Since the benefits of breastfeeding are obvious, and hospitals are supposed to help us stay healthy, you'd think that all hospitals would support breastfeeding. Unfortunately, things are not always as they should be. Partly because of inertia, and partly because of economic pressures, many hospitals have practices that interfere with successful breastfeeding.
    The Baby-friendly Hospital Initiative (BFHI) was launched by WHO and UNICEF in 1991 at the meeting of the International Paediatric Association in Ankara, Turkey, with the following objectives:

• to enable mothers to make an informed choice about how to feed their newborns;
• to support early initiation of breastfeeding;
• to promote exclusive breastfeeding for the first 6 months;
• to ensure the cessation of free and low cost infant formula supply to hospitals;
• to include, possibly at a later stage and where needed, other mother and infant health care issues.

It doesn't take much for a hospital to be baby-friendly. Any hospital that follows the guidelines below qualifies:
Ten steps to successful breastfeeding
Every facility providing maternity services and care for newborn infants should follow these ten steps to successful breastfeeding.

1. Have a written breast-feeding policy that is routinely communicated to all health care staff.
2. Train all health care staff in skills necessary to implement this policy.
3. Inform all pregnant women about the benefits and management of breastfeeding.
4. Help mothers initiate breastfeeding within a half-hour of birth.
5. Show mothers how to breastfeed, and how to maintain lactation even if they should be separated from their infants.
6. Give newborn infants no food and drink other than breast milk, unless medically indicated.
7. Practice rooming-in - allow mothers and infants to remain together - 24 hours a day.
8. Encourage breast-feeding on demand.
9. Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants.
10. Foster the establishment of breast-feeding support groups and refer mothers to them on discharge from the hospital or clinic.

The main economic pressure that prevents many hospitals from following these simple guidelines that could save hundreds of thousands of lives every year is that infant formula companies pay hospitals a lot of money to promote their products. It is typical for a formula company to pay several hundred thousands of dollars to a hospital in a lump sum, followed by about fifty to two hundred thousand dollars a year for five to ten years to use stationery and posters mentioning the company's product and to give out free samples of the company's formula to new mothers. Both of these practices are known to reduce the chances that a new mother will breastfeed her child; a child may very well die because of this. Yet, hospitals need money, and many are unable to turn down this economic incentive to act as a formula company's advertising agent. Many hospitals also use "educational" materials prepared by formula companies that supposedly teach people how to breastfeed. These often contain lots of ads for the company's formula, and almost invariably have incomplete information on breastfeeding, inordinate attention to problems compare to rewards, and many subtle messages against breastfeeding (like showing breastfeeding mothers in dark rooms in their nightgowns with their hair all in a mess, while they show bottle-feeding mothers in their best dresses in bright and cheerful surroundings). See the page on formula marketing for more on this.
    If you have a choice of hospitals, it would make sense to pick one that's most baby-friendly for your birth. Another thing I've done is write a letter to our hospital (Alta Bates) criticizing their baby-unfriendly practices, and refuse to give them a donation. This kind of letter will only be effective if large numbers of people write similar letters. Do it!
    Ultimately, I would like to have a list of hospitals with baby-friendly and unfriendly features listed for each. I really need your help in this! Please go to the baby-friendly hospital form and fill it out for your hospital. It'll just take a few seconds of your time, but you'll really be contributing something important to the world. The form also lets you let me know about URLs of web pages with lists of baby-friendly hospitals so I can link to them.

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