Background

The implementation of the Ten Steps to Successful Breastfeeding (TSSB) of the Baby-Friendly Hospital Initiative (BFHI) has been shown to be associated with improved breastfeeding outcomes. Indonesia still lags other countries in promoting breastfeeding in the first hour and 6 months of exclusive breastfeeding. This study aimed to assess health facilities’ compliance with the TSSB in Indonesia.

Methods

A cross-sectional survey of 242 health facility managers and 130 postpartum mothers across hospitals, community health centers (puskesmas), and private clinics at 5 sites in the East Java province was conducted between January and June, 2019. The health facility managers and mothers were interviewed using questionnaires consisting of questions adopted from the TSSB. The data were analyzed using the descriptive method to present the level of compliance with each step, the overall steps, comparing self-appraisal and validating methods, and comparing results by study site and type of health facility.

Results

The assessment data showed various levels of compliance with the TSSB, with scores ranging from 65.47 to 98.09 (mean score 77.5 on a scale from 0 to 100). The highest compliance was found in step 8 (breastfeeding on demand) and the lowest in step 7 (rooming-in). The validation results showed a significantly lower compliance with steps 3, 4, 8, and 9 compared with the self-appraisal. The assessment of compliance with the TSSB also showed certain variations between the site and the type of health facility.

Conclusion

We recommend that policy makers and managers of health facilities formulate effective and appropriate policies to increase institutional compliance with the TSSB. Greater efforts are needed to facilitate puskesmas and private clinics in implementing the TSSB for better breastfeeding outcomes.