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Woman breastfeeding child while nurse is supervising
Photo Credit: SPRING

USAID Advancing Nutrition is documenting and sharing country experiences in expanding the coverage and sustainability of the Baby Friendly Hospital Initiative (BFHI). BFHI includes 10 well-known evidence-based steps (The Ten Steps) that health facilities can implement to promote, protect, and support breastfeeding. The 2018 WHO/UNICEF BFHI implementation guidance also emphasized nine key government responsibilities to integrate the 10 steps into national health systems as standards of care, implement them at scale, and sustain them over time—essential to helping as many mothers as possible to breastfeed their babies. Several low- and middle- income countries have made progress in adopting some of the nine responsibilities, but their experiences and lessons are not well documented.

Lessons Learned from the Kyrgyz Republic and Malawi

USAID Advancing Nutrition conducted a two-country case study in the Kyrgyz Republic and Malawi to support efforts to document and share country experiences in implementing three of the responsibilities:

  • health professional competency building
  • incentives for compliance and/or sanctions for non-compliance with the Ten Steps
  • technical assistance to facilities.

The case study manuscripts, the first of which was published in 2022, document country experiences in institutionalizing BFHI, including lessons learned and barriers and challenges in policy and program support. They highlight the need to continue to share country processes, tools and experiences of implementing the national responsibilities as countries seek to protect, promote, and support breastfeeding through BFHI. Sign up to be notified when both the case studies have been published.

Nine key responsibilities of a national BFHI program (WHO/UNICEF):

  1. Establish or strengthen a national breastfeeding coordination body.
  2. Integrate the Ten Steps into relevant national policy documents and professional standards of care.
  3. Ensure the competency of health professionals and managers in implementation of the Ten Steps.
  4. Utilize external assessment systems to regularly evaluate adherence to the Ten Steps.
  5. Develop and implement incentives for compliance and/or sanctions for non-compliance with the Ten Steps.
  6. Provide technical assistance to facilities that are making changes to adopt the Ten Steps.
  7. Monitor implementation of the initiative.
  8. Advocate for the BFHI to relevant audiences.
  9. Identify and allocate sufficient resources to ensure the ongoing funding of the initiative.


On September 21, 2023, USAID Advancing Nutrition hosted a learning event in Bolgatanga, marking the end of three years of project implementation in northern Ghana focused on improving multi-sectoral…