title: Implementation of the baby-friendly hospital initiative steps in Iowa hospitals.
abstract: OBJECTIVE
  To determine the status of each of the Baby-Friendly Hospital Initiative (BFHI) Ten Steps and associated policies in Iowa hospitals.
  
  
  METHODS
  Exploratory, descriptive study using the World Health Organization BFHI self-assessment survey.
  
  
  METHODS
  Iowa hospitals with maternity services.
  
  
  METHODS
  Fifty-three Iowa hospital administrators.
  
  
  METHODS
  Hospitals were classified by level of implementation of each of the Ten Steps and related criteria.
  
  
  RESULTS
  The majority of the hospitals were implementing at least three of the Ten Steps. The most widely adopted policy, encouraging breastfeeding on demand, was implemented by 83% of the hospitals. None of the hospitals had implemented all six criteria included in Step One. Step One describes a written breastfeeding policy routinely communicated to all healthcare staff.
  
  
  CONCLUSIONS
  Implementation of the steps varied by hospital locale; urban hospitals had higher implementation rates for Step 10 than rural hospitals. Areas identified as needing the greatest attention by hospitals were posting of breastfeeding policy, evaluation, and providing education to all mothers.
authors.affiliation: Division of Health Promotion and Chronic Disease Prevention, Iowa Department of Public Health, Des Moines, IA 50319, USA. catherine.lillehoj@idph.iowa.gov
authors.forename: Catherine J
authors.initials: CJ
authors.lastname: Lillehoj
authors.forename: Brenda L
authors.initials: BL
authors.lastname: Dobson
mesh_terms: D001942:Breast Feeding; D003430:Cross-Sectional Studies; D005260:Female; D017408:Guidelines as Topic; D006284:Health Plan Implementation; D006739:Hospital Administration; D006761:Hospitals / Q000592:standards* / Q000639:trends; D006801:Humans; D007229:Infant Welfare; D007231:Infant, Newborn; D007484:Iowa; D008297:Male; D009035:Mothers / Q000193:education; D009936:Organizational Innovation; D010353:Patient Education as Topic; D018743:Perinatal Care / Q000592:standards / Q000639:trends; D011247:Pregnancy; D012424:Rural Population; D014505:Urban Population