With the talk about BFHI I thought I would forward this from a lecture I gave
recently. Perhaps it will answer some of your questions about why hospitals
are not Baby Friendly in the US
Marie Davis
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BFHI verses BfHI: The U.S. Amends the Baby Friendly Hospital Initiative

"The process for obtaining certification as a Baby-Friendly Hospital has been
established by UNICEF in collaboration with the national governments in more
than 175 countries."  (Gartner 2) The situation in the United States is quite
different.  It seems that some U.S. hospitals and organizations felt that the
BFHI was too restrictive.  The BFHI includes a provision that does not allow
the institution to accept free or low cost breastmilk substitutes (formula),
a provision of the WHO code.  It is important to note, that when the World
Health Organization was adopting its code for marketing of human milk
substitutes, the United States delegate, initially an avid supporter of the
code, cast the sole dissenting vote.  Apparently he was pressured by high
government officials to change his vote.  He resigned immediately after he
cast his vote.  The United States has not adopted the WHO code for marketing
breastmilk substitutes. (Stuart-Macadam and Dettwyler 155).  An "Expert
Workgroup made a large number of changes in the 'Ten Steps' and changed the
name of the program.  .  . to the U.S.  BfHI: Breastfeeding Hospital
Initiative (hence, the lowercase f).  Some key professional health
organizations disagreed with the changes "including the American Academy of
Pediatrics, the American College of Nurse Midwives, the American College of
Obstetrics and Gynecology, the International Lactation Consultant's
Association and La Leche League International."  These groups would not sign
the BfHI.  However, the American Academy of Pediatrics did endorse the Global
 BFHI.  The major problem with the U.S.  version is that hospitals would have
to meet a mere percentage of the original criteria to be accredited rather
than the 80-90% compliance required for BFHI.  It also allows hospitals to
accept free and low cost formula.  "Based on a self assessment tool, 234
hospitals and eight birthing centers in 43 states have received Certificates
of Intent."  Many hospitals have already made the changes necessary for true
Baby Friendly Hospital status based on the original requirements.  It is
unfortunate that government officials feel that the Global  BFHI ideal cannot
be implemented to its fullest in the U.S.  (Gartner 2, 6).

Gartner, Lawrence.  *BFHI and BfHI: THe baby Friendly hospital in the U.S..*
ABM News and Views: The News Letter of the Academy of Breastfeeding Medicine
1(1) 1995: 2,6,8.

Stuart-Macadam, Patricia and Kathrine A Dettwyler. *Breastfeeding:
Biocultural Perspectives.* NY. Aldine De Gruyter, 1995.