Achieving Breastfeeding Equity through the Baby-Friendly Hospital Initiative

We would not have the resources we now have for breastfeeding support if it wasn't for the Baby-Friendly Hospital Initiative. To have breastfeeding as one of the basics, as one of the things that have to be covered, it's a game-changer.

Ana Delgado, Clinical Professor

UCSF Department of Obstetrics, Gynecology and Reproductive Sciences, Zuckerberg San Francisco General Hospital (ZSFG) Division

Speakers from left to right: Ana Delgado, Carol Thomason, Jonique Bell, Tanefer Camara, Kimarie Bugg

To celebrate August as Breastfeeding Awareness Month we heard from experts who have first-hand experience working with the Baby-Friendly Hospital Initiative’s (BFHI). BFHI is an initiative launched globally in 1991 by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF). The initiative is a structure to support hospitals in their implementation of the Ten Steps to Successful Breastfeeding (see figure 1) as well as the International Code of Marketing of Breastfeeding Substitutes. 

The first speaker, Ifeyinwa Asiodu, RN, PhD, an assistant professor at UCSF School of Nursing, provided a brief introduction to the BFHI. She explained that the inequities in breastfeeding persist and that hospitals play a critical role in breastfeeding initiation, duration and exclusivity. However, it is well documented that providers are less likely to speak with Black women about breastfeeding. BFHI’s goal is to normalize and mandate evidence-based maternity policies and practices that support breastfeeding. BFHI has been shown to improve breastfeeding rates, regardless of race, ethnicity, and socioeconomic status.

It is only in the last five years that there have been a significant uptick in hospitals adopting the accreditation (see figure 2). This is partly due to political intervention, such as the 2011 surgeon general’s call to accelerate Baby-Friendly Hospital Initiative in the US and, for California, the 2013 Senate Bill 402 that required all California birthing hospitals and birthing centers to adopt the Baby-Friendly Ten steps by 2025.  

Ten Steps to Successful Breastfeeding

Figure 1. 

Baby-Friendly Hospital Designations

Figure 2.

Kimarie Bugg, the evening’s keynote speaker shared her experience leading CHAMPS (Communities and Hospitals Advancing Maternity Practices), an initiative created to support 89 Mississippi hospitals through the Baby-Friendly designation process. She explained that, “If it’s not a policy, nurses don’t do it. Only 6 percent of the hospitals in the US had policies around breastfeeding. That is why the first step of the ten steps is to have a written breastfeeding policy that is routinely communicated to healthcare staff.” Through the success of CHAMPS in Mississippi, 89 percent of Black women and 85 percent of white women giving birth had access to breastfeeding support. CHAMPS was also able to reach 80 percent of WIC peer counselors in the state.

Others speakers included:

  • Ana Delgado, a midwife who leads the Breastfeeding Initiative at Zuckerberg San Francisco General Hospital and Trauma Center
  •  Tanefer Camara, an IBCLC who shared her experience at Highland Hospital, Oakland
  • Jonique Bell, RN, IBCLC, and Carol Thomason, CNM, who explained the current steps UCSF is taking to become Baby-Friendly.

Kimarie Bugg


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Keynote Speaker:

Kimarie Bugg

Kimarie Bugg

Kimarie Bugg DNP, FNP-BC, MPH, IBCLC, CLC, is President and CEO of Reaching Our Sisters Everywhere (ROSE), a national nonprofit created in 2011 to address breastfeeding inequities in the African American community. She was the first African American IBCLC in the state of Georgia. She is a member of the faculty for CHAMPs, a Baby-Friendly Hospital Initiative, and the recipient of the 2018 CHAMPS Lifetime Achievement Award.


Jonique Bell

Jonique Bell

Jonnique Bell is a registered nurse (RN), postpartum specialist and Certified Lactation Consultant (IBCLC) at UCSF. She most recently helped UCSF on the journey to Baby-Friendly status. She supported UCSF's process by working with other nurses in this transition while also conducting audits and education sessions for providers. 

Tanefer Camara

TaNefer Camara

T’Amentanefer  Lumukanda Camara (TaNefer) was born and raised in Oakland, California. TaNefer is an International Board Certified Lactation Consultant (IBCLC) and Certified Doula. TaNefer is dedicated to improving maternal and child health outcomes, reducing birth disparities and increasing access to quality care for all.

Ana Delgado

Ana Delgado

Ana Delgado is a Clinical Professor in the UCSF Department of Obstetrics, Gynecology and Reproductive Sciences, Zuckerberg San Francisco General Hospital (ZSFG) Division. She acts as the Assistant Director of Inpatient Obstetrics, primarily responsible for quality improvement (QI) and systems change, and as Director of Inpatient Services for the Nurse-Midwives of ZSFG, a 45 year-old, autonomous midwifery service.