Benchmarks	Category of change	Change	Domains			Rationale
AG1: There have been major events that have drawn media attention to breastfeeding issues.	Benchmark description	Major events include planned events to galvanize public attention towards advocating for breastfeeding.	Existence	Volume/frequency		(a) BBF committees suggested using numbers of national events to rank. (b) BBF committees counted national events so level of coverage removed and only national events included; focus on number and “persistence” (i.e., range throughout year) of events.
	Data sources	Consider including a table that documents both positive and negative media attention around a planned event and weigh whether it galvanized public attention towards advocating for breastfeeding.
	Scoring	Addition of the actual numbers of events drawing national media coverage to breastfeeding issues at different times during the year.
AG2: There are high‐level advocates (i.e., “champions”) or influential individuals who have taken on breastfeeding as a cause that they are promoting.	Benchmark description	Addition of frequency: Champions are seen at least 3 times within the year promoting breastfeeding. Committee should consider the level of influence for each potential champion.	Existence	Volume/frequency		Definition clarified to standardize measurement.
	Data sources	Media surveys conducted by the committee or a commissioned agency can identify high‐level champions.
AG3: There is a national advocacy strategy based on sound formative research.	Benchmark description	Clarification that a national advocacy strategy is a governmental or non‐governmental document or initiative that aims to organize and/or systematize breastfeeding advocacy actions within the country.	Existence	Quality	Effective	Definition clarified to standardize measurement.
	Data sources	Annual reports from advocacy groups can be evaluated.
	Scoring description	Define effective as “operational” = strategy implemented AND generated support for breastfeeding protection, promotion, and support.
AG4: A national cohesive network(s) of advocates exists to increase political and financial commitments to breastfeeding.	Benchmark description	(a) A network is formed by two or more advocate groups and is considered cohesive when they work collectively. (b) Network activity must be proportional to its coverage (national, subnational, and/or local). (c) Network needs to include breastfeeding advocacy as a key focus but not only advocacy issue it defends.	Existence	Coverage		(a) Clarification requested about networks comprising organizations and not individuals. (b) Scoring differences meant clarification needed on focus of network.
	Scoring	Addition of the word “national “to cohesive network(s).
PWG1: High level political officials have publicly expressed their commitment to breastfeeding action.	Benchmark description	(a) Public expression of commitment or promise by at least two government officials. (b) High level political officials can be within the federal and/or state government.	Existence	Volume/frequency	Quality	(a) Standradize scoring by specifying number of officials. (b) Commitment can come from different levels of government. (c) Countries choose how to score strength of commitment of officials at state/federal level.
	Scoring description	To assess the difference between minimal and partial progress, the high level political officials must have publicly spoken about breastfeeding AND expressed their commitment to action.
	Scoring	Changed no progress from “no progress has been made if high level political officials have not publically expressed their commitment to breastfeeding action at all” to “no progress has been made if high level political officials have not spoken publically about breastfeeding nor publically expressed their commitment to breastfeeding action at all” to make sure that it reflects that no one has spoken about breastfeeding to be sure it is different form minimal progress.”
	Example	Changed example from Michelle Obama to another figure (TBD) because it may vary from country to country whether the first lady is considered a political official.
PWG2: Government initiatives have been implemented to create an enabling environment that promotes breastfeeding.	Benchmark description	(a) Government led initiatives can cross multiple sectors. (b) List of interventions/initiatives that create an enabling environment for breastfeeding. (c) Enabling interventions remove structural & societal barriers that interfere with optimal breastfeeding.	Existence	Effective		(a) Actions to change environment emanate from different areas. (b) Help to operationalize benchmark and better measure the impact of initiatives.
	Scoring description	Sets out specific steps: (a) Identify the specific barriers to improving breastfeeding practices. (b) Identify enabling initiatives that have been implemented. (c) Match those initiatives with how they have impacted the breastfeeding‐friendly environment. The scoring of this benchmark reflects the level of implementation and the quality of the enabling environment.
PWG3: An individual within the government has been especially influential in promoting, developing, or designing breastfeeding policy.	Benchmark description	Reflects existence and level of influence of a government individual or collective group of individuals.	Existence	Effective		Taking into account different governance structures.
