Examining the Washington State Breastfeeding-Friendly Policy Development Process Using the Advocacy Coalition Framework

Abstract

Objectives Breastfeeding promotion is increasingly recognized as a key public health strategy. Policies can promote breastfeeding by creating supportive environments and addressing challenges. In 2014, the Washington State legislature considered bills to create a voluntary recognition system for breastfeeding-friendly hospitals, clinics, worksites and childcare settings. These Breastfeeding-Friendly Washington (BFW) bills (SB 6298 and HB 2329) did not pass. Methods The purpose of this case study was to analyze the policy development process for the BFW bills using the Advocacy Coalition Framework. Data were collected through semi-structured interviews with key stakeholders in the state policy process, and document review. We used thematic analysis to identify deductive and inductive themes. Results Though all policy actors indicated general support for breastfeeding, two main coalitions (proponents and opponents) diverged in their support of the BFW bills as policy solutions to address barriers to breastfeeding. We conducted 29 interviews with mainly bill proponents, and 54 documents confirmed data about bill opponents. Proponents supported the bills given increasingly strong evidence of breastfeeding's benefits and that public policy could address environmental challenges to breastfeeding. Opponents saw the bills as government overreach into the private matter of choosing to breastfeed. Opposition to the bills came late in the session, and proponents felt opponents' messaging misconstrued the intent of the legislation. Conclusions for Practice Key learnings for developing breastfeeding-friendly state policies include analyzing differences between proponents' and opponents' beliefs, framing advocacy messages beyond individuals and health, expanding the coalition outside of traditional health entities, and anticipating the opposition.

Biodiversity conservation, advocacy coalitions, and science-focused disputes: the case of Caymanian coral reef conservation and the proposed port expansion project

“…These domains are still relevant and include public health, education, science and technology, social welfare, foreign relations and national defense, urban planning and transportation, energy, and environment. Generally, applications of the ACF in the public health sector have examined the role of advocacy coalitions to promote health policies, such as the Maternal and Child Healthcare policy in Nigeria (Ritter et al, 2018), social health determinants and the prevention of chronic disease in Canada (Nykiforuk et al, 2009;Kershaw et al, 2017), actions against stunted growth in Zambia (Harris, 2019), and promotion of Breastfeeding-Friendly bills in Washington State (Steinman et al, 2017). The ACF has also been employed in the education sector to identify the role of coalition groups and their respective belief systems to implement education bills and policies (Wang, 2020).…”

How is the Advocacy Coalition Framework Doing? Some Issues since the 2014 Agenda.

“…Only four studies use all of the model's elements (9%), analyzing a variety of subjects: breastfeeding policy in Washington (STEINMAN et al, 2017), the privatization of water in Jakarta, Indonesia (LEONG, 2015), the prohibition of smoking shisha in public places in the Province of Kerman in Iran (KHAYATZADEH- MAHANI et al, 2017) and the use of police dogs in the fight against drug trafficking in New South Wales in Australia . These works all have in common the fact that they study policy on a state or local level, which can facilitate the use of the whole framework.…”