At a glance
Learn which questions in CDC's Maternity Practices in Infant Nutrition and Care (mPINC) survey align to step 1 in the World Health Organization's Ten Steps to Successful Breastfeeding. Fillable versions of the tool are available to download at the bottom.
Step 1: Hospital policies
Comply fully with the International Code of Marketing of Breast-milk Substitutes and relevant World Health Assembly resolutions. Have a written infant feeding policy that you routinely communicate to staff and parents. Establish ongoing monitoring and data-management systems.*
| Ten Steps Competency1 | mPINC Item | mPINC Domain | mPINC Data Element | Ideal Response† | Hospital Response | Did the Hospital Select the Ideal Response? |
|---|---|---|---|---|---|---|
| Compliance with the Code: Acquisition of infant formula | Indicates how your hospital acquires infant formula. | Institutional Management | G4_a1 | Pays fair market price Not ideal: Receives free or unknown/unsure |
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| Compliance with the Code: Distribution of infant formula or formula-related supplies/coupons as gifts | Indicates whether your hospital gives mothers any of these items free of charge (not including items prescribed as part of medical care):
a) infant formula, b) feeding bottles/nipples, nipple shields, or pacifiers, or c) coupons, discounts, or educational materials from companies that make or sell infant formula or feeding products. |
Discharge Support | G5_a1/G5_a2/ G5_a3 | No to all three items Not ideal: Yes to any item |
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| Written infant feeding policies | Indicates whether your hospital has a policy requiring…
…documentation of medical justification or informed consent for giving non-breast milk feedings to breastfed newborns. |
Institutional Management | G2_a1 | Yes Not ideal: No |
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| Written infant feeding policies | …formal assessment of staff’s clinical competency in breastfeeding support. | Institutional Management | G2_a2 | Yes Not ideal: No |
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| Written infant feeding policies | …documentation of prenatal breastfeeding education. | Institutional Management | G2_a4 | Yes Not ideal: No |
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| Written infant feeding policies | …staff to teach mothers breastfeeding techniques AND staff to show mothers how to express milk. | Institutional Management | G2_a5/G2_a6 | Yes to both items Not ideal: No to either item |
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| Written infant feeding policies | …purchase of infant formula and related breast milk substitutes by the hospital at fair market value AND a policy prohibiting distribution of free infant formula, infant feeding products, and infant formula coupons. | Institutional Management | G2_a8/G2_a12 | Yes to both items Not ideal: No to either item |
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| Written infant feeding policies | …staff to provide mothers with resources for support after discharge. | Institutional Management | G2_a9 | Yes Not ideal: No |
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| Written infant feeding policies | …placement of all newborns skin-to-skin with their mother at birth or soon thereafter. | Institutional Management | G2_a7 | Yes Not ideal: No |
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| Written infant feeding policies | …the option for mothers to room-in with their newborns. | Institutional Management | G2_a11 | Yes Not ideal: No |
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| Monitoring and data-management system | Indicates whether your hospital records/tracks exclusive breastfeeding throughout the entire hospitalization. | Institutional Management | G1 | Yes Not ideal: No |
Note:
This tool does not correspond to or replace Baby-Friendly USA's on-site assessments or Baby-Friendly designation.
*This step aligns with step 1 in the Ten Steps to Successful Breastfeeding. Although this tool evaluates many aspects of each of the Ten Steps, it does not assess every aspect. You cannot assess every aspect of each step using mPINC™ data alone.
†Ideal responses are in bold.
- World Health Organization. Protecting, promoting and supporting breastfeeding in facilities providing maternity and newborn services: implementing the revised Baby-friendly Hospital Initiative. Geneva: World Health Organization; 2018.