Stakeholders' views of the Baby Friendly Initiative
A mixed methods study by Fair, Morison and Soltani (July 2024) explores stakeholders’ views of the Baby Friendly Initiative programme, the barriers and facilitators to accreditation, and its perceived impact. The fieldwork for the study consisted of an online survey conducted from September 2020 to November 2020 alongside individual semi-structured interviews. A total of 322 respondents from 16 countries took part in the survey, with over half (60.5%) from England. Fifteen respondents took part in the interviews.
The study demonstrates that the Baby Friendly Initiative was viewed by most respondents as an intervention that could improve breastfeeding initiation and duration and infant health outcomes. The provision of Baby Friendly training was seen to empower staff to support mothers and families, provide consistent messaging, and positively impact care.
Importantly, findings highlight the contributory nature that the Baby Friendly Initiative makes to supporting infant feeding in the UK and how the programme should not be seen as a standalone intervention, but rather part of a holistic systems and cultural change approach to address the complex barriers to breastfeeding and so enable a breastfeeding-friendly environment. It was very positive to see that respondents welcomed the programme’s emphasis within the UK around infant attachment and bonding and the breadth of the UK programme within university midwifery and health visiting programmes. It was also positive that respondents reported that achieving Baby Friendly accreditation was seen as a celebratory event. The UNICEF UK Baby Friendly Initiative recognises the time, effort and dedication required to implement and maintain the Baby Friendly programme and admires services’ commitment to embedding and maintaining high-quality care in the long term.
The study also explored respondents’ perceptions on the importance of all the standards within the Baby Friendly approach. Whilst several respondents felt that all the standards were equally important, some felt that certain standards were more important than others.
As it relates to the UK context, a significant limitation of the study included the researchers’ decision to use the Ten Steps to Successful Breastfeeding and Seven Point Plan for Sustaining Breastfeeding in the Community as a basis for their enquiry. These standards were superseded in 2012 when the UK Committee for UNICEF (UNICEF UK) Baby Friendly Initiative programme standards were reviewed to include support for parents/primary caregivers who are bottle feeding and for all parents/primary caregivers to develop close and loving relationships with their babies.
There is also a notable lack of representation of the UNICEF UK Baby Friendly Initiative neonatal standards which were introduced in 2015.
The study references feedback from respondents around making opportunities for Baby Friendly accreditation available for different organisations such as children’s hospitals. In 2023, in response to calls from health professionals, voluntary sector workers and parents to improve infant feeding and early relationship building in all relevant UK public services, the UNICEF UK Baby Friendly Initiative launched standards for hospital-based children’s services.
Notably, a sizeable number of the survey respondents (~25%) and interview participants (~46%) were not currently involved in the implementation of the Baby Friendly standards or were unaware of their involvement. A further sample from those working in institutions did not have full Baby Friendly accreditation. With no separate analysis undertaken on those who were or were not directly involved, and interview quotes not including this information, this provides additional limitations.
Despite these limitations the study provides a useful contribution to the current evidence surrounding the impact of the Baby Friendly Initiative, some of which will be explored further as part of the UNICEF UK Baby Friendly Initiative Review Project in 2024-2027. In addition, the study will also help to inform communication strategies for the UNICEF UK Baby Friendly Initiative to develop clearer messaging about the programme’s role, remit, purpose and funding.
Further references can be found here, including the current UNICEF UK Baby Friendly Initiative standards, the current WHO Global Baby Friendly Hospital Initiative standards, the evidence for the effectiveness of the Baby Friendly Initiative, and the evidence-based policy recommendations in the UK.
Citation:
Fair, F., J., Morison, A., Soltani H. (2024). Stakeholders’ views of the Baby Friendly Initiative implementation and impact: a mixed methods study. International Breastfeeding Journal. https://shura.shu.ac.uk/33958/1/s13006-024-00639-8.pdf