	Scoring description	(a) Addition of the term “collective group of individuals.” (b) Advise mapping all the individuals who work on breastfeeding policy, then map the activities or the collective activities they have been working on towards on promoting, developing, or designing breastfeeding policy.
LPG1: A national policy on breastfeeding has been officially adopted/approved by the government.	Benchmark description	(a) A policy is a “high level overall plan embracing the general goals and acceptable procedures of a governmental body.” (b) Existence of a policy does not necessarily mean funding or an implementation plan in place.	Existence	Effective
LPG2: There is a national breastfeeding plan of action.	Benchmark description	An action plan is a series of steps that need to be taken to implement the policy. The action plan should include step‐by‐step actions including targets and timeframes.	Existence	Quality		Implementation, evaluation, and monitoring should be included.
	Scoring	• Minimal progress: Some strategies in national breastfeeding plan of action implemented but the plan does not contain measurable nor time‐bound objectives/targets.• Partial progress: Some strategies in national breastfeeding plan of action implemented and the plan contains measurable and time‐bound objectives/targets. • Major progress: All strategies in national breastfeeding plan of action implemented and the plan does contain measurable and time‐bound objectives/targets.
LPG3: The national BFHI/Ten Steps criteria has been adopted and incorporated within the health care system strategies/policy.	Scoring description	The difference between partial and major progress is reflected in the example of a country that has national BFHI/Ten Steps criteria, consistent with BFHI WHO/UNICEF global criteria and is adopted, but it has only been incorporated into the hospital strategies/policies nationally and not into the primary health network or community services strategies/policies.	Existence	Effective	Quality
LPG4: The International Code of Marketing of Breast Milk Substitutes has been adopted in legislation.	Benchmark description	Addition of an annex summarizing the main points of the Code.	Existence	Effective	Quality
	Scoring description	If a country modifies their Code to a lower standard than the International Code, they cannot receive a score of major progress.
LPG5: The National Code of Marketing of Breast Milk Substitutes has been enforced.	Scoring description	Scoring reflects the degree and coverage of enforcement of the National Code. Penalties and sanctions must be considered only if they are proportional to the violation.	Coverage			To ensure sanctions are a disincentive.
LPG6: The International Labour Organization maternity protection convention has been ratified.	Scoring description	Benchmark assesses whether the Maternity Protection Convention 2000 (No. 183), put forth by the International Labour Organization (ILO), has been ratified or existing maternity protection legislation meets some or all of their provisions. It allows for other maternity laws but uses the standards expressed in the Maternity Protection Convention 2000 as the benchmark countries should strive to meet.	Existence	Coverage		Change takes into account countries with maternity protection laws that meet/exceed Maternity Protection Convention 2000 but it has not been ratified.
	Scoring	• No progress: No maternity protection laws in the country and Maternity Protection Convention, 2000 (No 183) has not been ratified. • Minimal progress: A few maternity protection laws meet provisions of Maternity Protection Convention, 2000 (No. 183) but not ratified. • Partial progress: Most maternity protection laws meet provisions of Maternity Protection Convention, 2000 (No. 183) but not ratified. • Major progress: All maternity protection laws meet or exceed the provisions of Maternity Protection Convention, 2000 (No. 183) or is ratified.
LPG7: There is paid maternity leave legislation for women.			Existence	Quality
LPG8: There is legislation that protects and supports breastfeeding/expressing breaks for lactating women at work.	Benchmark description	If a country committee feels that this legislation is not being effectively exercised or not enforced, it can be put forth as a recommendation for action.	Existence	Coverage		Captures effectiveness of legislation and allows committees to define “effective.”
LPG9: There is legislation for supporting worksite accommodations for breastfeeding women.	Benchmark description	If a country committee feels that this legislation is not being effectively exercised or not enforced, it can be put forth as a recommendation for action.	Existence	Coverage		Captures effectiveness of legislation and allows committees to define “effective.”
LPG10: There is legislation providing employment protection and prohibiting employment discrimination against pregnant and breastfeeding women.	Benchmark description	If a country committee feels that this legislation is not being effectively exercised or not enforced, it can be put forth as a recommendation for action.	Existence	Quality		Captures effectiveness of legislation and allows committees to define “effective.”
