Republic of the Philippines

Department of Health
OFFICE OF THE SECRETARY
2/F Building 1, San Lazaro Compound, RizalAvenue, Sta.Cruz, Manila
TtunkLine: 7t:.3-8301; Direct Line: 711-950l;Fax: 743-1829; 743-1786
URL: IJ!!p://www.doh.gov.ph; e-mail: osec@doh.gov.ph

July 10, 2007

ADMINISTRATIVE ORDER
No. 20o'{, 00 ~(0

SUBJECT: Revitalization of the Mother-Baby Friendly Hospital

Initiative in Health Facilities with Maternity and
Newborn Care Services

1. RATIONALE

The WHO experts on child health estimates that 19% of under five (5) year-old
deaths in the Philippines can be traced to inappropriate feeding practices including
formula feeding. In the first two (2) months of life, an infant who is not breastfed is
up to twenty-five (25) times more likely to die from diarrhea and four (4) times more
likely to die from pneumonia than an exclusively breastfed child.

Only sixteen percent (16%) of infants at five (5) months of age were exclusively
breastfed. Thirty-nine percent (39%) are using infant formula in their first twelve
(12) months of life. Thirteen percent (13%) of infants were never breastfed, making
the Philippines the lowest in ever-breastfed rates among fifty-six (56) countries that
have conducted a Demograp_hic Health Survey (DHS) in the past ten (10) years.

In 2003, the infant mortality rate (IMR) was 29 per 1000 live births.
Improvements in the health and nutrition status of infants and young children
through exclusive and extended breastfeeding as well as proper complementary
feeding will significantly contribute to the achievement of the Millennium
Development Goal (MDG) of reducing infant mortality by two-thirds by the year
2015.

Almost all children can be breastfed and the decision of the pregnant mother to
breastfeed starts even before the delivery of the newborn. It is therefore in the health
facilities where the opportunity to drive across the message to breastfeed can be
initiated and nurtured by providing emphasis on the greater social roles of the health
 The results of the National Demographic Health Survey (NDHS) conducted in
2003 showed that deliveries attended by health professionals or those delivered in
health facilities are less likely to be breastfed.

The Mother-Baby Friendly Hospital Initiative Program of the Department of

Health was launched in 1992 pursuant to RA 7600 otherw;se known as the
"Rooming-In and Breastfeeding Act of 1992". To implement this Act, all hospitals,
both government and private offering maternity and newborn care services may be
accredited as Mother-Baby Friendly by implementing the Ten Steps to Successful
Breastfeeding which is a nationally adopted UNICEF/WHO global criteria.

The Mother-Baby Friendly Hospital Initiative (MBFHI) aims to facilitate and

protect breastfeeding in private and public hospitals and help mothers and their
newborns start with breastfeeding soon after birth. MBFHI in the Philippines
reached a peak in the late nineties, when the Department of Health certified 1,427 or
83% ofthe 1,713 targeted hospitals and lying-in clinics.

However, MBFHI implementation weakened due to several factors. In 2006, a

retrospective study conducted by the University of the Philippines (UP) on the
Philippine MBFHI experience in 15 regions covering 98 government and private
hospitals revealed poor compliance to the ten steps to successful breastfeeding. The
study showed that while 92.9% of the participating hospitals sustained its
accreditation, the breastfeeding policies were communicated only during orientation
in 59.1% of respondents and during meetings in 42%.

Fifty-two percent (52%) of the participating hospitals had lactation

coordinators. The survey showed that in only 63% were the mothers assisted in the
initiation of· breastfeeding within half an hour of birth; while only 52% of post-
partum mothers were assisted to breastfeed and maintain lactation. A significant
proportion of hospitals, 60.2%, allowed provision of milk formula in specific
circumstances while only 43% of personnel did not allow food or drinks other than
breastmilk.

A significant number of the babies were provided non-breastmilk for the

following reasons: mother is. incapable of breastfeeding or is sick (35.7%); baby is
sick (21.4%); mother refused to breastfeed (5.9%); doctor's order (1.7%); baby had
cleft palate (2.1%); mother delivered by Caesarean Section (1.7%); it is hospital
routine to give water and sugar (1.3%). Only 27.6% of health facilities foster~Jd the
establishment of breastfeeding support groups.

