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

Abstract

Scaling up breastfeeding programmes has not been highly prioritized despite overwhelming evidence that breastfeeding benefits the health of mothers and children. Lack of evidence-based tools for scaling up may deter countries from prioritizing breastfeeding. To fill this gap, Becoming Breastfeeding Friendly (BBF) was developed to guide countries in effectively scaling up programmes to protect, promote, and support breastfeeding. BBF includes an evidence-based toolbox that consists of a BBF Index, case studies, and a 5-meeting process. These three interrelated components enable countries to assess their breastfeeding scaling up environment, identify gaps, propose policy recommendations, develop a scaling up plan, and track progress. The toolbox was developed based on current evidence and expert guidance from a Technical Advisory Group, which was composed of global breastfeeding and metric experts with experience in the scaling up of health and nutrition programmes in low-, middle-, and high-income countries. The BBF toolbox required a step-by-step iterative approach to describe and systematize each component, thus an operational manual was developed. The BBF toolbox and BBF operational manual underwent intensive pretesting in two countries, Ghana and Mexico, resulting in the modification of each component plus the operational manual. Pretesting continues in six additional countries demonstrating that BBF is a robust and dynamic multi-sectoral process that, with relatively minor adaptations, can be successfully implemented in countries across world regions.

Scaling up breastfeeding policy and programs in Samoa: application of the Becoming Breastfeeding Friendly initiative

“…Additionally, members were supportive of breastfeeding initiatives and thus motivated to complete BBF accurately and on-time. This supports the BBF guidance that selecting committee members is an essential component leading to the successful implementation of BBF [9].…”

“…Several lessons were learned during the implementation of BBF in Samoa. First, for countries planning to implement BBF, an in-country director is needed to lead and coordinate BBF [9]. Therefore, it is essential to include BBF into the director's annual workplan so that is a planned responsibility rather than an added one.…”

“…Becoming Breastfeeding Friendly is grounded in the Breastfeeding Gear Model framework, which uses a complex adaptive systems approach to stipulate that eight gears -advocacy; political will; legislation & policy; funding & resources; training & program delivery; promotion; research & evaluation; coordination, goals & monitoringmust work in harmony to achieve large-scale improvements in a country's breastfeeding friendly environment [8]. The BBF toolbox consists of a BBF index (BBFI), case studies, and a 5-meeting process [9]. Application of the BBF toolbox is expected to drive policy changes within a country, subsequently strengthening the breastfeeding environment following the cyclical policy heuristic model that includes five key elements: (a) leadership and partnerships; (b) agenda setting; (c) policy formulation and adoption; (d) implementation; and (e) evaluation [9,10].…”

“…The BBF toolbox consists of a BBF index (BBFI), case studies, and a 5-meeting process [9]. Application of the BBF toolbox is expected to drive policy changes within a country, subsequently strengthening the breastfeeding environment following the cyclical policy heuristic model that includes five key elements: (a) leadership and partnerships; (b) agenda setting; (c) policy formulation and adoption; (d) implementation; and (e) evaluation [9,10]. Ideally, by strengthening each of these elements, the BBF toolbox contributes to strengthening the friendliness of the breastfeeding environment through its repeated application across time [9,10].…”

Integrating nutrition services into health care systems platforms: Where are we and where do we go from here

“…The studies also emphasize that this cannot happen unless there is adequate development of a well‐trained health workforce that is motivated to remain on board to prevent the very high turnover of front line personnel identified in this special issue; the programmes have access to the needed supplies and technology; and there is demand for service delivery. These findings are highly consistent with previous analyses, identifying key elements for integrating breastfeeding services across health and social platforms (Hromi‐Fiedler, dos Santos Buccini, Gubert, Doucet, & Pérez‐Escamilla, ; Pérez‐Escamilla, Curry, Minhas, Taylor, & Bradley, ), integrating kangaroo mother care into health systems (Engmann, Wall, Darmstadt, Valsangkar, & Claeson, ; Seidman et al, ), integrating micronutrient powders into health care platforms (Nyhus Dhillon et al, ), integrating early childhood development services including nutrition (Pérez‐Escamilla, Cavallera, Tomlinson, & Dua, ), and integrating family planning into nutrition (Kavle et al, ). Findings are also highly consistent with best practices recommended for the effective scaling up of nutrition programmes across platforms (Gillespie, Menon, & Kennedy, ; Glandon, Paina, Alonge, Peters, & Bennett, ; Kung'u et al, ).…”