Becoming Breastfeeding Friendly Index: Development and application for scaling‐up breastfeeding programmes globally

Abstract

Global efforts to further improve exclusive breastfeeding rates have not been successful, in part because effective scaling-up frameworks and roadmaps have not been developed. The Becoming Breastfeeding Friendly (BBF) toolbox includes an evidence-based index, the BBF Index (BBFI), to guide the development and tracking of large scale, well-coordinated, multisector national breastfeeding promotion programmes. This paper describes the development of the BBFI, which is grounded in the Breastfeeding Gear Model complex adaptive systems framework. The BBFI was developed by the BBF Steering Committee in collaboration with a high-level Technical Advisory Group following the Delphi consensus methodology. Key benchmarks and definitions were informed by evidence-based health, nutrition, and newborn survival initiatives identified from the academic and grey literature. The BBFI consists of 8 gears (54 benchmarks): Advocacy (4); Political Will (3); Legislation and Policies (10); Funding and Resources (4); Training and Program Delivery (17); Promotion (3); Research and Evaluation (10); and Coordination, Goals, and Monitoring (3). Scores are generated for 8 gear scores plus a total country score to gauge the scaling-up enabling environment. The BBFI provides an evidence-based index to assist countries in (a) assessing their readiness to scale up breastfeeding programmes and (b) tracking scaling-up progress.

Scaling Up Breastfeeding Programs in Mexico: Lessons Learned from the Becoming Breastfeeding Friendly Initiative

“…The BBF benchmarks and scoring methods were developed by the BBF Steering Committee at Yale University on the basis of the advice of the International Technical Advisory Group (11). The Mexico BBF committee was composed of 11 experts in the breastfeeding and lactation field from government, academia, and civil society organizations.…”

“…The third step involves calculating the BBF-TS by multiplying each GTS by the weight allocated to that gear by the BBF Technical Advisory Group (11). The formulas used are as follows: Weighted GTS Advocacy = GTS Advocacy × 1.6; Weighted GTS Political Will = GTS Political Will × 1.5; Weighted GTS Legislation and Policies = GTS Legislation and Policies × 1.6; Weighted GTS Funding and Resources = GTS Funding and Resources × 1.6; Weighted GTS Training and Program Delivery = GTS Training and Program Delivery × 1.6; Weighted GTS Promotion = GTS Promotion × 1.5; Weighted GTS Research and Evaluation = GTS Research and Evaluation × 1.5; Weighted GTS Coordination, Goals, and Monitoring = GTS Coordination, Goals and Monitoring × 1.4.…”

“…More recently, Pérez-Escamilla et al (10, 11) developed the Becoming Breastfeeding Friendly (BBF) Toolbox to guide countries in assessing their readiness to scale up breastfeeding protection, promotion, and support on the basis of the Breastfeeding Gear Model. The Toolbox consists of 1 ) BBF benchmarks to assess the strength of each of the gears enabling countries to scale up breastfeeding efforts (11) and 2 ) a highly participatory and iterative multisectoral process through which the BBF country's committee uses the BBF Total Index Score (BBF-TS) to make policy recommendations.…”

“…The Toolbox consists of 1 ) BBF benchmarks to assess the strength of each of the gears enabling countries to scale up breastfeeding efforts (11) and 2 ) a highly participatory and iterative multisectoral process through which the BBF country's committee uses the BBF Total Index Score (BBF-TS) to make policy recommendations. The overall objectives of this project were as follows: 1 ) to apply the BBF-TS, 2 ) to identify scaling-up gaps on the basis of the Breastfeeding Gear Model, and 3 ) to develop and present evidence-based recommendations to policymakers and the media to improve breastfeeding protection, promotion, and support in Mexico.…”

Development and pretesting of “Becoming Breastfeeding Friendly”: Empowering governments for global scaling up of breastfeeding programmes

“…To operationalize the BFGM into a useful resource for stakeholders and policymakers, BBF includes a toolbox to help countries assess, develop plans, and track breastfeeding scaling up in their specific contexts. The BBF toolbox has three main components: the Becoming Breastfeeding Friendly Index (BBFI), case studies (CS), and a 5‐meeting process that culminates with the development of policy recommendations (Pérez‐Escamilla et al, ).…”