Breastfeeding framework.

With this communication, we aim to answer some of the initial questions we imagine you might have about these changes and what they will mean for your facility.

Before moving to FAQs, however, I would first like to emphasize that Baby-Friendly USA (BFUSA) played an active role through the BFHI Network, along with four other global breastfeeding promotion organizations, in providing feedback on the draft that WHO and UNICEF released last October. We are pleased that our recommendations were considered and largely incorporated into the final version, and we fully support the key goal of the new guidance to scale-up BFHI coverage and ensure its sustainability over time.

I would also like to inform you that, to help the US develop a plan to scale up BFHI coverage in all facilities providing maternity and newborn care, BFUSA is collaborating with the Kellogg Foundation and Johns Hopkins Bloomberg School of Public Health to conduct a needs assessment of current BFHI coverage levels and identify areas in the US where there are significant gaps. This will require BFUSA to enter into a data sharing agreement with Johns Hopkins to provide specific demographic information about hospitals currently participating in the BFHI.  Please be assured that this will NOT include protected health information (PHI).  BFUSA does not even collect PHI from facilities. The information we plan to share includes: your facility name and address; system name, if applicable; CEO name and contact information; CNO name and contact information; director of maternity name and contact information; primary and secondary users names and contact information, teaching facility and type; number of beds (facility, maternity and NICU); NICU level; and total number of births. Please note that we intend to share this information about your facility for the specific purpose of this needs assessment and will include your information unless you request in writing that we not do so. We will be providing instructions on how to request that we not share your data. Look for information on the BFUSA website portal in the next two weeks.


Q: What happens next?

A: We have a lot of work to do before we can implement the new guidance in the United States. BFUSA will be forming an expert committee to conduct a disciplined review of the guidance and develop an implementation strategy. Once the committee has completed this work, BFUSA will create comprehensive development, implementation and communication plans in order to:

  • Update and publish revised Guidelines and Evaluation Criteria
  • Notify training companies of the changes to training requirements
  • Notify companies that develop patient education materials of new requirements
  • Update 4-D Pathway materials, website and assessment tools
  • Announce the implementation date for the revised program

Q: When do you estimate the implementation of the new guidance will occur?

A: We estimate the implementation date will be a minimum of two years from now.

Q: What should facilities preparing for assessments do in the meantime?

A: The current standards will remain in place until we roll out our plan for implementing the new guidance. Please continue to follow the current Guidelines and Evaluation Criteria until otherwise informed. We will provide ample advance notice before any official changes are made to the initiative.

Q: Should we use the new Ten Steps infographics created by the WHO and UNICEF?

A: Not yet. These infographics contain the language for the new Ten Steps, which are not yet in use in the US. We will transition from the current Ten Steps language to the revised language at some point in the future, and we will notify you when that is happening. But for now, the current language is still in place and published educational materials should contain the current language until further notice.


Please send additional questions to us at and we will do our best to answer them in future communications.

Thank you for your support.


Trish MacEnroe
Executive Director

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