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. 2024 Jul 12;19(1):49.
doi: 10.1186/s13006-024-00639-8.

Stakeholders' views of the Baby Friendly Initiative implementation and impact: a mixed methods study

Frankie Joy Fair  1 , Alison Morison  1 , Hora Soltani  2
Affiliations

Stakeholders' views of the Baby Friendly Initiative implementation and impact: a mixed methods study

Frankie Joy Fair et al. Int Breastfeed J. .

Abstract

Background: The Baby Friendly Hospital Initiative (BFHI) was launched in 1991 as an intervention to support healthy infant feeding practices, but its global coverage remains around 10%. This study aimed to explore stakeholders' views of the Baby Friendly Initiative (BFI) programme, the barriers and facilitators to accreditation and its perceived impact.

Methods: A mixed methods approach was used. An online survey was distributed through numerous professional networks from September 2020 to November 2020. Quantitative data were analyzed using descriptive statistics, with simple content analysis undertaken on open-ended responses. Individual semi-structured interviews were also undertaken and analyzed using inductive thematic analysis.

Results: A total of 322 respondents completed the survey in part or in full, mainly from the United Kingdom. Fifteen key stakeholders and two maternity service users undertook interviews. Respondents were from various professional backgrounds and currently worked in different roles including direct care of women and their families, public health, education and those responsible for purchasing health services. Survey respondents viewed the BFI to have the greatest impact on breastfeeding initiation, duration, and infant health outcomes. Three overall themes were identified. The first was "BFI as an agent for change". Most participants perceived the need to implement the whole package, but views were mixed regarding its impact and the accreditation process. Secondly, BFI was regarded as only "one part of a jigsaw", with no single intervention viewed as adequate to address the complex cultural context and social and health inequities that impact breastfeeding. Finally, "cultural change and education" around breastfeeding were viewed as essential for women, staff and society.

Conclusions: The BFI is not a magic bullet intervention. To create a more supportive breastfeeding environment within society a holistic approach is required. This includes social and cultural changes, increased education ideally starting at school age, and advancing positive messaging around breastfeeding within the media, as well as fully banning breastmilk substitute advertising. Although the BFI comprises a whole package, few survey respondents rated all aspects as equally important. Additional evidence for the effectiveness of each element and the importance of the whole package need to be established and communicated.

Keywords: Baby Friendly Initiative; Breast milk; Breastfeeding; Infant feeding.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Percentage of respondents ranking each element as 1 or 2 (the most important, or the second most important) for each element of the BFHI 10 steps (n = 129)
Fig. 2
Fig. 2
Percentage of respondents ranking each element as 1 or 2 (the most important, or the second most important) for each of the BFCI 7 points (n = 113)
Fig. 3
Fig. 3
Themes identified within the interviews and the additional comments section of the survey
See this image and copyright information in PMC

References

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