As such, appropriate interventions and enabling mechanisms should be

revitalized to protect, promote and support/sustain breastfeeding practices within
health facilities.

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 Reassessment of previously certified hospitals need to be done, assess new ones
and continue capacity building of health workers. There is a need to integrate
mother-friendly indicators such as positioning during labor and delivery, initiation/
skin to skin contact in vaginal/abdominal deliveries, minimal ust> of anesthesia and
episiotomies, encourage spouse involvement and/or other family support to a woman
before, during and after delivery. Likewise, addressing emerging issues affecting
breastfeeding should also be considered.

This Administrative Order aims to guide heath workers in revitalizing the

mother-baby friendly hospital initiative, towards a more sustainable action to protect,
promote, and support breastfeeding.

II. LEGAL MANDATES

The following laws and administrative issuances provide the mandate for the
appropriate support, promotion and protection of breastfeeding:

1. Executive Order No. 51 dated 20 October 1986, otherwise known as "National

Code of Marketing of Breastmilk Substitutes, Breastmilk .Supplements and
Related Products" calls for the intensification of the dissemination of
information on breastfeeding and proper nutrition and the regulation of
advertising, marketing, distribution of breastmilk substitutes and other related
products including bottles and teats and prohibiting the use of health facilities
and health workers in the promotion and marketing of the products covered by
the Code.

2. Under Article 24 of the 1989, the United Nations Convention on the Rights of
the Child emphasized the social responsibility of the member States to protect
children and to provide them with appropriate support and services,
emphasizing their right to the highest attainable level of health care services and
guarantees the provision of and access to adequate nutrition for all infants and
young children.

3. Republic Act 7600 otherwise known as the "Rooming-In and Breastfeeding

Act" of 1992 provides that rooming-in shall be observed within 30 minute;; after
birth. For normal spontaneous deliveries, breastfeeding should be done within
one hour after birth and for Caesarean Section (C/S) deliveries, 3-4 hours after
birth, to ensure support for early, exclusive and continuous breastfeeding.

4. The Philippine and Infant and Young Child Feeding (IYCF) policy as adopted
from the WHO and UNICEF "2002 Global Strategy on Infant and Young Child
Feeding" calls for a renewed and accelerated action toward~ the promotion of
appropriate infant and young child feeding practices.

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 5. PHIC Circular No. 26 s.2005 has included the Mother-Baby Friendly Hospital
Initiative as part of its accreditation requirements for all hospitals in order to
encourage, S\lpport and promote breastfeeding in the primary, secondary and
tertiary levels of hospital facilities recognizing that breastfeeding is essential for
the health and well-being of the infant and the mother.

6. Administrative Order No. 2005-0023 of the Department of Health identified

Fourmula One for Health as the implementing mechanism for health sector
reforms, thereby ensuring better health outcomes, a more responsive public
health system, and a more equitable health care financing for Filipinos. This
involves critical reform initiatives which focuses on Fl Health Priority
Programs/Projects/Activities (PPA's) for the National Investment Plan for
Health, ·where the Breastfeeding Program is one of the priorities for Public
Health Program Development.

III. OBJECTIVES

This Administrative Order aims to:

A. Transform all health institutions with maternity and newborn services in both
the government and the private sector and other health facilities into facilities
that fully protect, promote and support rooming-in, breastfeeding and mother-
baby friendly practices.

B. Build the critical capacity and commitment of health care staff in protecting,
promoting and providing support for appropriate infant and young child feeding
practices.

C. Establish linkage with the primary health care facilities and community support
groups to sustain the practice and ensure an enabling environment for optimal
feedi1ig practices.

IV. COVERAGE-AND SCOPE

These guidelines shall. apply to all government, private and other health
facilities nationwide providing maternity and newborn care services regardless of
their current MBFHI certification/accreditation status.

