Indicators at a glance … Indicator TWO

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The ‘Ten Steps to Successful Breastfeeding’ are the cornerstone of the World Health Organisation (WHO) Baby-friendly Health Initiative (BFHI), first introduced in Australia in 1993. The BFHI aims to protect, promote and support breastfeeding in maternity health facilities. The steps include facility guidance such as having a written breastfeeding policy, and ensuring staff have the knowledge and competence to support breastfeeding.

Using updated evidence in 2018, WHO revised the Ten Steps and expanded on earlier concepts grouping these into: critical management procedures (Steps 1 and 2), and key clinical practices (Steps 3- 10).

Adhering to the International Code of Marketing of Breastmilk Substitutes (WHO Code) is explicit under Step 1.

The rest of the Ten Steps include:

• the importance of facilitating uninterrupted skin to skin contact between mother and baby,

• initiating breastfeeding as soon as possible after birth,

• avoiding any other fluids for the infant unless medically indicated,

• keeping mothers and babies together,

• avoiding the use of bottles and teats, and

• supporting mothers to recognise feeding cues and manage common difficulties with ongoing support after discharge.

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Hospitals in Australia can seek BFHI accreditation once they meet the minimum BFHI Ten Steps standards. The 2023 WBTiAUS report shows only 24% of Australian maternity hospitals (both public & private) have been designated/accredited as BFHI facilities, representing a slight increase of 2% from the previous assessment in 2018. The new updated BFHI guidance emphasises the importance of integration of the Ten Steps into national hospital accreditation standards however so far, in Australia, this has not happened.

National health survey data shows that the majority of Australian women want to breastfeed (96%) and breastfeeding mothers should expect to enter a maternity health system that complies with the WHO BFHI recommendations. Yet less than a quarter of all breastfeeding women in Australia can access an accredited facility!

The Australian National Breastfeeding Strategy (2019) Priority Action Area 2 cites increasing BFHI accreditation as an essential activity for creating enabling breastfeeding environments. But without reliable data collection there is no way to measure improvements towards the Strategy target of 50% of infants exclusively breastfed at six months. Government and health department action and commitment are required if we are to genuinely protect, promote and support breastfeeding in Australia!

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