Scaling up the Baby Friendly Hospital Initiative in support of maternal and newborn health

Breastfeeding is important to women's as well as children's lifelong health, not only reducing risk of infectious illness and later life chronic dieases but also lessening the likelihood of women's reproductive cancers such as breast- and
ovarian cancers, and contributing to normal recovery from childbirth. The WHO/UNICEF Baby Friendly Hospital Initiative (BFHI)/Ten Steps is an evidence based maternal and newborn care program to support successful breastfeeding. Its implementation dramatically increases exclusive and continued breastfeeding. It has wide global takeup, and is adopted in Australia, but it has not yet achieved scale. In 2018 WHO issued revised guidelines for BFHI to assist scaling up and clinical application, and in 2019 the National Breastfeeding Strategy agreed on by all Australian governments included scaling up BFHI as a Key Priority Action.
This research assesses whether BFHI hospitals and the Ten Steps to Successful Breastfeeding are equitably available to women, using geospatial modelling and an index of social fragmentation to link breastfeeding and health outcomes to BFHI access. It will also identify the economic value that maternity services consumers place on the BFHI/Ten Steps procedures and clinical practices, using discrete choice experiments. Armed with this information, and together with key partners involved in delivering breastfeeding support after hospital discharge, we will develop information resources for BFHI accredited hospitals to provide a quick and easy 'Tenth Step' guide for new mothers on where to get breastfeeding support after hospital discharge, and to promote BFHI adoption across the Australian health system. By focussed resourcing of the BFHI's 10th Step, and by documenting the value of BFHI policies and practices, BFHI uptake will be promoted and greater equity in breastfeeding support will be achieved, with well-established gains for womens and children's health from best practice healthcare and breastfeeding.