Baby-Friendly Facility, 2019 Health Of Women And Children Report
Measure: Baby-Friendly Facility, 2019 Health Of Women And Children Report

Why does this matter?

Breastfeeding is beneficial for both the infant and mother. To increase breastfeeding initiation and duration, it is important for mothers to breastfeed soon after delivery. Hospital practices during the first hours and days after delivery influence successful breastfeeding. In 1991, the World Health Organization and the United Nations International Children's Emergency Fund launched the Baby-Friendly Hospital Initiative to promote and support breastfeeding around the world. Any facility that provides maternity care services, including hospitals, birth centers and military facilities, can be designated as a Baby-Friendly Facility when it has implemented the Ten Steps to Successful Breastfeeding and passed a formal evaluation process.

Ten Steps to Successful Breastfeeding:

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

As of March 2018, all 50 states, the District of Columbia and Puerto Rico had at least one Baby-Friendly facility, accounting for more than 500 facilities.

  • CDC, Breastfeeding Report Card, 2018

mPINC, 2019 Health Of Women And Children Report
Measure: mPINC, 2019 Health Of Women And Children Report

Why does this matter?

Postpartum experiences in the hospital reflect routine practices at the facility level because patients rarely request care different than what is offered to them by health care professionals. Although most hospital administrators and staff agree that breastfeeding provides optimal nutrition for most infants, many remain unaware of the specific characteristics of a hospital environment that promote breastfeeding.

In 2003, the Centers for Disease Control and Prevention (CDC), with the assistance of an expert panel, established an ongoing, national survey system to monitor and evaluate hospital practices related to breastfeeding among all facilities that routinely provide maternity care in the United States. First administered in 2007 and repeated every two years since, the Maternity Practices in Infant Nutrition and Care (mPINC) survey measures the quality of hospital maternity practices to support breastfeeding. These practices are generally aligned with the Baby-Friendly Hospital Initiative’s Ten Steps to Successful Breastfeeding, put forth by the World Health Organization and the United Nations Children’s Fund.

Each hospital and birth center facility in the United States that routinely provides maternity care services is surveyed and receives an overall mPINC score. mPINC scores range from 0 to 100, with higher scores representing better maternity care practices. Each state also receives a total mPINC score, which represents the proportion of hospital facilities within that state that reported the ideal responses to each question on the survey.

This score reflects subscores for hospital practices in each of seven dimensions of care:

  1. Labor and delivery care
  2. Feeding of breastfed infants
  3. Breastfeeding assistance
  4. Contact between mother and infant
  5. Facility discharge care
  6. Staff training
  7. Structural and organizational aspects of care delivery

Following the establishment of the mPINC survey, researchers have observed improvements in many of the maternity care policies and practices that are part of the mPINC survey, though such changes cannot be directly attributed to the survey itself. Further, the mPINC survey has led some hospitals and birth facilities to work together to improve adherence to the standard of care.

  • CDC, mPINC State Reports, 2018

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