FRG1: There is a national budget line(s) for breastfeeding protection, promotion, and support activities.			Existence	Quality
FRG2: The budget is adequate for breastfeeding protection, promotion, and support activities.	Scoring	Addition to minimal and partial progress of the line “There is a national budget line(s) for breastfeeding protection, promotion and support activities or there is not a specific budget line but funding is provided for breastfeeding resources … ”	Existence	Quality		Allows for countries without specific budget line for breastfeeding but with other resources in place (e.g., staffing) that are invested in breastfeeding to account for those resources.
	Scoring	Addition to no progress of the line “There is no national budget line(s) for breastfeeding protection, promotion and support activities nor is funding provided for breastfeeding resources.”
FRG3: There is at least one fully funded government position to primarily work on breastfeeding protection, promotion, and support at the national level.			Existence	Quality
FRG4: There is a formal mechanism through which maternity entitlements are funded using public sector funds.			Existence	Coverage
TPDG1: A review of health provider schools and pre‐service education programmes for health care professionals that will care for mothers, infants, and young children indicates that there are curricula that cover essential topics of breastfeeding.	Data sources	If no surveys exist, a survey of relevant university administrators can be administered to determine curricula content or the survey can be applied a representative sample of schools.	Existence	Coverage	Quality	Suggestion based on beta testing experiences.
TPDG2: Facility‐based health care professionals who care for mothers, infants, and young children are trained on the essential breastfeeding topics as well as their responsibilities under the Code implementation.			Existence	Quality	Effective
TPDG3: Facility‐based health care professionals who care for mothers, infants, and young children receive hands‐on training in essential topics for counselling and support skills for breastfeeding.			Existence	Quality	Effective
TPDG4: Community‐based health care professionals who care for mothers, infants, and young children are trained on the essential breastfeeding topics as well as their responsibilities under the Code implementation.			Existence	Quality	Effective
TPDG5: Community‐based health care professionals who care for mothers, infants, and young children receive hands‐on training in essential topics for counselling and support skills for breastfeeding.			Existence	Quality	Effective
TPDG6: Community health workers and volunteers that work with mothers, infants, and young children are trained on the essential breastfeeding topics as well as their responsibilities under the Code implementation.	Benchmark description	Volunteers are people who provide breastfeeding counselling and support but are not paid for providing that service.	Existence	Quality	Effective
TPDG7: Community health workers and volunteers that work with mothers, infants, and young children receive hands‐on training in essential topics for counselling and support skills for breastfeeding.			Existence	Quality	Effective
TPDG8: There exist national/subnational master trainers in breastfeeding (i.e., breastfeeding specialists or lactation consultants) who give support and training to facility‐based and community‐based health care professionals as well as community health workers.	Benchmark description	Addition: “Master trainers have received national or international certification as breastfeeding specialists or lactation consultants.”	Existence	Coverage		(a) Clarify master trainer certification. (b) Allow for assessing coverage, if master trainers exist at national or state level—is coverage country‐wide?
	Scoring	Addition to partial and major progress: “Master trainers in breastfeeding at the national and subnational level throughout the country.”
TPDG9: Breastfeeding training programmes that are delivered by different entities through different modalities (e.g., face‐to‐face; on‐line learning) are coordinated.		(a) Clarify that benchmark is specific to breastfeeding training programmes.(b) Courses can be implemented by different entities; however, they should be integrated, registered, evaluated, and/or certified in order to be coordinated.	Existence	Coverage		Original wording not clear that breastfeeding training programmes implemented by different entities should be included.
TPDG10: Breastfeeding information and skills are integrated into related training programmes (e.g., maternal and child health, IMCI).	Benchmark description	Addition of Ten Steps; the Supplemental Nutrition Program for Women, Infants, and Children (WIC) as examples of related training programmes.	Existence	Coverage
	Data sources	If documentation does not exist, surveys can be distributed to training programmes to assess training courses, manuals, and curricula to determine if breastfeeding information and skills are integrated into these programmes and the level of integration.
