Background: A worldwide campaign has been initiated to improve the inhospital care of mothers and babies through increased breastfeeding. The four objectives of the current investigation were to determine the in-hospital breastfeeding rate for Minnesota hospitals, to analyze the relationship between the in-hospital breastfeeding rates and selected hospital demographic characteristics, to determine the rate of adherence to each of the Baby-Friendly Hospital Initiative (BFHI) Ten Steps, and to analyze the relationship between the adherence rates for each of the Ten Steps and selected demographic characteristics. Methods: A descriptive survey was conducted and analyzed for the year of 1994 from 79 (83%) Minnesota hospitals. Respondents were directors of nursing, nursing managers, or other staff familiar with their hospital's breastfeeding policies and practices. Results: The average breastfeeding initiation rate was 59 percent. Four of the Ten Steps were implemented with a low adherence rate (0-49%), five were implemented with a moderate rate (50-89%), and none was implemented with a high rate (90-100%). Breastfeeding initiation rates and adherence to the Ten Steps varied with the size of the city and the number of births per year. Conclusions: Improvements in breastfeeding policies, practices, and staff education are needed if Minnesota hospitals are to provide care consistent with the Ten Steps of the BFHI. The results provide baseline information to guide institutional change that could promote successful breastfeeding experiences for postpartum families. This survey instrument could be used easily by researchers in other sites to assess nine of the Ten Steps.