PhD Exit Seminar: Implementation of the Baby Friendly Hospital Initiative in Australia and Ten Steps to Successful Breastfeeding in Indonesia: a sequential mixed methods study of two hospitals

Mother with baby


Breastfeeding is the normal biological standard of infant feeding, yet the exclusive breastfeeding rate globally in 2018 was only 41%. Breastfeeding has benefits to infant and maternal health, as well as to environment and country.

The first few hours and days of a newborn’s life are a critical window for establishing lactation and providing mothers with the support they need to breastfeed successfully. This support is not always provided, as illustrated by a review of UNICEF data showing that 78% of deliveries were attended by a skilled health provider, but only 45% of newborns were breastfed within the first hour after birth. WHO launched Ten Steps to Successful Breastfeeding (Ten Steps) in 1989, then updated this in 2018. In 1991 WHO launched the Baby Friendly Hospital Initiative (BFHI) to encourage maternity facilities implement the Ten Steps. Positive associations between the BFHI implementation and breastfeeding prevalence has been found in many studies.

However, only 10% babies are born in BFHI-accredited hospitals globally. Only 26% of Australian hospitals are BFHI-accredited, and while BFHI-accreditation does not exist in Indonesia, 8% of Indonesian hospitals implement the Ten Steps. For my PhD, I am using mixed methods to examine the barriers and facilitators to implementing the BFHI in Australia and the Ten Steps in Indonesia. In this seminar, I will present the findings of my research.


AndiniAndini Pramono is a PhD student at the Department of Health Services Research and Policy of National Centre for Epidemiology and Population Health supervised by Dr Jane Desborough, Associate Professor Julie Smith and Dr Siobhan Bourke. She is also an International Board Certified Lactation Consultant (IBCLC) since 2017 and has been affiliated with Indonesian Breastfeeding Mothers Association since 2012. Prior her PhD, Andini completed bachelor and master degree in public health, majoring in hospital administration, and worked in a hospital consulting firm afterward for eight years.