TPDG11: National standards and guidelines for breastfeeding promotion and support have been developed and disseminated to all facilities and personnel providing maternity and newborn care.	Benchmark description	Addition: “Breastfeeding standards and guidelines can be developed and disseminated as an individual guideline or included in other maternity and/or child health materials (e.g., young child feeding guidelines, child health guidelines).”	Existence	Coverage		Beta testing found that some countries only considered those specific to breastfeeding but guidance may be incorporated into other maternal and/or child health information.
TPDG12: Assessment systems are in place for designating BFHI/Ten Steps facilities.			Existence	Quality	Effective
TPDG13: Reassessment systems are in place to re‐evaluate designated Baby‐Friendly/Ten Steps hospitals or maternity services to determine if they continue to adhere to the Baby‐Friendly/Ten Steps criteria.			Existence	Quality
TPDG14: More than 66.6% of deliveries happen in facilities designated or reassessed as “Baby Friendly.”	Benchmark title	Previous wording: “More than 66.6% of hospitals and clinics offering maternity services have been designated or reassessed as ‘Baby Friendly’ in the last 5 years.”	Coverage			(a) Assessing coverage of the deliveries to better measure BFHI coverage and compatible with the revised BFHI guidelines. (b) Impact of BFHI better assessed by coverage of deliveries in facilities versus BFHI designation. (c) Births in private facilities not captured in previous definition.
	Benchmark description	It is important to understand if the per cent of public and private hospitals and maternity facilities designated or reassessed as Baby‐Friendly is increasing, decreasing, or remaining the same.
	Benchmark description	The following questions from the WHO Global Nutrition Policy Review module on the Baby‐friendly Hospital Initiative can be used to help assess how many health care facilities (public and private) have ever been designated Baby‐Friendly: • How many of these have been designated or reassessed as Baby‐Friendly in the past 5 years? • What is the total number of births per year in the facilities that were designated or reassessed as Baby‐Friendly in the past 5 years?
	Scoring description	Scoring reflects the coverage of deliveries in BFHI designated or reassessed hospital and maternity facilities in a country.
	Scoring	Addition of number of deliveries taking place in hospitals and maternity facilities designated or reassessed as “Baby‐Friendly” in the last 5 years to minimal, partial, and major progress.
TPDG15: Health care facility‐based community outreach and support activities related to breastfeeding are being implemented.			Existence	Quality	Effective
TPDG16: Community‐based breastfeeding outreach and support activities have national coverage.	Scoring description	Addition: “Full national coverage refers to the fact that all activities are being implemented to cover all of the specific target population. For example, if a community based breastfeeding initiative is designed to reach an indigenous/ethnic population that only lives within a certain geographical area within the entire country, coverage would be considered national if the programme activities reach the entire target population.”	Existence	Coverage		Clarification of coverage needed regarding population specific or entire population programmes.
	Benchmark description
TPDG17: There are trained and certified lactation management specialists available to provide supportive supervision for breastfeeding programme delivery.	Scoring	• Minimal progress: Subnational/local coverage changed to Local. • Partial progress: Partial national coverage changed to Subnational .	Existence	Coverage
PG1: There is a national breastfeeding promotion strategy that is grounded in the country's context.	Benchmark description	(a) Addition: “The national breastfeeding promotion strategy can include formal campaign(s) (including one or more) targeting specific or entire population. It can also include the relaying of messages through one or multiple channels including mass media campaigns, interpersonal communication, posters, educational materials, etc.” (b) Strategy must specify time frame.	Existence	Quality	Quality	(a) Definition of promotion strategy requested by beta testers. (b) Time frame missing from description but in scoring.
PG2: The national breastfeeding promotion strategy is implemented.	Benchmark description	Addition “… can include formal campaign(s) (including one or more) targeting specific or entire population. It can also include the relaying of messages through one or multiple channels including mass media campaigns, interpersonal communication, posters, educational materials, etc.”	Existence	Effective	Coverage	(a) Definition of promotion strategy requested by beta testers. (b) Clarification of coverage needed.
	Scoring description	Coverage can be national or full depending on goals of strategy National coverage = implemented to the entire population Full coverage = complete coverage of a subpopulation
PG3: Government or civic organizations have raised awareness about breastfeeding.	Benchmark description	Addition: “Government and/or civic organizations' promotion campaigns, activities, or actions designed to raise awareness about breastfeeding should be considered under this benchmark.”	Coverage			Ensure assessments include any civil society involvement.