V. DEFINITION OF TERMS

A. Breastmilk substitute - means any food being marketed or otherwise represented

as a partial or total replacement for breastmilk, whether or not suitable for that
purpose.

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 B. Complem~ntary food - means any food, whether manufactured or locally
prepared, suita~le as a complement to breastmilk or to infant formula, when either
becomes insufficient to satisfy the nutritional requirements of the infant. Such
food is also commonly called "weaning food" or "breastmilk supplement"
C. Exclusive breastfeeding - providing breastmilk as the sole source of nutrition for
infants
D. Health workers - any person working in the health care system, whether
professional or non-professional, including voluntary and unpaid workers, m
public or private practice.
E. Infant- a child within zero (0) to eleven (11) months and 29 days of age
F. Infant formula - the breastmilk substitute formulated industrially in accordance
with applicable Codex Alimentarius standards, to satisfy normal nutritional
requirements of infants up to six (6) months of age, and adopted to their
physiological characteristics .
G. Lactation Management - the general care of a mother-infant nursing couple
during the mother's prenatal, immediate post-partum and post-natal periods. It
deals with educating and providing knowledge and information to pregnant and
lactating mothers on the advantages of breastfeeding, the physwlogy of lactation,
the establishment and maintenance of lactation, the proper care of the breasts and
nipples, and such other matters that would contribute to successful breastfeeding.
H. Low birth weight infant - a newborn weighing less than two thousand five
hundred (2,500) grams at birth.
I. Rooming-In- the practice of placing the newborn in the same room as the mother
right after delivery up to discharge to facilitate mother-infant bonding and to
initiate breastfeeding. The infant may either share the mother's bed or be placed
in a crib beside the mother.
J. Skilled birth attendant - refers to professional health workers such as doctor,
nurse, midwife with the training or educational background to perform safe and
clean deliveries.

VI. IMPLEMENTING GUIDELINES

In order to become a 1-Jother-Baby Friendly facility, a set of criteria based on

the current guidelines of the UNICEF/WHO have been developed and adopted
locally for the purpose of setting the standards which shall be the basis for the
requirements among others to be institutionalized through licensing, accreditation
and other regulatory mechanisms in the pursuit of quality maternity and newborn
care service· delivery in the hospital facilities.

A. To become a Mother-Friendly Institution, the following are the required steps to

be followed by the health facilities according to the UNICEF/WHO Global
Criteria: (See Annex A: Steps to a Mother-Friendly/ Safe Motherhood Initiative)

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1. The hospital facility shall incorporate mother-friendly labor and birthing
practices in the health facilities' policies or standard operating procedures,
including:
a. Clean birthing technique
b. Delayed cord clamping (3 minutes)
c. Placenta removal and disposal
d. Collaboration/consultation with other maternity services,
including maintaining communication with all caregivers
when referral or transfer is necessary
e. Linking the mother and the baby to appropriate
community resources, including pre-natal and post-natal
discharge follow-up and breastfeeding support

2. Train staff responsible on maternity services on essential and emergency

obstetric and newborn care.

3. Educate. the staff in non-drug methods of pain relief that can provide options in
minimizing the use of analgesics or anesthetic drugs.

4. Motivate and refer pregnant women for STD/HIVIAIDS screenmg and

voluntary counseling and treatment.

5. Provide the best available care, including quality antenatal, delivery, postpartum
and newborn care with timely referral.

6. Birthing mothers may be offered access to a birth companion of her choice who
can provide emotional and physical support during labor. A labor-SlltJport
professional can provide this support until the mother delivers.

7. Birthing mothers may be allowed the freedom to walk, move about and assume
the positions of her choice during labor and birth as a feasible option that shall
not be limited to the lithotomy position.

8. Women may be allowed to drink during labor, upon the discretion of the
attending physician.

9. The performance of obstetrical procedures shall be rationalized to minimize or

avoid unnecessary procedures and instrumentation that may inhibit
breastfeeding. A baby born by Caesarean Section is less likely to have early
skin to skin contact and more likely to have nursery care increasing the risk of
cross infection as well as restricting breastfeeding. The option to perform
invasive procedures such as rupture of membranes, episiotomies, acceleration or
induction of labor, instrumental deliveries or caesarean section specifically
required for a complication shall be governed by implementing guidelines to be
set by the National Management Committee based on the Global criteria on
mother friendly care.

