School of Public Health

Washington Offers Community-Focused Alternative to Baby-Friendly Hospitals

April 2017

Breastfeeding Friendly Washington Program | Community Based Prevention

Have you heard about the ongoing evidence debate surrounding Baby-Friendly Hospitals?

In 2015, a workgroup at the Washington State Department of Health (DOH) saw an opportunity to help hospitals and birth centers improve maternity care practices and improve breastfeeding support to families. They developed the Breastfeeding Friendly WA program to formally recognize birthing facilities that want to practice evidence-based breastfeeding care but are unable to meet the financial and administrative requirements of the Baby-Friendly Hospital Initiative (BFHI). The BFHI is an international designation program with 4 separate Designation Phases that can take hospitals years to complete and costs several thousands of dollars to achieve.


Breastfeeding Friendly WA's
Ten Steps for Birthing Centers and Hospitals

  1. Have a written breastfeeding policy that is routinely communicated to all healthcare staff
  2. Train all healthcare staff in the skills necessary to implement this policy
  3. Inform all pregnant women about the benefits and management of breastfeeding
  4. Place babies skin-to-skin with their mothers for 60 minutes immediately after birth and help mothers recognize and respond to feeding cues
  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 to allow mothers and infants to remain together 24 hours a day
  8. Encourage breastfeeding on demand. Teach mothers cue-based feeding regardless of feeding method
  9. Give no artificial nipples or pacifiers to breastfeeding infants
  10. Establish a system for referring mothers to out-patient and community support

Breastfeeding Friendly WA is a recognition awarded by the DOH with no fee to apply. Program staff coach hospitals and birth centers on how to write breastfeeding policies, implement evidence-based practices, identify resources for staff training, and more. Most hospitals achieve the first recognition level within a few months.

The DOH workgroup researched the BFHI’s Ten Steps to Successful Breastfeeding and  identified those most likely to positively impact breastfeeding outcomes. They revised the BFHI requirements to help hospitals begin the journey toward evidence-based practices or as a stepping stone towards the implementation of the BFHI.

The workgroup designed the program for incremental implementation as opposed to the BFHI requirement that all 10 steps be achieved before recognition is granted. With Breastfeeding Friendly WA, organizations have the option to apply for Gold level recognition (implementation of all 10 steps at once) or to work toward one or more tiers of recognitions. The Bronze level requires compliance with steps 1, 4, 7, and 10. Only after an organization achieves Bronze level can it apply for the Silver level (steps 3, 5, 6, 8 and 9).  A Gold level organization should have everything in place to apply for the recognition through the BFHI.


The workgroup recently adapted the hospital program to a clinical setting following a successful three month pilot project with WIC clinics. Because the clinics’ state and federal breastfeeding requirements already aligned with Breastfeeding Friendly WA, this ensured levels of consistency that allowed clinic staff to focus solely on assessing the application process. They provided valuable feedback on the program’s content and helped the workgroup develop requirements that are reasonable, relevant, and impactful for a clinical practice.  

This spring, the Breastfeeding Friendly certification will be available to smaller healthcare organizations such as community health centers, outpatient clinics, group and individual medical practices and Women, Infants, and Children (WIC) offices.  

The workgroup plans to develop a formal evaluation to gauge Breastfeeding Friendly WA’s influence on state breastfeeding rates. For now, they rely on data from the CDCs Maternity Practices in Infant Nutrition and Care (mPINC), the Joint Commission, WIC, and the breastfeeding report card.

For more information about this program please contact Michele Lord, Breastfeeding Coordinator, at