Despite growing evidence for the positive impact of the Baby Friendly Initiative (BFI) on breastfeeding outcomes, few studies have investigated the barriers and facilitators to the implementation of Baby Friendly practices. Therefore, a review was carried out to identify the barriers, facilitators, and recommendations related to implementation of the BFI from international, peer-reviewed literature.

A total of 13 databases were searched and a total of 45 English language articles from 16 different countries met the inclusion criteria for the review. The researchers categorised findings into socio-political, organisational-level, and individual-level barriers and facilitators to implementing the BFI and recommendations for strengthening BFI implementation.

They were able to identify a wide variety of obstacles and potential solutions to BFI implementation (see full paper for a full list of recommendations). Findings suggest some priority issues to address when embarking on the process including: gaining the endorsement of both local and governmental level policy makers, effective leadership of the practice change process, health-care worker training across all levels to include managers and medical staff, the marketing influence of formula companies, and integrating hospital and community health services.

In particular, the most commonly mentioned organisational facilitator was a well-co-ordinated change management strategy, characterised by strong administrative support, multidisciplinary involvement, motivated and credible leaders, open communication, and a flexible, participatory approach. They recommend therefore that it is important to frame the BFI as a complex, multilevel, evidence-based change process and support it accordingly.

Semenic S, Childerhose JE, Lauzière J et al (2012). Journal of Human Lactation, published online 24 May 2012. DOI:10.1177/0890334412445195