Just Follow the (Ten) Steps Breastfeeding Education in Baby-Friendly Hospitals

Main Article Content

Jaclyn Wells


This study investigates infant feeding rhetoric from the Baby-Friendly Hospital Initiative (BFHI), a World Health Organization (WHO) and United Nations Children’s Fund (UNICEF) partnership that prioritizes exclusive breastfeeding. The study approaches patient education materials as user documentation and analyzes the materials for kairos and metaphor. The author argued that the materials function as documentation for the birthing parent’s body operating within the system of the BFHI. The article concludes with recommendations for future research and for creating infant feeding resources that provide critical access to the healthcare system by rejecting the body-as-machine metaphor and reflecting families’ diverse situations, not just the situation of the U.S. healthcare system or BFHI.  

Article Details

Research Articles
Author Biography

Jaclyn Wells, University of Alabama Birmingham

Jaclyn Wells is an associate professor of English at the University of Alabama at Birmingham. She is co-author of Partners in Literacy: A Writing Center Model for Civic Engagement (2016). Jaclyn’s work has also
appeared in CCC, The Writing Center Journal, Pedagogy, and other edited collections and journals.



American Academy of Pediatrics. (2022). Breastfeeding policy statement. https://www.aap.org/breastfeeding

Apple, Rima. (2006). Perfect motherhood: Science and childrearing in America. Rutgers University Press. https://doi.org/10.36019/9780813539980

Atchan, M., Foureur, M., & Davis, D. (2011). The decision not to initiate breastfeeding--women's reasons, attitudes and influencing factors--a review of the literature. Breastfeeding review: Professional publication of the Nursing Mothers’ Association of Australia, 19(2), 9–17.

Baby-Friendly USA. (2022). https://www.babyfriendlyusa.org/

Baby-Friendly USA. (2022). The ten steps to successful breastfeeding. https://www.baby


Banks, Adam. (2005). Race, rhetoric, and technology: Searching for a higher ground. Routledge.

Bass, J.L., Gartley, T., & Kleinman, R. (2020). Outcomes from the centers for disease control and prevention 2018 breastfeeding report card: Public policy implications. The Journal of Pediatrics, 218, 16-21.e1. https://doi.org/10.1016/j.jpeds.2019.08.059

Bentley, M., Dee, D., & Jensen, J. (2003). Breastfeeding among low income, African-American women: power, beliefs and decision making. The Journal of Nutrition, 133(1), 305S–309S. https://doi.org/10.1093/jn/133.1.305S

Bernie, Kate. (2014). The factors influencing young mothers' infant feeding decisions: The views of healthcare professionals and voluntary workers on the role of the baby's maternal grandmother. Breastfeeding Medicine: The Official Journal of the Academy of Breastfeeding Medicine, 9(3), 161–165. https://doi.org/10.1089/bfm.2013.0120

Blum, Linda M. (1999). At the breast: Ideologies of breastfeeding and motherhood in the contemporary United States. Beacon Press.

Brown, A., Raynor, P., & Lee, M.. (2011). Healthcare professionals’ and mothers’ perceptions of factors that influence decisions to breastfeed or formula feed infants: a comparative study. Journal of Advanced Nursing, 67(9), 1993–2003. https://doi.org/10.1111

Burnham, L., Gambari, A., Beliveau, P., Ustianov J., Parker, M.G., & Merewood, A. (2021). Perspectives of nurses in Mississippi on implementation of the Baby-Friendly Hospital Initiative. Journal of Obstetric, Gynecologic & Neonatal Nursing, 50(4), 392-401. https://doi.org/10.1016/j.jogn.2021.02.010

Clements, Jessica & Nixon, Kari. (2022). Optimal motherhood: And other lies Facebook told us. MIT Press.

Cooper Owens, Deirdre. (2018). Medical bondage: Race, gender, and the origins of American gynecology. University of Georgia Press.

Derkatch, Colleen. (2018). The self-generating language of wellness and natural health. Rhetoric of Health and Medicine, 1(1-2), 132-160. http://dx.doi.org.ezproxy3


Echols, Amani. (2019). The challenges of breastfeeding as a Black person. https://www.aclu.org/news/womens-rights/challenges-breastfeeding-black-person

Edbauer, Jenny. (2005) Unframing models of public distribution: From rhetorical situation to rhetorical ecologies. Rhetorical Society Quarterly, 35(4), 5-24. https://doi.org/10.1080/02773940509391320

Fitzgerald, Erin. (2019). Gendered responsibility: A critique of HPV vaccine advertisements, 2006-2016. In White-Farnham, J., Siegel Finer, B., & Molloy, C. (Eds.), Women’s health advocacy: Rhetorical ingenuity for the 21st century (pp. 102-110). Routledge.

