The Ten Steps to Successful Breastfeeding Policy Review

摘要

In 2018, the World Health Organization (WHO) issued the first revision of the 1989 WHO/UNICEF Ten Steps to Successful Breastfeeding. While there is evidence of the effectiveness of those Ten Steps in increasing breastfeeding rates, there has been no published analysis of the key differences between the two versions. We aim to summarise the key changes in each of the Ten Steps and explore the benefits and cost implications. We first review the background to recent changes and then compare the evolution of each of the Ten Steps since 1989. Thirdly, we explore the implications of new implementation guidelines in terms of the cost and benefits from different perspectives. Revisions are subtle, yet meaningful for implementation. A major change made by WHO is subdividing the Ten Steps into 1) critical management procedures, and 2) key clinical practices. Lessons have been learned on how the change has shifted the focus from health care staff to parents and families and shifted the responsibility for some elements of care from hospitals to the community. Exploring the costs and benefits of the Ten Steps, and who has responsibility for implementation, may increase understanding of how the Baby-Friendly Hospital Initiative (BFHI) can be implemented to make it more universal, cost-effective and sustainable. Commitment is needed from policy-makers to integrate the BFHI into health systems and health financing. Future research will examine this at the country level.