The Baby-Friendly Hospital Initiative (BFHI): Global Context
The Baby-Friendly Hospital Initiative (BFHI) is a global quality improvement program launched in 1991 by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) to improve maternity care and support optimal infant feeding. BFHI operationalizes the global commitments set out in the Innocenti Declaration (1990), which called on governments to protect, promote, and support breastfeeding, and aligns with the Global Strategy for Infant and Young Child Feeding (2003), the foundational framework guiding infant and young child nutrition worldwide. The Global Strategy remains in force today and is reinforced through updated WHO and UNICEF action plans, targets, and technical guidance. Together, these initiatives link international policy commitments to measurable health system action and frontline maternity care practices.
At the core of the BFHI are the Ten Steps to Successful Breastfeeding, developed by WHO and UNICEF in 1989. These evidence-based policies and clinical practices guide maternity and newborn services to create environments that protect, promote, and support breastfeeding. Facilities that fully implement the Ten Steps – including compliance with the International Code of Marketing of Breastmilk Substitutes and relevant World Health Assembly (WHA) resolutions – may achieve Baby-Friendly designation.
Since 2015, the proportion of births occurring in Baby-Friendly designated facilities has been included as a key global indicator within the Global Nutrition Monitoring Framework, reported regularly at WHA meetings. While nearly all countries have implemented BFHI to some degree, global coverage remains limited. To strengthen and reinvigorate the initiative, WHO and UNICEF released updated guidance in 2018, including monitoring indicators. This revised framework integrates the WHO Code directly into Step 1 and reflects evolving evidence and health system realities. In addition, in 2020, WHO and UNICEF expanded the guidance to better address the needs of the most vulnerable infants, further strengthening the initiative’s scope and inclusivity.
The BFHI Network
The BFHI Network is an international organization that supports the global coordination, advocacy, and advancement of the Baby-Friendly Hospital Initiative. It provides leadership, technical guidance, and collaboration opportunities for national BFHI authorities and stakeholders worldwide.
Learn more about the BFHI Network and its work here:
https://bfhinetwork.com
Canada’s Role in Global BFHI Leadership
Canada is actively represented within the BFHI Network. Three Canadian leaders, all members of the BCC, currently serve on the Board and subcommittees:
- Kathy O’Grady (Canadian Delegate – BFHI Network Board of Directors)
- Michelle LeDrew (Canadian Delegate – BFHI Network External Relations Committee)
- Laura Haiek (Canadian Delegate – Network Development Committee)
All three play active leadership roles, contributing to strategic planning, policy development, and international collaboration to strengthen Baby-Friendly practices worldwide. Their participation ensures that Canadian perspectives and expertise inform global standards while supporting continuous quality improvement of maternity and newborn care across Canada.