Optimisation of breastfeeding practices could reduce high mortality rates in children younger than 5 years, but in DR Congo, despite near-universal breastfeeding initiation and nine of ten children still breastfeeding at 1 year of age, exclusivity remains a difficulty. This article looks at an assessment of the effect on breastfeeding outcomes of a short-cut implementation of a programme called the Ten Steps to Successful Breastfeeding, the key component of the Baby-Friendly Hospital Initiative (BFHI).

A cluster-randomised controlled trial was carried out in randomly assigned health-care clinics in Kinshasa, DR Congo, to standard care (control group), BFHI steps 1–9 (steps 1–9 group), or BFHI steps 1–9 plus additional support during well-child visits (steps 1–10 group) with computer-generated random numbers used to assign matched pairs to study groups. Mothers at these clinics who had given birth to one healthy baby during enrolment, and who expressed their intentions of visiting a well-baby session at the same clinic, were eligible and received the treatment assigned to their clinic.