Operationalising a global strategy in a national setting: the implementation of the Baby Friendly Health Initiative in Australia

Marjorie ATCHAN, Deborah DAVIS, Maralyn Foureur

Research output: Contribution to conference (non-published works)Abstractpeer-review


Aim: To explore how a global health promotion strategy, the Baby Friendly Hospital Initiative, was initially operationalized in the Australian national setting.
Background: The World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) launched the Baby Friendly Hospital Initiative (BFHI) globally in 1991 as a desirable health promotion strategy. A positive association clearly exists between BFHI implementation and breastfeeding initiation and duration1. This effect is more marked where a wide range of stakeholders provides support. On the positive side BFHI implementation in Australia has ‘in principle’ support at a national and governmental level, inclusion in health policy in several states. Nationally2, currently 74 maternity facilities (19%) are ‘baby friendly’, there is ongoing interest in the process of acquiring accreditation and significant numbers have achieved multiple reaccreditations. On the negative side, across states and territories there is significant variation in numbers of accredited facilities and presumably levels of implementation, which must impact on the consistency of breastfeeding support provided. A recent national infant feeding survey3 demonstrated that while 96% of women interviewed initiated breastfeeding, duration rates were mediocre at best. Australian studies4 reveal the existence of multi-level barriers to the BFHI. These barriers include a lack of knowledge, understanding and only a modest regard for the Initiative’s aims.
Methods: A case study research approach was used to examine the influencing factors on the initial implementation of the BFHI in Australia. Case study research requires a range of data to be collected to illustrate the case and increase confidence in the findings. Data collected consisted of a review of archival data including published minutes, journal articles and newsletters, plus interviews with strategic stakeholders who provided an oral history with particular reference to key time points.
Results/Findings: Each stakeholder interviewed presented a unique perspective of the events of the early development of the Initiative internationally and in Australia. Archival data provided valuable supportive evidence and detail unobtainable elsewhere. The initial implementation process of the BFHI in Australia encountered a number of obstacles. UNICEF Australia’s brief included handing over the Initiative to an appropriate champion within a globally predetermined timeframe. The Australian Federal government did not take up the offer however. Some stakeholders believe the process surrounding the subsequent search for other opportunities was neither comprehensive nor robust. The Australian College of Midwives (ACM) assumed governance of the Initiative in 1994. Funding that was presumed to be attached to the transfer did not eventuate. The ACM discovered that governance of the BFHI would prove to be far more challenging than originally anticipated.
Conclusion: Implementing a global Initiative in a national setting presented many anticipated and also a number of unforeseen challenges. In Australia the effects of the initial implementation process have been far reaching. Many women have benefited from the additional support they have received. In some states though the BFHI has struggled to gain momentum. The level of commitment to and understanding of the Initiative by policy makers, health professionals, health administrators and clinicians varies widely.
Original languageEnglish
Number of pages1
Publication statusPublished - 2014
EventMaternal and Infant Nutrition and Nurture: “Bicultural, Relational and Spatial Perspectives” 5th International Conference - Western Sydney University , Sydney, Australia
Duration: 5 Nov 20147 Nov 2014


ConferenceMaternal and Infant Nutrition and Nurture: “Bicultural, Relational and Spatial Perspectives” 5th International Conference


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