ObjectiveThe WHO/UNICEF Baby-Friendly Hospital Initiative (BFHI) is an effective strategy to increase breast-feeding exclusivity and duration but many countries have been slow to implement it. The present paper describes the development of a computer-based instrument that measures policies and practices outlined in the BFHI.DesignThe tool uses clinical staff/managersa€? and pregnant women/mothersa€? opinions as well as maternity unit observations to assess compliance with the BFHI's Ten Steps to Successful Breastfeeding (Ten Steps) and the International Code of Marketing of Breastmilk Substitutes (Code) by measuring the extent of implementation of two to fourteen indicators for each step and the Code. Composite scores are used to summarize results.SettingExamples of results from a 2007 assessment performed in nine hospitals in the province of Qu??bec are presented to illustrate the type of information returned to individual hospitals and health authorities.SubjectsParticipants included nine to fifteen staff/managers per hospital randomly selected among those present during the interviewer-observer's 12 h hospital visit and nine to forty-five breast-feeding mothers per hospital telephoned at home after being randomly selected from birth certificates.ResultsThe Ten Steps Global Compliance Score for the nine hospitals varied between 2?·87 and 6?·51 (range 0a€“10, mean 5?·06) whereas the Code Global Compliance Score varied between 0?·58 and 1 (range 0a€“1, mean 0?·83). Instrument development, examples of assessment results and potential applications are discussed.ConclusionsA methodology to measure BFHI compliance may help support the implementation of this effective intervention and contribute to improved maternal and child health.
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