Get access

Implementation of the Baby-Friendly Hospital Initiative Steps in Iowa Hospitals


  • The authors report no conflict of interest or relevant financial relationships.


Catherine J. Lillehoj, PhD, Division of Health Promotion and Chronic Disease Prevention, Iowa Department of Public Health, Lucas State Office Building, 321 E. 12th St., Des Moines, IA 50319. catherine.lillehoj@idph.



To determine the status of each of the Baby-Friendly Hospital Initiative (BFHI) Ten Steps and associated policies in Iowa hospitals.


Exploratory, descriptive study using the World Health Organization BFHI self-assessment survey.


Iowa hospitals with maternity services.


Fifty-three Iowa hospital administrators.


Hospitals were classified by level of implementation of each of the Ten Steps and related criteria.


The majority of the hospitals were implementing at least three of the Ten Steps. The most widely adopted policy, encouraging breastfeeding on demand, was implemented by 83% of the hospitals. None of the hospitals had implemented all six criteria included in Step One. Step One describes a written breastfeeding policy routinely communicated to all healthcare staff.


Implementation of the steps varied by hospital locale; urban hospitals had higher implementation rates for Step 10 than rural hospitals. Areas identified as needing the greatest attention by hospitals were posting of breastfeeding policy, evaluation, and providing education to all mothers.

Get access to the full text of this article