About the mPINC Ten Steps Assessment Tool

This is a tool to help assess a hospital’s implementation of each of the Ten Steps to Successful Breastfeeding (Ten Steps). The tool identifies, or crosswalks, which items from CDC’s Maternity Practices in Infant Nutrition and Care (mPINC) survey align with each of the Ten Steps. The Ten Steps included in this tool are based on WHO’s and UNICEF’s Implementation Guidance – Protecting, promoting, and supporting breastfeeding in facilities providing maternity and newborn services: the revised Baby-friendly Hospital Initiative 2018external icon.

This tool is intended for use by state and local health departments, breastfeeding coalitions, and institutions and organizations working with hospitals on quality improvement in maternity care practices. It can also be used by hospitals to assess their own implementation of the Ten Steps and highlight areas of strength and needed improvement. This tool can help guide the implementation of maternity care practices and policies supportive of breastfeeding and identify and prioritize quality improvement efforts.

This tool does not correspond to or replace Baby-Friendly USA’s on-site assessments or Baby-Friendly designation. Although this tool assesses many aspects of each of the Ten Steps, it does not assess every aspect. Every aspect of each Step cannot be assessed using mPINC data alone. This tool is not an additional mPINC survey. Instead, it presents a crosswalk between mPINC items and the Ten Steps and is designed to help with assessment efforts.

mPINC and the Ten Steps

CDC’s mPINC survey is a national survey of maternity care practices related to breastfeeding. Approximately every other year, facilities routinely providing maternity care in the United States and territories are invited to participate in the survey. Only hospitals and birthing centers inside hospitals are eligible to participate; as of 2018, freestanding birth centers are not eligible to participate.

CDC calculates total mPINC scores for all participating hospitals to indicate their overall level of maternity care practices and policies that support optimal infant feeding and also calculates subscores across multiple maternity care practice subdomains. CDC sends hospitals these scores and their responses to each scored mPINC item in their mPINC Hospital Report.

The Ten Stepsexternal icon were developed by WHO and UNICEF to summarize key maternity care practices and policies that support breastfeeding. The Ten Steps help guide maternity care quality improvement efforts in many hospitals. The mPINC scoring algorithm is not aligned with the Ten Steps, and a hospital’s total mPINC score or subscores do not necessarily indicate how well a hospital has implemented the Ten Steps. However, many mPINC items and responses can be used to help assess a hospital’s implementation of each of the Ten Steps. This tool is designed to help with this process.