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 10. Encourage all mothers and families with sick premature newborns or infants
with congenital problems, to touch, cuddle, breastfeed and care for their b'lbies
to the extent compatible with their condition.

11. Encourage postpartum mothers to have at least two postpartum visits.

12. Maintain records for self-assessment, reporting and monitoring purposes.

13. The hospital as a workplace must have in its hospital policy the following:

• Milk Code enforcement

• Breastfeeding breaks
- two additional breaks to allow mothers to express breastmilk
• Breastmilk storage facilities
- there shall be a refrigerator exclusively for the storage of expressed
breastmilk from the mother
• Breastfeeding room or a safe designated area in the hospital
- this is a physical facility where mothers can express breastmilk and
where a refrigerator is located, exclusively used for the storage of
breastmilk. A hand washing facility must be accessible.
• Support group
- other hospital personnel ready or available to assist and counsel the
mother to be successful in breastfeeding or a peer counselor from
among the successful breastfeeding mothers

Working mothers need a supportive environment. Employers must give

due consideration in adjusting work schedules of breastfeeding mothers such
that those working on "shift" basis shall be assigned on a morning schedule.

Women in paid employment can be helped to continue breastfeeding by

being provided with the minimum enabling conditions such as paid maternity
leave, part-time work arrangements, on-site creches, day-care facilities or
facilities for expressing and storing breastmilk and paid breastfeeding breaks.
Mothers should be able to continue breastfeeding and care for their infants after
they return to paid employment

B. To become a Baby-Friendly Institution, the following are the recommended

steps to be followed by the health facilities according to the UNICEF/WHO
Global Criteria: (See Annex B: Ten Steps to Successful Breastfeeding))

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The Ten (1 Q) Steps to Successful Breastfeeding:

1. Developm~ntof a written breastfeeding policy that is routinely

communicated to all health care staff

Indicator: Implementation of a current breastfeeding protocol that has been

communicated to all staff during orientation or during department
level meetings

2. Training of all health care staff in skills necessary to implement the policy
on breastfeeding within the first six months upon entry into the hospital

Indicator: Schedule of staff that will attend in-service training that teach the
skills necessary to implement the breastfeeding protocol

3. Providing information to all pregnant women about the benefits and

management ofbreastfeeding in the OPD during pre-natal and in the wards
during the postpartum period

Indicator: Written, non-commercial pre-natal information on breastfeeding

· Schedule of parents referred to breastfeeding classes I childbirth
education classes

4. Assisting mothers to initiate breastfeeding within one hour .after birth for
normal spontaneous deliveries and within 3-4 hours after birth for CIS
deliveries.

Indicator: Infant is placed on the mother's chest to promote pre-feeding

sequence of behavior that leads to proper latching and sucking

5. Training mothers how to breastfeed and maintain lactation, even if they

should be separated from their infants

Indicator: A breast pump should be available for expressing milk and milk is
expressed at least eight times in 24 hours
Provision for milk banking in the hospital facility for the collection
and storage of expressed breast milk

6. Giving newborn infants no food or drink other than breast milk, unless
medically indicated and educating mothers on the importance of exclusive
breastfeeding unless other food/drink are medically indicated

Indicator: No sterile water, glucose water or milk formula in the clinical

wards

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 7. Practicing rooming-in to allow mothers and infants to remain together 24
hours a day

Indicator: All babies are roomed-in and only pathologic babies are placed in
a nursery (NICU)

8. Encouraging breastfeeding on demand

Indicator: Mothers are taught behavioral feeding cues for them to feed their
infants on cue for 8 to 12 times each 24 hours