REG1: Indicators of key breastfeeding practices are routinely included in periodic national surveys.			Volume/frequency
REG2: Key breastfeeding practices are monitored in routine health information systems.	Benchmark description	This benchmark assesses if key breastfeeding practices are monitored in routine health information systems, and gauges their coverage and if key indicators have been publicly reported. Clarification: full coverage = national, subnational, and local coverage	Existence	Coverage	Quality	(a) Consistent with the other benchmarks evaluating monitoring systems. (b) Possible fragmentations within health care systems that affect national coverage.
	Scoring description	Clarification: full coverage = national, subnational, and local coverage
	Scoring	Addition of “key indicators publicly reported” to minimal, partial, and major progress
REG3: Data on key breastfeeding practices are available at national and subnational levels, including the local/municipal level.			Existence	Coverage
REG4: Data on key breastfeeding practices are representative of vulnerable groups.			Existence	Coverage
REG5: Indicators of key breastfeeding practices are placed in the public domain on a regular basis.	Benchmark description	Include more complete definition of “public domain”:Published reports, media coverage, public social media sites, and database(s) available to researchers & public.	Volume/frequency			To differentiate between publicly available information for those interested and specific efforts to make information available to the general public.
REG6: A monitoring system is in place to track implementation of the Code.	Scoring description	Addition of an operational element to scoring, i.e., the monitoring system should be used to track and enforce Code violations.	Existence	Effective		Need to include operational dimension to ensure properly functioning monitoring system.
	Scoring	Operational dimension added to scoring of minimal, partial, and major progress.
REG7: A monitoring system is in place to track enforcement of maternity protection legislation.	Benchmark description	Addition: “Monitoring systems systematically and routinely collect data on process indicators in order to track progress of programs or initiatives to ensure implementation and effectiveness.”	Existence	Effective		Need to include operational dimension to ensure properly functioning monitoring system.
	Scoring description	Addition of an operational element to scoring, i.e., the monitoring system should be used to track and enforce maternity protection legislation.
	Scoring	Operational dimension added to scoring of minimal, partial, and major progress.
REG8: A monitoring system is in place to track provision of lactation counselling/management and support.	Benchmark description	Addition: “Monitoring systems systematically and routinely collect data on process indicators in order to track progress of programs or initiatives to ensure implementation and effectiveness.”	Existence	Effective		Need to include operational dimension to ensure properly functioning monitoring system.
	Scoring description	Addition of an operational element to scoring, i.e., the monitoring system should be used to track the provision of lactation counselling/management and support.
	Scoring	Operational dimension added to scoring of minimal, partial, and major progress.
REG9: A monitoring system is in place to track implementation of the BFHI/Ten Steps.	Benchmark description	Addition: “Monitoring systems systematically and routinely collect data on process indicators in order to track progress of programs or initiatives to ensure implementation and effectiveness.”	Existence	Effective		Need to include operational dimension to ensure properly functioning monitoring system.
	Scoring description	Addition of an operational element to scoring, i.e., the monitoring system should be used to track the compliance of the BFHI/Ten Steps.
	Scoring	Operational dimension added to scoring of minimal, partial, and major progress.
REG10: A monitoring system is in place to track behaviour change communication activities.	Benchmark description	Addition: “Monitoring systems systematically and routinely collect data on process indicators in order to track progress of programs or initiatives to ensure implementation and effectiveness.”	Existence	Effective		Need to include operational dimension to ensure properly functioning monitoring system.
	Scoring description	Addition of an operational element to scoring, i.e., the monitoring system should be used to track behaviour change communication activities.
	Scoring	Operational dimension added to scoring of minimal, partial, and major progress.
CGMG1: There is a National Breastfeeding Committee/IYCF Committee.			Existence	Volume/frequency	Quality
CGMG2: National Breastfeeding Committee/IYCF Committee work plan is reviewed and monitored regularly.	Scoring description	Addition: “However, if the country does not have a National Breastfeeding Committee/IYCF Committee, this benchmark must be scored as no progress.”	Existence	Effective		Clarification of scoring.
CGMG3: Data related to breastfeeding programme progress are used for decision making and advocacy.			Volume/frequency