A Seven Point Plan for the Protection, Promotion and Support of Breastfeeding in Community Health Care Settings

The WHO/UNICEF Baby-Friendly™ Initiative in the Community

The WHO/UNICEF Baby-Friendly™ Hospital Initiative was developed to help create conditions in which women would be supported in their efforts to breastfeed their babies. While the Initiative's focus is hospital settings, it also recognizes that a supportive community is necessary for women to initiate and maintain breastfeeding. This pamphlet is an introduction to the expansion of the Initiative into Community Health Care Settings.

The Seven Point Plan for the Protection, Promotion and Support of Breastfeeding in Community Health Care Settings was developed by the United Kingdom Baby-Friendly™ Initiative Committee in response to the great enthusiasm among health care professionals and mother-to-mother support groups for the Baby-Friendly™ Initiative's work to be expanded into the community. The Ten Steps to Successful Breast-feeding, represent best practice in hospitals and maternity facilities and are the basis of the Seven Points. These Seven Points were developed as a result of an extensive consultation procedure involving health professionals, service providers, mother-to-mother support groups, professional organizations and other interested parties who were invited to suggest best practice standard statements and supporting criteria. Therefore, the Seven Points reflect what constitutes best practice in the care for and support of breastfeeding mothers and babies in community health care settings and are intended for the attention of all health care professionals. However, other community groups may use them as a beginning framework to give direction to their breastfeeding activities.

The Seven Point Plan sets out the standard which providers will achieve if they are to reach levels of good practice similar to those attained by Baby-Friendly™ accredited hospitals and maternity facilities. An assessment and designation process will be developed by the Breastfeeding Committee for Canada (BCC) along with the Provincial/Territorial Baby-Friendly™ Initiative Implementation Committees which will enable community service providers to apply for designation as Baby-Friendly™.

Seven Point Plan

For the protection, promotion and support of breastfeeding in Community Health Care Settings

All providers of community health care will:

1. Have a written breastfeeding policy that is routinely communicated to all health care staff.
2. Train all staff involved in the care of mothers and babies in the skills necessary to implement the policy.
3. Inform all pregnant women about the benefits and management of breastfeeding.
4. Support mothers to initiate and maintain breastfeeding.
5. Encourage exclusive and continued breastfeeding, with appropriately-timed introduction of complementary foods.
6. Provide a welcoming atmosphere for breastfeeding families.
7. Promote co-operation between health care staff, breastfeeding support groups and the local community.

1. Have a written breastfeeding policy that is routinely communicated to all staff.

The policy will:

Compliance with the policy should be audited annually by the community health care facility. Breastfeeding rates (both exclusive and partial) should be monitored by the collection of statistics at nationally selected age groups.

Each facility/organization should have a designated individual who is responsible for monitoring breastfeeding rates, developing initiatives to enhance breastfeeding, reviewing policies/protocols, disseminating relevant research findings and providing ongoing staff education.

It is expected that community health care breastfeeding policies will be developed in consultation with all groups involved in the care of families. Close liaison between hospitals/ maternity facilities and community health care facilities/organizations is essential when joint policies are developed.

2. Train all staff involved in the care of mothers and babies in the skills necessary to implement the policy.

All staff will be oriented to the policy at the commencement of employment. The type of orientation will be dependent on employee's role. Those who have clinical responsibility for the care of pregnant women and breastfeeding mothers and babies should receive specific training in the skills needed to implement the policy within six months of hire.

Training should:

3. Inform all pregnant women about the benefits and management of breastfeeding.

Women, their partners and families will be provided with information on all of following:

The principles of successful management of breastfeeding will be explained to enable women to take a proactive role in decisions about infant feeding and the management of potential breastfeeding challenges. All materials and teaching should reflect the Ten Steps to Successful Breast-feeding.

4. Support mothers to initiate and maintain breastfeeding.

This Point encompasses Steps 4,5,7,8 and 9 of the Ten Steps to Successful Breastfeeding and seeks to ensure that the practice of community health care staff is consistent with these steps.

Evidence indicates that breastfeeding is enhanced by:

The acquisition of specific skills such as correct attachment techniques and hand expression of breastmilk enhances a woman's ability to manage breastfeeding independently. Staff will ensure that mothers are offered opportunities to acquire these skills. Referral to mother-to-mother support groups will be recognized as an important component in supporting mothers to breastfeed.

5. Encourage exclusive and continued breastfeeding, with appropriately-timed introduction of complementary foods.

This Point reflects Step 6 of the Ten Steps to Successful Breast-feeding, and includes the introduction of complementary foods.

Mothers will be provided with appropriate information and support to enable them to breastfeed exclusively for about 6 months and to continue breastfeeding for at least two years as identified by The World Health Assembly (Resolution 47.5 1994).

Educational materials must be free of commercial bias and not promote breastmilk substitutes, age-inappropriate complementary foods, pacifiers, bottles and artificial nipples.

6. Provide a welcoming atmosphere for breastfeeding families.

All staff will recognize and support the policy that recognizes breastfeeding as the norm. Mothers should be enabled to breastfeed in all public areas and their right to do so must be upheld in the face of any complaint from other service users. A comfortable area for privacy will be provided for those women who desire it.

7. Promote co-operation between health care staff, breastfeeding support groups and the local community.

Staff should foster the establishment of support networks for breastfeeding women. Mothers will be given information about the support that is available to them, both professional and lay, and about how they may access it. Provision will be made for mothers experiencing breastfeeding difficulties outside regular office hours.

There should be involvement of health care staff, mother-to-mother support group leaders and lay counselors in the development of local policies and protocols relating to breastfeeding so that the complementary nature of breastfeeding support is understood by all.

The health care staff will collaborate with community groups and individuals to foster a breastfeeding culture. This will involve liaison with any organization/group involved with families, including businesses and the media to raise awareness of the importance of breastfeeding.