Freeman, Andrea. (2021). Skimmed: Breastfeeding, race, and injustice. Stanford.

Gomez-Pomar, Enrique & Blubaugh, Robert. (2018). The Baby-Friendly Hospital Initiative and the ten steps for successful breastfeeding: A critical review of the literature. J Perinatol 38, 623–632. https://doi.org/10.1038/s41372-018-0068-0

Harper, Kimberly. (2020). The ethos of black motherhood in America: Only white women get pregnant. Lexington Books.

Hausman, Bernice L. (2003). Mother’s milk: Breastfeeding controversies in American culture. Routledge.

Hausman, Bernice L. (2011) Viral mothers: Breastfeeding in the age of HIV/AIDS. University of Michigan Press.

Healthcare.gov. (n.d.). Breastfeeding benefits. U.S. Centers for Medicare & Medicaid Services. https://www.healthcare.gov/coverage/breast-feeding-benefits/

Johnson, Jillian. (2018, August 2). My message to parents during world breastfeeding week--just one bottle. Fed is Best. https://fedisbest.org/2018/08/jillian-johnson-message-parents-world-breastfeeding-week/

Koerber, Amy. (2013). Breast or bottle?: Contemporary controversies in infant-feeding policy and practice. University of South Carolina Press.

Kong, Sarah & Lee, Diana. (2004). Factors influencing decision to breastfeed. Journal of Advanced Nursing, 46(4), 369–379. https://doi.org/10.1111/j.1365-2648.2004.03003.x

Kukla, Rebecca. (2006). Ethics and ideology in breastfeeding advocacy campaigns. Hypatia, 21(1), 157-181. https://doi.org/10.1111/j.1527-2001.2006.tb00970.x

Lawrence, Heidi Yoston. (2020). Vaccine rhetorics. Ohio State UP.

McCaughey, Jessica. (2021). The rhetoric of online exclusive pumping communities: Tactical technical communication as eschewing judgment. Technical Communication Quarterly, 30(1), 34-47. https://doi.org/10.1080/10572252.2020.1823485

Morrissey, Megan & Kimball, Karen. (2016). #SpoiledMilk: Blacktavists, visibility, and the exploitation of the Black breast. Women's Studies in Communication, 40, 1-19. https://doi.org/10.1080/07491409.2015.1121945

Mueffelmann, R., Racine, E., Warren-Findlow, J., & Coffman, M. (2015). Perceived infant feeding preferences of significant family members and mothers’ intentions to exclusively breastfeed. Journal of Human Lactation: Official Journal of International Lactation Consultant Association, 31(3), 479–489. https://doi.org/10.1177/0890334414553941

Owens, Kim Hensley. (2015). Writing childbirth: Women’s rhetorical agency in labor and online. Southern Illinois University Press.

Piankusol, C., Sirikul, W., Ongprasert, K., & Siviroj, P. (2021). Factors affecting breastfeeding practices under lockdown during the COVID-19 pandemic in Thailand: A cross-sectional survey. International Journal of Environmental Research and Public Health, 18(16), 8729. https://doi.org/10.3390/ijerph18168729

Reid, J., Schmied, V., & Beale, B. (2010). “I only give advice if I am asked”: Examining the grandmother's potential to influence infant feeding decisions and parenting practices of new mothers. Women and Birth: Journal of the Australian College of Midwives, 23(2), 74–80. https://doi.org/10.1016/j.wombi.2009.12.001

Reitman, Catherine (Writer & Director). (2017, January 10.) Bare. (Season 1, Episode 1). [TV series episode]. In Horwitz, T., Reitman, C., Sorge, J., & Sternberg, P. (Executive Producers), Workin’ Moms. Wolf and Rabbit Entertainment.

Roberts, Dorothy. (2017). Killing the Black Body. (2nd ed.). Vintage Books.

Segal, Judy Z. (2005). Health and the rhetoric of medicine. Southern Illinois University Press.

Segal, Judy Z. (2009). Internet health and the 21st-century patient: A rhetorical view. Written Communication, 26(4), 351-369. https://doi.org/10.1177/0741088309342362

Seigel, Marika. (2014). The rhetoric of pregnancy. University of Chicago Press.

Wage and Hour Division. (n.d.) Frequently asked questions—breaktime for nursing mothers. U.S. Department of Labor. https://www.dol.gov/agencies/whd/nursing-mothers/faq

World Health Organization. (2017). International code of marketing of breast-milk substitutes. https://apps.who.int/iris/bitstream/handle/10665/254911/WHO-NMH-NHD-17.1-eng.pdf