UNICEF and WHO developed implementation guides for the BFHI. A maternity facility can be designated 'baby-friendly' when it does not accept free or low-cost breastmilk substitutes, feeding bottles or teats, and has implemented 10 specific steps to support successful breastfeeding. The 10 steps outline how to transform hospital practices and verify the ending of free and low-cost supplies of breastmilk substitutes.
The process of awarding Baby-Friendly status is currently controlled by national breastfeeding authorities, using Global Criteria that can be applied to maternity care in every country. Additional BFHI components, including questionnaires used by external teams to assess facilities before Baby-Friendly designation, may be requested when appropriate from the breastfeeding authority of each country.
Since the BFHI began, more than 15,000 facilities in 134 countries have been awarded Baby-Friendly status. In many areas where hospitals have been designated Baby-Friendly, more mothers are breastfeeding their infants, and child health has improved.
The Mother-Baby Friendly Hospital Initiative (MBFI), the name for the Filipino version of the initiative, was launched by the Department of Health in 1992 in line with the Rooming-in and Breastfeeding Act of 1992 (RA 7600). In this law, all private and government private hospitals offering maternity and newborn care may be accredited as Mother-Baby Friendly if they implement the 10 Steps to Successful Breastfeeding adopted from UNICEF/WHO criteria of BFI. In the mid-1990s, the Philippines Department of Health accredited 83% of 1,700 targeted hospitals.
The Philippines Department of Health (DOH) issued an administrative order to revitalize the BHFI guidelines after a UNICEF study found that most of the accredited hospitals deviated from the guidelines set by the DOH. It was argued that the poor compliance could be attributed to the strong pressure from formula milk companies and the “re-engineering” of DOH key officials. The guidelines for accreditation now includes trainings and other forms of capacity building to be facilitated by regional DOH offices.
To receive the BFHI certification, the Bangladesh Breastfeeding Foundation and the participating hospital must follow the following steps:
- BFHI training: A trainer must carry out a 20 hour long course over 4 days on breastfeeding promotion and support for the maternity doctors and nurses of qualifying hospitals.
- Half-day orientation session: The core trainers will also conduct a half-day orientation session for doctors of other disciplines, and well as an orientation for other hospital staff (e.g., pharmacists, messengers, ward boys, ayahs, cleaners etc.)
- Practice 15 steps to successful breastfeeding: Indonesia has 5 additional steps to the already existing 10 steps for BFHI accreditation. Once all the staff members have received training on breastfeeding, IYCF, and maternal nutrition, it is expected that all hospital staff members, auxiliary/ancillary staff will start practicing the successful breastfeeding steps in their hospitals.
- Self assessment appraisal: After practicing the 15 steps, the hospital will conduct a self-assessment, relate their status to BBF, and ask for an external assessment.
- External assessment: After completion of the self-assessment, one international assessor and two national assessors will conduct an external assessment using the “Global standard external hospital assessment tool”, which will examine the successful completion of each of the ten steps. The two day long assessment includes an interview with maternity staff, pregnant mothers, and post natal mothers.
- BFHI committee: A BFHI committee consisting of 7 members will be formed and headed by a Hospital authority. They will meet monthly to review and conduct internal monitoring of the BFHI status and send the resulting report to the BBF secretariat.
- Certification: After successful completion of the external assessment, BBF will certify the hospital as "baby friendly".