Step 1 : WABA Action Chart

What You or Your Organisation Can Do

• General
  The Ten Steps call for health facilities to have written policies that are displayed for all to read, indicating that staff is committed to implementing them.
  
  
• Health System
  Visit maternity hospitals, health centres and primary care facilities and see if policies covering the Ten Steps are displayed.
  
  Ask health service managers if they have developed a policy, and explain how the Ten Steps are now considered "best practice". Tell them about the new BFHI materials, especially Section 1 on implementation.
  
  
• Community
  Arrange meetings with community leaders to discuss how to promote baby friendly policies in local maternity facilities.
  
  
• National / Global
  Call upon Governments to issue a policy directive to integrate the Ten Steps into the standard operating procedures and quality assurance for maternity facilities.
  
  Advocate for baby-friendly certification to be part of certification for hospital and health centre quality.
  
  

Step 2 : WABA Action Chart

What You or Your Organisation Can Do

• General
  Training at all levels should address the Ten Steps, breastfeeding counselling, and the International Code.
  
  Consider holding regular meetings to discuss the latest evidence.
  
  
• Health System
  Advocate for health worker training to include the 10 Steps in pre-service curricula and in-service training.
  
  Make sure trainers know about these materials and the internet links for them:
  • WHO Model Chapter on infant and young child feeding;
  • Breastfeeding Promotion and Support in a Baby-Friendly Hospital, a 20-hour course for maternity staff (Section 3 of the new BFHI materials)
  • WHO/UNICEF Breastfeeding Counselling: A Training Course;
  • WHO/UNICEF Infant and young child feeding; An Integrated course;
  • WHO Infant and young child feeding: Model Chapter for textbooks for medical students and allied health professionals
    
    
• Community
  Advocate for training of peer counsellors and primary care workers to support breastfeeding.
  
  
• National / Global
  Educate political leaders about the importance of the Ten Steps in health worker training.

Step 3 : WABA Action Chart

What You or Your Organisation Can Do

• General
  By the time a baby is born, the new mother must be comfortable about breastfeeding, understand its benefits and what she has to do.
  
  
• Health System
  Advocate for breastfeeding information and discussion opportunities to be available for all women, individually and in groups as part of all antenatal care.
  
  Talk to women about their care, and learn if they have been informed about the dvantages of breastfeeding and the risks of not breastfeeding; about how they will be helped at the time of delivery, how to hold the baby and how to ensure that the baby gets plenty of milk.
  
  Make sure that they have relevant and accurate literature on these topics.
  
  
• Community
  Arrange Promotional activities to raise community awareness of the importance of breastfeeding and the support that new mothers need.
  
  
• National / Global
  Work to make breastfeeding an accepted norm in all sectors based on up-to-date evidence of the risks of artificial feeding;
  
  and an understanding that women need active support from the health service and community to enable them to breastfeed effectively.

Step 4 : WABA Action Chart

What You or Your Organisation Can Do

• General
  This step now means, for all healthy newborns, skin-to-skin contact from immediately after delivery for at least one hour or until the baby has attached and fed at the breast if this takes longer.
  
  
• Health System
  Advocate for training of all birth attendants to give skilled support to mothers for skin-to-skin contact immediately after delivery, allowing the baby to attach to the breast when he or she is ready.
  
  
• Community
  Work to increase community awareness of the importance of early initiation of breastfeeding. Show the video breastfeeding crawl so people see what newborns can do.
  
  
• National / Global
  Inform health professional organisations about new research on implementation of this and other Ten Steps, and ask them to support the new practice.

see Initiation of Breastfeeding by Breast Crawl video here

Step 5 : WABA Action Chart

What You or Your Organisation Can Do

• General
  Helping mothers to breastfeed effectively with a good technique is a vital step. If infants are separated from their mothers, or are unable to suckle, their mothers need to express their milk. Health workers need skills to help mothers do these things.
  
  
• Health System
  Get to know the staff of maternity hospitals and primary care services in your area, show appreciation for their help for mothers, and make sure that they have the latest information.
  
  Encourage them to show every mother how to position and attach her baby at the breast to prevent difficulties such as sore nipples and insufficiency of milk; and to teach all mothers to express their breast milk by hand, for comfort, to maintain their milk supply, and to ensure that babies can be fed with breast milk if they are separated. There is generally no need for a breast pump.
  
  
• Community
  Ensure that all mothers learn the techniques for breastfeeding and hand expression and how to overcome common difficulties.
  
  
• National / Global
  Advocate for skilled breastfeeding help to be available to all mothers as a routine part of Maternal and Child Health care, and for all health workers who care for mothers and babies to be trained to give effective help.

Step 6 : WABA Action Chart

What You or Your Organisation Can Do

• General
  Families and health workers may believe that infants need prelacteal feeds of formula or glucose water or other drinks before their mother's milk "comes in". This may lead to failure to breastfeed. Infant formula and advertisements in maternities can mislead people on this important point.
  
