The 10 WBTi Indicators for Policies and Programs

World Breastfeeding Trends Initiative (WBTi) – What are countries assessed on?

“The World Health Assembly (WHA) and the UNICEF Executive Board adopted the Global Strategy for Infant and Young Child Feeding in the year 2002. The Global Strategy has a framework of action on 10 indicators of policy and programs to improve optimal breastfeeding and infant & young child feeding practices. It calls for urgent action by all Member States to develop, implement, monitor and evaluate a comprehensive policy and a plan of action on to achieve a reduction in child malnutrition and mortality.” WBTi Guidebook 2018


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Indicators 1-10

Policies and programs that protect, promote and support breastfeeding

Indicator 1: National Policy, Program and Coordination

Key question: Is there a national infant and young child feeding/ breastfeeding policy that protects, promotes and supports optimal infant and young child feeding and the policy is supported by a government program?

Is there a mechanism to coordinate, such as a national infant and young child feeding committee and a coordinator for the committee?

Background: The “Innocenti Declaration was adopted in 1990. It recommended all governments to have national breastfeeding committees and coordinators as established mechanisms to protect, promote and support breastfeeding in the country. The Planning Guide for national implementation of the Global Strategy for Infant and Young Child Feeding (2007) calls for implementation of the GSIYCF into concrete focused national strategy, policy and action plans.


Indicator 2: Baby Friendly Care and Baby-Friendly Hospital Initiative (BFHI) (Ten Steps to Successful Breastfeeding)

Key question: What percentage of hospitals and maternity facilities that provide maternity services have been designated as “Baby Friendly” based on the global or national criteria?

What is the quality of BFHI program implementation?

Background: The Joint WHO/UNICEF Statement: Protecting, promoting and supporting breastfeeding: the special role of maternity services, in 1989 called on the leadership of those working in maternity services to sustain or if necessary to re-establish a “ breastfeeding culture”. The Innocenti Declaration of 1990 calls on governments to ensure that all maternity services fully practice all ten of the Ten Steps to Successful Breastfeeding.

Indicator 3: Implementation of the International Code of Marketing of Breastmilk Substitutes

Key question: Is the International Code of Marketing of Breastmilk Substitutes (WHO Code) and subsequent World Health Assembly (WHA) resolution are in effect and implemented?

Has any new action been taken to give effect to the provisions of the Code?

Background: The “Innocenti Declaration” calls for all governments to take action to implement all the articles of the International Code of Marketing of Breastmilk Substitutes and the subsequent World Health Assembly resolutions. The aim of the Code is to contribute to the provision of safe and adequate nutrition for infants, by the protection and promotion of breastfeeding, and by ensuring the proper use of breastmilk substitutes, when these are necessary, on the basis of adequate information and through appropriate marketing and distribution.

Indicator 4: Maternity Protection

Key question: Is there a legislation and are there other measures (policies, regulations, practices) that meet or go beyond the International Labor Organization (ILO) standards for protecting and supporting breastfeeding for mothers, including those working mothers in the informal sector?

Background: The Innocenti Declarations (1999, 2005) and WHO Global Strategy for IYCF (2002) call for provision of imaginative legislation to protect the breastfeeding rights of working women and further monitoring of its application consistent with ILO Maternity Protection Convention No 183, 2000 and Recommendation 191.

Indicator 5: Health and Nutrition Care Systems (in support of breastfeeding & IYCF)

Key question: Do care providers in these systems undergo skills training, and do their pre-service education curriculum support optimal infant and young child feeding; do these services support mother and breastfeeding friendly birth practices; do the policies of healthcare services support mothers and children, and whether health workers responsibilities to Code are in place?

Background: All providers who interact with mothers and their young children should attain the basic attitudes, knowledge and skills necessary to integrate breastfeeding counseling, lactation management, and infant and young child feeding into their care.

Indicator 6: Mother Support and Community Outreach – Community based support for the pregnant and breastfeeding mother

Key question: Are there mother support and community outreach systems in place to protect, promote and support optimal infant and young child feeding?

Background: Community-based support for women is essential for succeeding in optimal breastfeeding practices. Step 10 of BFHI as well as the Global Strategy for IYCF, which includes mother support and peer support, recognizes this need. Mother Support, as defined by the Global Initiative for Mother Support (GIMS) is “any support provided to mothers for the purpose of improving breastfeeding practices for both mother and infant & young child”. Women need the support of evidence-based public health policies, health providers, employers, friends, family, the community, and particularly of other women and mothers in regards to preparation for breastfeeding which can come during the pregnancy and postpartum and after delivery.

Indicator 7: Information Support

Key question: Are comprehensive Information, Education and Communication (IEC) strategies for improving infant and young child feeding (breastfeeding and complementary feeding) being implemented?

Background: Women and carers having the right to appropriate and objective support and information, education and communication (IEC) strategies are important aspects of a comprehensive program to improve infant and young child feeding practices. However, because such programs are expensive and often take place within a commercial context, they tend to attract inappropriate funding, for example, from the baby feeding industry. This can undermine the effectiveness of any campaign and lead to unwise decision making.

Indicator 8: Infant Feeding and HIV

Key question: Are policies and programs in place to ensure that HIV – positive mothers are supported to carry out the national recommended Infant feeding practice?

Background: The fact that HIV can pass through breastfeeding and also that breastfeeding has life saving implications for infants and children, pose a dilemma to all, including policy makers, infant feeding counsellors and mothers who are HIV positive, whether to choose breastfeeding for their baby or give replacement feeding. Optimal replacement feeding is rarely possible in resource-limited settings. In view of this breastfeeding has remained the best feeding practice regardless of HIV status in most settings especially in the developing countries where HIV prevalence is high.

In countries that recommend formula feeding for HIV-infected mothers, great care should be taken to ensure that Code-compliant infant formula is available only for those infants who need it.

Indicator 9: Infant and Young Child Feeding during Emergencies

Key question: Are appropriate policies and programs in place to ensure that mothers, infants and young children will be provided adequate protection and support for appropriate feeding during emergencies?

Background: Infants and young children are among the most vulnerable groups in emergencies. Absence of or inadequate breastfeeding and inappropriate complementary feeding increase the risks of undernutrition , illness and mortality.

Indicator 10: Mechanisms of Monitoring and Evaluation System

Key question: Are monitoring and evaluation systems in place that routinely collect, analyse and use data to improve infant and young child feeding practices?

Background: Monitoring and evaluation components should be built into all major infant and young child feeding program activities and collection of data concerning feeding practices integrated into national nutritional surveillance and health monitoring systems or surveys.


World Breastfeeding Trends Initiative (WBTi) Assessment Tool

World Breastfeeding Trends Initiative (WBTi) Guidebook 2018