Scaling up breastfeeding in England through the Becoming Breastfeeding Friendly initiative (BBF)

Abstract

Breastfeeding is the most accessible and cost-effective activity available to public health and has been shown to be one of the most effective preventive measures mothers can take to protect their children's health. Despite the well-documented benefits, the UK has one of the lowest breastfeeding rates in the world. The Becoming Breastfeeding Friendly (BBF) toolkit was developed through highly structured technical and academic collaboration, led by Yale University. It provides an evidence-based process to help countries assess their breastfeeding status and readiness to scale up, and identifies concrete measures countries can take to sustainably increase breastfeeding rates, based on data-driven recommendations.BBF is grounded in the Breastfeeding Gear Model complex adaptive systems framework which is made up of eight simultaneous conditions that sustain breastfeeding. In 2018, a committee of multi-agency stakeholders implemented the BBF process in England, collecting evidence to score the 'gear' components of England's breastfeeding environment against 54 benchmarks. The Training and Programme Delivery gear received the highest score, attributable to existing learning outcomes for health professionals and practitioners, peer supporters and specialist services, although there is a need for greater coordination and integration. The lowest scores were given for Promotion and Coordination, Goals and Monitoring due to the lack of a dedicated national strategy for breastfeeding and poor sharing of localised strategies and programmes. The process generated clear recommendations highlighting the need for more robust routine infant feeding data collection and reporting, and the necessity for strengthening leadership, monitoring and oversight to scale up and sustain breastfeeding.

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).…”

Gearing to success with national breastfeeding programmes: The Becoming Breastfeeding Friendly (BBF) initiative experience

“…Furthermore, BBF showed the strong potential that it has to improve breastfeeding policy. Given the dearth of data on breastfeeding practices and programming, the BBF committee in England (co‐chaired by the University of Kent and Public Health England) chose to focus on the Research and Evaluation gear and the Coordination, Goals and Monitoring gears (Merritt et al, 2022 ). The BBF process generated specific recommendations highlighting the need for: (a) The establishment of a national multiagency group to deliver strategic leadership and oversight for breastfeeding; and (b) More robust routine infant feeding data collection and reporting, and the necessity for strengthening leadership within existing national programmes, such as the Best Start in Life programme.…”