  
• Health System
  Make sure that mothers receive help to breastfeed effectively, so that they do not feel a need to give a baby other drinks.
  
  Make sure that health workers understand that supplements are seldom needed, even in the first few days when the volume of breast milk is small; and that the first milk, colostrum is what a baby needs.
  
  Raise awareness of what are the very few medical indications for supplements and what are not medical indications, so that babies do not receive supplements unnecessarily. (see Resources section)
  
  
• Community
  Work with the community to raise awareness about the importance of colostrum, and why a baby needs nothing else in the first few days; and of continuing to breastfeed exclusively six months.
  
  
• National / Global
  Advocate for renewal of government efforts to implement, monitor and legislate all provisions of the International Code of Marketing of Breast-milk Substitutes and subsequent relevant WHA resolutions.

Step 7 : WABA Action Chart

What You or Your Organisation Can Do

• General
  In many hospitals newborns are kept in nurseries after delivery. Rooming-in allows mothers and their babies to stay together day and night to bond and to establish breastfeeding.
  
  
• Health System
  Visit maternity facilities and discuss the importance of mothers keeping their newborns with them 24 hours a day following from the initial skin-to-skin contact. The baby can be in the same bed as the mother, or in a cot beside her bed where she can see and reach him or her without getting up. The baby should not be in a cot at the end of the mother's bed.
  
  
• Community
  Support traditions and environments that allow a mother and child to be together throughout early infancy.
  
  
• National / Global
  Advocate for a policy of rooming-in for all maternity services.
  
  Advocate for adequate paid maternity leave to enable mothers to be with their young infants and to breastfeed. Ask global organisations to support the ILO maternity leave and other breastfeeding support provisions.

Step 8 : WABA Action Chart

What You or Your Organisation Can Do

• General
  Babies should feed according to their needs, not on a schedule decided by the hospital or mother. Understanding her infant's feeding cues improves breastfeeding and the mother-child relationship.
  
  
• Health System
  Encourage maternity facilities to support breastfeeding on demand, and not on a schedule. Health workers should know infant feeding cues (signs) and teach families about them.
  
  Signs of hunger are the baby opening the mouth, rooting, sucking hands, and moving arms and legs. Crying is a distress call and a late sign.
  
  Signs that a baby is full, are turning away, closing the mouth, and not suckling. Breastfeeding in response to feeding cues encourages appropriate intake and growth.
  
  
• Community
  Make families aware of feeding cues, and the importance of responding to them. They should feed a baby when it is hungry and not wait for it to cry; but not over feed a child and risk obesity.
  
  
• National / Global
  Advocate with government for breastfeeding on demand in all maternity facilities; and for development partners to include feeding cue recognition and responsive feeding in nutrition programmes.

Step 9 : WABA Action Chart

What You or Your Organisation Can Do

• General
  During the early weeks, the baby's need to suckle should be satisfied at the breast. Using teats or pacifiers may interfere with suckling and the adjustment of the breast milk supply to the baby's requirements.
  
  
• Health System
  Ask maternity staff not to allow use of teats and pacifiers in maternities, unless medically indicated for comfort if the mother is not available. In such cases, care should be taken to avoid spill over to other infants.
  
  Teach cup feeding for infants who cannot breastfeed.
  
  
• Community
  Talk to families and community groups about the risks of using teats and pacifiers while breastfeeding is being established.
  
  
• National / Global
  Advocate with health authorities to ensure that hospital and health centre policies do not allow teats and pacifiers to be used routinely and that communication materials include appropriate messages.
  

Step 10 : WABA Action Chart

What You or Your Organisation Can Do

• General
  Breastfeeding support groups are often part of a community nutrition strategy.
  
  Peer counsellors are women from the community, who receive training in breastfeeding support. They often contact mothers in their homes. They are very effective in increasing exclusive breastfeeding.
  
  
• Health System
  Talk to health service managers about the need for skilled breastfeeding support in postnatal services and in the community, and for them to work together.
  
  Peer counsellors may be trained and supervised by health facility staff, and refer mothers to them.
  
  Make sure that maternity staff informed about sources of breastfeeding support in the community, and that they have contact details.
  
  Mothers and infants should be in contact with a breastfeeding counsellor or support worker, in a health facility or at home, on the first day after delivery and at:
  
  
  • 2-3 days
  • 4-7 days
  • 7-28 days
  • 4-8 weeks
    

and thereafter at the time of other contacts for immunization, growth monitoring, family planning, or any other reason.

• Community
  Work with communities to develop a source of skilled support for breastfeeding mothers. Women who have successfully breastfed can form groups to support each other, or they can lobby the health authorities or a local organisation to train peer counsellors.
  
  
• National / Global
  Build alliances with community organisations to help develop breastfeeding support services.
  
  Advocate for governments to include peer counselling in strategies and plans, alongside counselling in the health system.