9. Giving no artificial teats or pacifiers (also called dummies or soothers) to

breastfeeding infants

Indicator: No artificial nipples and pacifiers or any feeding paraphernalia in

the wards

10. Fostering the establishment of breastfeeding support groups and referring

mothers to them upon discharge from the hospital

Indicator: Organized peer breastfeeding support groups supervised by a

lactation consultant/ staff nurse

Documented regular monitoring and coaching activities with the

roster of breastfeeding support groups recognized as peer
counselors within their catchment area to further strengthen I
sustain the 1oth Step

C. Responsibilities of the Hospital Staff Relative to EO 51:

The Health Worker's Responsibilities under the Milk Code:

1. Protect, promote and support breastfeeding with the capacity to explain the
following:

• The benefits and superiority of breastfeeding

• Proper maternal nutrition in preparation for/ maintenance of
breastfeeding
• The risk of partial or non-breastfeeding, such as but not limited to the
following:
the health hazards of inappropriate foods or feeding methods
the health hazards of unnecessary or improper use of infant
formula and other breastmilk substitutes
the financial and social implications in the use of breastmilk
substitutes

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 2. Refuse any gifts/ samples, offered by manufacturers or distributors as well as
the representatives of the milk companies

3. Never pass any samples or gifts to pregnant women, mothers of infants and
young children and members of their families that will undermine breastfeeding

4. Refrain from accepting or availing of any contribution made by the

representatives of the milk industry for fellowships, study tours, research grants,
attendance to professional conferences or the like, intended for the health
workers or the management staff of the health facility.

5. Be aware that any form of support/logistics and other incentives for health
professionals and administrators working for infant and young child health
should in no way create conflict of interest.

6. Ensure that the health facility is not used for the display, dissemination and
distribution of products within the scope of the Code.

D. Capacity Building

The trainers who have satisfactorily undergone the prescribed 40 hours standard
training with t1le National Lactation Management Training Center (Dr. Jose Fabella
Mt.morial Hospital) and other designated Regional Lactation Management Training
Centers shall be responsible in the conduct of Lactation Management Courses for local
government unit (LGU) and private health facilities.

Coaching and mentoring services shall be conducted by the CHD Coordinators/

Assessors within three months after the training as a follow-up activity.

Government and private health facilities providing maternity and newborn care
services shall ·conduct continuing education/orientation on mother-baby friendly,
rooming-in and bnmstfeeding practices with their staff.

E. Roles and Responsibilities

The National Management Committee shall provide the over-all management of

the IYCF program duly supported by its National Technical Working Group (NTWG).
The members of the TWG shall provide technical assistance and conduct performance
audit to ensure quality assurance on program implementation.

The CHp Coordinators/ Assessors Team shall provide the technical assistance,
conduct assessment/ reassessment, conduct monitoring, facilitate the accreditation
process and build the critical capacity of both the government and private health
facilities in their respective regions in the implementation of MBFHI.

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 The Di. Jose Fabella Memorial Hospital shall continue to serve as the
designated National- Lactation Management Center for all government and private
health facilities providing newborn and maternity care services within the National
Capital Region (NCR). A continuing program of training shall be in place to capacitate
the core of trainers at the Centers for Health Development (CHD) and supervise core of
trainers on program implementation on a regular basis. It shall also spearhead efforts to
promote the Kangaroo Mother Care for all newborns especially the premature infants to
improve their survival.

VII. ASSESSMENT AND ACCREDITATION PROCESS

The health facility shall appraise its practices, using the Self-Appraisal Tool,
after studying the Global Criteria. Upon accreditation, it shall fully implement and
sustain the ten steps to successful breastfeeding. The creation of a functional
Breastfeeding Committee in the health facility, with recording and reporting
mechanisms, may facilitate MBFHI program implementation and promote its
sustainability.

The self-assessment tool shall be submitted to the regional assessors team in the
Ce11ters for Health Development (CHD), who shall be responsible in assessing/
validating the compliance with the MBFHI steps to successful breastfeeding, for the
issuance of a Certificate of Commitment which shall be valid for two years.

