Ten steps for successful breast-feeding: assessment of hospital performance, its determinants and planning for improvement.

This paper discusses results from a project which aims to document the maternity hospital practices in istanbul within the context of Ten Steps for Successful Breastfeeding. Instruments developed for use in hospital level implementation of the WHO/UNICEF baby friendly hospital initiative were used in five hospitals (two public and three private). No hospital was implementing all Ten Steps. A core hospital team on lactation management and a sufficient number of health personnel skillful in breastfeeding counselling and adequate delivery room conditions are required to implement the Ten Steps. It is very difficult to provide these conditions in public hospitals with an excessive patient load. On the other hand, the fee for service system and the policy of changing practices according to the wishes of the clients can also become barriers to successful breastfeeding, as may occur in some private hospitals.