A meta-ethnographic study of health care staff perceptions of the WHO/UNICEF Baby Friendly Health Initiative

Abstract

Findings: Three overarching themes were identified. First the BFHI was viewed variously as a 'desirable innovation or an unfriendly imposition'. Participants were passionate about supporting breastfeeding and improving consistency in the information provided. This view was juxtaposed against the belief that BFHI represents an imposition on women's choices, and is a costly exercise for little gain in breastfeeding rates. The second theme highlighted cultural and organisational constraints and obstacles to BFHI implementation including resource issues, entrenched staff practices and staff rationalisation of non-compliance.Theme three captured a level of optimism and enthusiasm amongst participants who could identify a dedicated and credible leader to lead the BFHI change process. Collaborative engagement with all key stakeholders was crucial.Conclusions: Health care staff hold variant beliefs and attitudes towards BFHI, which can help or hinder the implementation process. The introduction of the BFHI at a local level requires detailed planning, extensive collaboration, and an enthusiastic and committed leader to drive the change process. This synthesis has highlighted the importance of thinking more creatively about the translation of this global policy into effective change at the local level.

Perspectives about the baby friendly hospital/health initiative in Australia: an online survey

“…Another Australian study also identified national breastfeeding statements as 'soft' policy due to the lack of tangible incentives or measurable outcomes [21,40]. In regards to establishing a BFHI culture, recent literature has also identified the impact of leadership support at the government [40] and organisational levels on the uptake and implementation of the BFHI [37,41] via providing required resources as enablers [42] while 'intangible government support' and 'suboptimal capacity building' and resource issues flag barriers [21,25,43]. Other barriers to the successful establishment of the BFHI culture are difficulties associated with changing existing practices of hospitals [37] or resistance to new policies [43] and therefore, a change in practice and attitude by staff is required [38].…”

“…Recent Australian studies, including our own study, have identified barriers and facilitators related to the uptake and implementation of the BFHI at both macro and micro levels [21,24,25]. Examples of barriers to successful uptake and implementation in Australia are cultural and organisational obstacles [25], intangible government support, suboptimal capacity building to implement the BFHI [21,25], and lack of established legal measures to implement the WHO Code [17].…”

“…Examples of barriers to successful uptake and implementation in Australia are cultural and organisational obstacles [25], intangible government support, suboptimal capacity building to implement the BFHI [21,25], and lack of established legal measures to implement the WHO Code [17]. Cultural and organisational obstacles may include old patterns, entrenched staff practices, staff rationalisation of noncompliance with the BFHI [25], and lack of essential resources [21,25]. Facilitators to successfully implement the BFHI have been identified as leadership support [17,21], improving BFHI and breastfeeding related knowledge, establishing better communication between stakeholders, facilitating the accreditation and reaccreditation process, and organisational cultural support of the BFHI according to findings of our research [24].…”

Global implications of the new WHO and UNICEF implementation guidance on the revised Baby‐Friendly Hospital Initiative

“…It is important to consider further research questions related to actual implementation of the revised BFHI to update existing knowledge (Pérez‐Escamilla et al, ; Schmied et al, ). Recognizing that scaling up breastfeeding takes place in a complex adaptive world (Pérez‐Escamilla & Hall Moran, ), we could use ecological perspectives to further explore the ways in which change in relation to the revised BHFI is managed at a macro (society level), meso (community level), and micro (individual level; McLaren & Hawe, ).…”

“…It is important to consider further research questions related to actual implementation of the revised BFHI to update existing knowledge Schmied et al, 2014). Recognizing that scaling up breastfeeding takes place in a complex adaptive world (Schmied, Beake, Sheehan, McCourt, & Dykes, 2011) and prioritizing relationships to better facilitate mothers' capacities to respond to their babies' cues (Dykes & Flacking, 2010;Thomson, Bilson, & Dykes, 2012).…”