The Certificate of Commitment shall be issued by the Regional Director based

on the recommendation of the regional MBFHI assessor team upon validation of its
readiness through the self-assessment scheme. The health facility shall then apply for
Accreditation with the Center for Health Development (CHD) after two years, at which
time a re-asses·sment shall be conducted by the regional MBFHI assessor team and
submit their recommendation to the Regional Director.

In case of non-compliance or backsliding, the regional assessor team shall assist

the health facility to enable them to comply and qualify for accreditation.

Accreditation shall be ·conferred to the health facility which has sustained

compliance to the MBFHI steps to successful breastfeeding and has integrated mother-
friendly steps in its MBFHI program implementation, upon the reco1nmendation of the
Regional Director to the Secretary of Health (See Annex C, Flow Chart on the
Accreditation Process)

A Plaque of Accreditation shall be issued by the Secretary of Health, upon the

recommendation of the Regional Director through the Field Implementation and
Coordination Office, based on the findings of the regional MBFHI assessor team, that
the health facility has successfully sustained its commitment to comply with the
MBFHI steps to successful breastfeeding and integrated mother-friendly steps within a

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period of two (2) years, which period shall be reckoned from the date of the issuance of
the Certificate of Commitment. Thereafter, a periodic re-assessment shall be conducted
by the regional MB_FHI assessor team every three years, to ensure sustainability of
MBFHI implementation.

VIII. REPEALING CLAUSE

The provisions of previous Orders and other related issuances inconsistent or

contrary with the provisions of this Administrative Order are hereby revised, modified,
repealed or rescinded accordingly. All other provisions of existing issuances which are
not affected by this Order shall remain valid and in effect.

IX. EFFECTIVITY

This Order shall take effect immediately.

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 ANNEXA
Steps to a Mother-Friendly I Safe Motherhood Initiative

1. The hospital facility shall incorporate mother-friendly labor and

birthing practices in the health facilities' policies or st<uldard
operating procedures.

2. Train staff responsible for maternity services on essential and

emergency obstetric and newborn care.

3. Pregnant women should have at least four (4) pre-natal visits to

ensure assessment, promotion on health, preventive care and
treatment of risk conditions.

4. All deliveries shall be attended by a skilled attendant that is within

two hours from a first level referral or well-equipped hospital that
can handle emergency obstetric cases.

5. The health staff shall be trained on mother-friendly, labor and

birthing policies and procedures and alternative non-drug methods of
pain relief. Non-drug methods of pain relief unless required for
medical reasons as an alternative to the use of analgesic or anesthetic
drugs may be provided to women in labor.

6. Women may be allowed to have companions of their choice during

labor and birth to provide physical and/or emotional support.

7. Women may be allowed to drink and eat light foods·during labor, if

desired relative to their obstetrical/medical condition and upon the
discretion of the physician.

8. Women may be allowed to walk and move about during labor, if

desired, and assume the positions of their choice while giving birth
(unless restrictions are required for medical reasons); such options
shall not be limited to the lithotomy position .
.
9. Care shall not routinely involve invasive procedures (such as rupture
of membranes or episiotomies), acceleration or induction oflabor, or
instrumental deliveries or caesarean section, unless medically
indicated.

10: The post-partum mother together with her newborn should have at
least two (2) post-partum visits, one month apart and newborn care
shall include among others counseling on exclusive breastfeeding.

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 ANNEXB

TEN STEPS TO SUCCESSFUL BREASTFEEDING

1. Develop a written breastfeeding policy that translates all the Ten Steps to
Successful Breastfeeding and protects breastfeeding by adhering to the
Philippine Milk Code (E.O. 51) and the Rooming-In and Breastfeeding Act
(R.A. 7600) which should be communicated to all health workers. This written
policy should be posted in areas where there are mother and baby dyad
translated in the local dialect/ language common to all.

2. Train all health care staff in skills necessary to implement the policy on
breastfeeding.
• All health care staff in-charge of mother and infant care shall be trained
on lactation management which includes the Ten Steps to Successful
Breastfeeding and the Milk Code. The training conducted should be
properly documented (training syllabus, training plan, attendance
sheets).
• All new hospital staff shall receive training within six months upon
entrance to duty
• Non-clinical staff shall be provided with skills needed to support
mothers to successfully breastfeed their infants
• Train hospital staff in breastfeeding and lactation management to enable
them to provide assistance to all mothers, breast care for mothers with
babies in special care and demonstrate to mothers the correct
positioning, attachment, how to hand express, collect, store and give
their expressed breastmilk.

