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

Background Breastfeeding is a critical, evidence-based intervention that addresses malnutrition, improves early childhood development outcomes, and influences long-term maternal and infant health by reducing the non-communicable disease risk. Scaling up breastfeeding is an indisputably strong action countries can take to prevent suboptimal maternal and infant health outcomes. The Becoming Breastfeeding Friendly (BBF) initiative assists countries with scaling up breastfeeding policy and programs. BBF has been successfully implemented within Latin America, Africa, Europe and South-East Asian regions. This study assessed its application in Samoa. Methods In 2018, BBF was implemented in Samoa by a 20 member committee of breastfeeding experts who participated in collecting and utilizing national level data to score the degree of friendliness of Samoa’s breastfeeding environment, identify gaps, and propose policy recommendations to address those gaps. This eight-month process resulted in a public event where priority recommendations were widely disseminated to decision makers and actions agreed upon. Results The total BBF Index score for Samoa was 1.6 out of 3.0, indicating a moderate breastfeeding friendly environment for scaling up policies and programs that protect, promote, and support breastfeeding. Gear total scores indicated that seven of the eight gears were moderately strong within Samoa, while the eighth gear, funding and resources, was weakest in strength. Six prioritized recommendations emerged: 1) development and implementation of a National Breastfeeding Policy and Strategic Action Plan; 2) strengthening monitoring and evaluation of all breastfeeding activities; 3) ratifying the International Labour Organization’s Maternity Protection Convention 2000 (No 183); 4) identifying high-level advocates to champion and serve as role models for breastfeeding; 5) creation of a national budget line for breastfeeding activities; and 6) hiring of a national breastfeeding coordinator and trainer. Decision makers demonstrated commitment by signing the breastfeeding policy for hospitals ahead of the BBF dissemination meeting and electing to move forward with establishing lactation rooms within government ministries. Conclusion Implementation of BBF in Samoa yielded important policy recommendations that will address current gaps in national level breastfeeding support. The BBF consultation process can be successfully applied to other countries within the Western Pacific region in order to strengthen their breastfeeding programs.

Scaling Up Breastfeeding in Myanmar through the Becoming Breastfeeding Friendly Initiative

ABSTRACT Background Optimal breastfeeding practices in Myanmar are above global averages, and the Ministry of Health and Sports (MoHS) has demonstrated its commitment to support nutrition and breastfeeding through continued policy and program actions. In 2017, the MoHS, in partnership with Save the Children, led the piloting of the Becoming Breastfeeding Friendly (BBF) Initiative. BBF provides a guide for countries to assess the enabling environment for breastfeeding and a country's readiness to scale up breastfeeding policies and programs. Objective The aim of this study was to document the BBF process and outcomes in Myanmar. Methods A Working Group (WG) of 14 members, led by a chair and 2 cochairs, conducted the BBF assessment using the BBF Index (BBFI), generated and prioritized recommendations, and disseminated the findings over the course of 5 meetings. Additional meetings were held to gain stakeholder endorsement and approval of the BBF process and WG before commencement and MoHS endorsement of the findings. Results The BBFI score for Myanmar was 1.2 out of 3.0, which indicates a moderate environment for scaling up breastfeeding policies and programs. The Funding and Resources gear earned the lowest score (0.5), whereas Political Will earned the highest score (2.0). Overall, 4 gears were weak and 4 were moderate in strength. Nine recommendation themes were generated and prioritized. The top priority recommendation was to form a National Infant and Young Child Feeding Alliance. The MoHS endorsed the 9 recommendations in December 2018 and has provided leadership for the formation of the alliance. Conclusions The BBF Initiative was successfully conducted in Myanmar, resulting in 9 prioritized recommendations for strengthening the breastfeeding enabling environment and substantial interagency collaborations. Adaptations to the BBF process were made for the context, and we note numerous lessons learned that should be considered by other countries that plan to commit to the BBF Initiative.

Can “Becoming Breastfeeding Friendly” Impact Breastfeeding Protection, Promotion, and Support in Mexico? A Qualitative Study

Background: The Becoming Breastfeeding Friendly (BBF) initiative includes a guide that helps countries worldwide assess their readiness to scale up national breastfeeding programs. Country committees of breastfeeding experts across government, academia, and civil society engage with BBF by applying the BBF toolbox that includes (1) the BBF Index (BBFI) to measure and score a country’s breastfeeding environment, (2) case studies that illustrate how countries have created enabling environments for breastfeeding, and (3) a 5-meeting process, during which country committees develop policy recommendations intended to improve breastfeeding outcomes based on the BBFI scores. Objective: This study seeks to understand how the application of the BBF toolbox impacted plans to improve the enabling environment for breastfeeding in Mexico. Methods: Semi-structured interviews were conducted with Mexico’s 11 BBF country committee members about the 5-meeting process between May and June 2017. Audio recordings were transcribed and were coded and analyzed using a grounded theory approach. Results: Three major themes emerged: (1) the unique enabling environment for breastfeeding consisted of obstacles and opportunities for improvement, (2) favorable country committee member dynamics positively affected the utility of the BBF toolbox, and (3) BBF revealed and shaped country committee members’ shared vision of change that laid the foundation for a shared public policy agenda. Conclusions: Becoming Breastfeeding Friendly can generate multisectoral breastfeeding champions who can advance the public policy agenda to improve breastfeeding outcomes at the national level both in Mexico and elsewhere.