The baby friendly health initiative in Australia : a case study of the uptake and development of a global programme into a national setting

University of Technology Sydney. Faculty of Health.Background: Breastfeeding has many known benefits. In 1991, the United Nations International Emergency Children’s Fund launched a global health strategy to help maternity facilities create a safe environment that supported women’s infant feeding decisions and practice; the Baby-friendly Hospital Initiative. In Australia, the Baby Friendly Health Initiative is governed by the Australian College of Midwives and receives ‘in principle’ policy support from the Commonwealth government. There are currently 70 maternity facilities (approximately 24%) registered as ‘baby friendly accredited’. Aim: To analyse the past and current policy support of breastfeeding in Australia with a specific focus on the Baby Friendly Health Initiative. Methods: The study used an instrumental case study design by examining a 'case' to provide insight into a particular issue of interest and facilitating the understanding of 'something else'. The case was the Baby Friendly Health Initiative (BFHI) in Australia, the issue of interest was the dissemination of a global health strategy in a national setting; and the ‘something else’ was the ongoing and future support of breastfeeding in Australia. Data collected, reviewed and thematically analysed included: 14 participant interviews, organisational minutes and correspondence, international and national policy documents and government reports. A modified knowledge translation model provides a conceptual framework. Findings: Triangulation of the findings revealed common themes. The conceptual model demonstrated the presence of enablers and barriers to the translation of knowledge and evidence into practice. Enablers for the uptake and development of the Baby Friendly Health Initiative in Australia are intangible, consisting of an altruistic belief in breastfeeding support as important for women, babies and the world. Barriers are tangible: widespread inadequate resourcing has constrained delivery of the Baby Friendly Health Initiative at local levels and created internal tensions. Future expansion requires authentic government engagement and tangible incentives in collaboration with key stakeholders. Conclusion: The political decision to fragment breastfeeding policy and situate it within a nutrition framework rather than as a standalone programme with a whole of government approach has had far-reaching consequences. The future of the Baby Friendly Health Initiative in Australia is heavily reliant on political will and level of resourcing