3. Provide information to all pregnant women about the benefits and management
of breastfeeding.

During pre-natal services, pregnant women shall receive information on

breastfeeding such as:

• Importance of exclusive breastfeeding for six (6) months

• Benefits of breastfeooing
• Basic breastfeeding management
• Importance of skin-to-skin contact, early initiation, rooming-in , on-demand
feeding, exclusive breastfeeding for six (6) months and to continue
breastfeeding with appropriate complementary feeding for two years and
beyond
• The risk of artificial feeding
• Information on the effects of the use of anesthetics, sedatives and analgesics
on breastfeeding

4. Practice· rooming-in to allow mothers and infants to be together 24 hours a day.

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 Start rooming-in the baby with the mother immediately after birth. For mothers
who have had caesarean section, the baby shall be roomed-in within 3 to 4 hours
or earlier as s9on as the mother is fully awake.

5. Help m·others initiate breastfeeding within one hour after birth for normal
spontaneous deliveries and 3-4 hours after birth for Caesarean Section \. C/S)
deliveries.

Place babies in skin-to-skin contact with their mothers immediately following

birth or at least an hour for babies delivered vaginally or by· caesarean section
as soon as the mothers are responsive and alert. Mothers are helped to recognize
the signs that their babies are ready to breastfeed and offered help if needed.
Such signs of readiness to breastfeed include: rooting, smacking of lips, placing
hands to mouth, sucking on fingers or hands, mouth opening in response to
tactile ~timulation. For babies in special care unit, their mothers are also
encouraged to hold them.

6. Show mothers how to breastfeed and how to maintain lactation, if they become
separated from their infants.

7. Encourage breastfeeding on demand.

Breastfeed the babies as often and for as long as the baby wants. Mothers can
recognize signs of hunger and can appropriately respond to the needs of her
baby.

8. Give newborn infants no food or drink other than breastmilk, unless medically
indicated.

Ensure that all babies receive no food or drink other than breastmilk from birth
to discharge unless there are acceptable medical conditions (galactosemia,
phenylketonuria and maple-syrup urine disease). The facility <:>hall not display or
distribute any materials on breastmilk substitutes, scheduled feeds or other
inappropriate feeding practices.

9. Give no artificial teats or pacifiers to breastfeeding infants.

Inform mothers of the risks in using artificial teats and pacifiers and ensure that
these are not available in the facility.

10. Foster the establishment of breastfeeding support groups and refer mothers to
them on discharge from the hospital or clinic.
Link with breastfeeding support groups and other community services that can
provide breastfeeding support to mothers discharged from the health facilities.
Provide IEC materials on breastfeeding to mothers before discharge.

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 ANNEXC

FLOW CHART ON THE ACCREDITATION PROCESS OF MBFHI

FACILITIES

Self-Assessment by the health facility using the Global Criteria on

MBFHI Self-Appraisal

•
Submission· of self-assessment of the health facility for validation by
the CHD MBFHI Assessors/ Coordinators

+
Issuance of Certificate of Commitment by the CHD Director for
validated compliance

•
Re-assessment of the CHD MBFHI Assessor/Coordinator after 2 years
of sa.tstained implementation by the health facility

•
Issuance of Plaque of Accreditation by the Secretary of Health for
sustained implementation on MBFHI and integration of Mother
Friendly indicators

•
Annual MBFHIImplementation Report {using the Self-Assessment
Tool) for submission by the health facility to the CHD

~
Re-Assessment every three {3) years by the CHD Team of Assessors
for MBFHI sustainabiJity

Best Practices/In~ovationf for sustaining MBFHI status

•
Hall of Fa.me Award based on guidelines set by the IYCF National
Management Committee and upon recommendation by the CHDs

16