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July 2019

The Spirit of Being Baby-friendly

Dr Patricia Ip
Chairperson, Committee on Designation of Baby-Friendly Health Facilities
Vice chairperson, Baby Friendly Hospital Initiative Hong Kong Association


The World Health Organization (WHO) introduced the Baby-friendly Hospital Initiative (BFHI) in 1991 to support mothers to establish lactation and breastfeed in the early days after childbirth. Hospitals that practise the Ten Steps to Successful Breastfeeding (Ten Steps) and comply with the International Code of Marketing of Breastmilk Substitutes are eligible for being designated as baby-friendly hospitals (BFH). Since the designation programme started in Hong Kong in 2013, there are now two baby-friendly hospitals with others at different stages of the designation process. Achieving certain stages or being designated are important milestones for hospitals. As the WHO is not asking for perfection in acquiring the BFH status, there can always be quality improvement, keeping in mind the purpose and spirit of BFHI.

Infant Feeding Policy

The Baby Friendly Hospital Initiative Hong Kong Association (BFHIHKA) asks hospitals to undertake a self-assessment of the practice of the Ten Steps each year before the World Breastfeeding Week. This both monitors the trend in Hong Kong and serves as a reminder to the hospitals of the Ten Steps. Some hospitals indicate they have a policy that all staff are acquainted with although it is not a written policy. Perhaps the management of hospitals feel they are supportive of breastfeeding and consider all their staff are like-minded. However, it cannot be over-emphasized that having a written policy is a serious matter. A policy is a means of guaranteeing that “appropriate care is equitably provided to all mothers and babies” independent of staff preference, as explained by the WHO Guidance on BFHI.1 The policy ensures “patients receive consistent, evidence-based care” whether it is during the early hours of the morning or a public holiday. Any deviation from the policy needs to be justified and documented. 

***Please click here to read more or download the whole article with the note of references.***


It is heartening to see more and more hospitals willing to adopt the WHO standards in support of optimal infant feeding, through the practice of the Ten Steps and mother-friendly childbirth care. The effort spent in achieving these standards could be massive but an important investment in public health. To maximise the benefits for mothers and babies, it is important to view being baby-friendly as a process and not an end. Understanding the substance of the Ten Steps and its significance will move one from following the letter to bringing alive the spirit of being baby-friendly.

Key Message

Being baby-friendly is a process and not an end. Understanding the substance of the Ten Steps will facilitate improvements beyond the letter of the Ten Steps to achieving the maximum benefits for mothers and babies through the BFHI.


Editor-in-Chief: Dr Shirley Leung
Illustrations from WHO poster of Ten steps to successful breastfeeding:
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