Abstract
BackgroundThe Baby Friendly Hospital (Health) Initiative (BFHI) is a global initiative aimed at protecting, promoting and supporting breastfeeding and is based on the ten steps to successful breastfeeding. Worldwide, over 20,000 health facilities have attained BFHI accreditation but only 77 Australian hospitals (approximately 23%) have received accreditation. Few studies have investigated the factors that facilitate or hinder implementation of BFHI but it is acknowledged this is a major undertaking requiring strategic planning and change management throughout an institution. This paper examines the perceptions of BFHI held by midwives and nurses working in one Area Health Service in NSW, Australia.MethodsThe study used an interpretive, qualitative approach. A total of 132 health professionals, working across four maternity units, two neonatal intensive care units and related community services, participated in 10 focus groups. Data were analysed using thematic analysis.ResultsThree main themes were identified: 'Belief and Commitment'; 'Interpreting BFHI' and 'Climbing a Mountain'. Participants considered the BFHI implementation a high priority; an essential set of practices that would have positive benefits for babies and mothers both locally and globally as well as for health professionals. It was considered achievable but would take commitment and hard work to overcome the numerous challenges including a number of organisational constraints. There were, however, differing interpretations of what was required to attain BFHI accreditation with the potential that misinterpretation could hinder implementation. A model described by Greenhalgh and colleagues on adoption of innovation is drawn on to interpret the findings.ConclusionDespite strong support for BFHI, the principles of this global strategy are interpreted differently by health professionals and further education and accurate information is required. It may be that the current processes used to disseminate and implement BFHI need to be reviewed. The findings suggest that there is a contradiction between the broad philosophical stance and best practice approach of this global strategy and the tendency for health professionals to focus on the ten steps as a set of tasks or a checklist to be accomplished. The perceived procedural approach to implementation may be contributing to lower rates of breastfeeding continuation.
Highlights
The Baby Friendly Hospital (Health) Initiative (BFHI) is a global initiative aimed at protecting, promoting and supporting breastfeeding and is based on the ten steps to successful breastfeeding
The BFHI was described as an evidence-based strategy that would lead to increased initiation and duration of breastfeeding: one participant stated, ‘evidence has shown us that this is the right way to go’ (FG1)
BFHI was viewed as a strategy whose time had come and participants reflected on the achievements of other hospitals across Australia that had received accreditation and one participant commented ‘Just looking at the ten steps... it is achievable’ (FG6)
Summary
The Baby Friendly Hospital (Health) Initiative (BFHI) is a global initiative aimed at protecting, promoting and supporting breastfeeding and is based on the ten steps to successful breastfeeding. The World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) have implemented a number of strategies to protect and promote breastfeeding globally. One of these strategies, launched in 19911992 is the Baby Friendly Hospital Initiative (BFHI) known in Australia as the Baby Friendly Health Initiative. The BFHI is aimed at promoting and supporting breastfeeding and is based on ten best practice standards [3] that must be attained in order for a hospital or health service to be accredited as ‘Baby Friendly’ (see table 1) [3]. There is increasing evidence that implementation of the BFHI increases initiation and, to a lesser extent, duration rates of any breastfeeding and exclusive breastfeeding individual studies show variable effects at different time points [4,5,6,7]
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