Background: The UNICEF/WHO Baby Friendly Hospital Initiative (BFHI) is a worldwide program aimed at promoting, protecting and supporting breastfeeding through the 'Ten Steps' for successful breastfeeding. Aim: To assess the underlying causes that lead to poor implementation of BFHI after the designation of the hospitals as Babyfriendly. Methods: This was a cross sectional descriptive study for comparing the knowledge, attitude and practice (KAP) of staff representing three types of hospitals: 7 University (UH), 7 public (PH) and teaching hospitals (TH) from different parts of the country. Interviews were conducted for 350 staff members (university staff, medical students, house-officers, nurses and doctors working in maternity and neonatal units) &140 mothers from different localities & different hospitals. Results: Knowledge, attitude and practice towards the Code was significantly lowest among UH staff compared to the other hospitals (P<0.001). Services that support breastfeeding mothers were highest in the UH (P=0.006). Education about breastfeeding was highest in UH (P=0.001). Practices of early initiation (step 4) was significantly higher in PH (36.7%) and TH (17.5%) compared to UH (5.4%), (P<0.001).Managing breastfeeding difficulties were highest in UH (P<0.007). Prescribing formula was significantly higher in PH (33.3%) and TH (20%) compared to UH (10.4) with P<0.001.Conclusions: Improving and sustaining breast feeding can be achieved by revising teaching methodologies and curricular contents and updating practices in UH. This can ensure that medical students who will become the future staff working in PH and TH will provide better services.