Becoming breastfeeding friendly in Wales: Recommendations for scaling up breastfeeding support

Abstract

Breastfeeding and the provision of human milk is established as protecting infant and maternal health. However, breastfeeding rates in many countries, including Wales, are low. Given the significant health, economic and environmental impacts of this, the need to strengthen breastfeeding promotion, protection and support is paramount. As part of this, the becoming breastfeeding friendly: a guide to global scale-up (BBF) initiative sets out a methodology to enable countries to assess their readiness to scale up breastfeeding protection, promotion and support by gathering data and scoring progress under eight areas, termed 'gears', shown to be essential for large-scale change. Recently, Wales took part in the BBF initiative. A cross-sector committee, including stakeholders from Universities, Welsh Government, Public Health Wales and Health Boards alongside critical friends scored Wales' support for breastfeeding across the eight gears. The overall score for Wales was 1.1 out of a possible 0-3, representing a moderate scaling up the environment for breastfeeding. Six gears were rated in the moderate gear strength category and two ('Promotion' and 'Advocacy') in the weak gear strength category. Gaps in breastfeeding support were identified and 31 recommendations covering six themes for change were put forward. These included a strategic action plan, consistent and long-term funding, a nuanced, cocreated engagement and promotion framework, strengthened education and training, robust monitoring and evaluation mechanisms and ensuring maternity rights and the International Code of Marketing of Breastmilk Substitute are upheld. Taken together, the analysis and recommendations present a clear vision for protecting and not merely promoting breastfeeding in Wales.

Experiences that influence how trained providers support women with breastfeeding: A systematic review of qualitative evidence

“…Furthermore, findings suggest that attention be given to personal and organisational factors in addition to education when considering how best to support women to breastfeed. Prior research has reported that effective support intervention implementation is complex and culturally specific [68,69]. This systematic review enhances our understanding of the complexity in implementing breastfeeding support interventions.…”

Becoming breastfeeding friendly in Great Britain—Does implementation science work?

“…The themes were presented back to the country committees in an iterative prioritisation process that supported the Delphi approach to arriving at a consensus on a long list of recommendations based on the score for each gear for each country. As is shown in the papers that follow (Brown et al, 2022;McFadden et al, 2022;R. Merritt et al, 2022), there was considerable variation in the scores for each country, summarised in Table 2.…”

“…(McAndrew et al, 2012) and rely on routine data collection by health visitors. These are described in more detail in the following country papers (Brown et al, 2022;McFadden et al, 2022;R. Merritt et al, 2022), but these layers of variation and complexity added to the rationale to undertake the BBF process across the three countries to make some observations and recommendations about how breastfeeding could be improved.…”

“…Themes were further defined by more detailed recommendations, agreed upon by the relevant country committee. Each country committee faced different challenges in its decision-making process towards recommendations and on this basis chose to focus on some specific aspects of their implementation challenge in the papers that follow (Brown et al, 2022;McFadden et al, 2022;R. Merritt et al, 2022).…”

“…Despite the strong evidence supporting action around these two interventions, not all countries prioritised them or T A B L E 2 Abbreviation: BBF, Becoming Breastfeeding Friendly.T A B L E 3 not solely governed by evidence, despite all countries practicing evidence-based health care and declaring an evidence-based approach to policymaking(Foreign & Commonwealth Office & Kemp, 2018). The country papers in this series provide further detail and discussion of the recommendations made(Brown et al, 2022;McFadden et al, 2022;R. Merritt et al, 2022).…”