The Baby Friendly Health Initiative in Australia – twenty years on

Introduction: Australia’s health care policy in relation to breastfeeding includes in-principle support for the Baby Friendly Health Initiative (BFHI). The BFHI is an evidence based quality assurance program that has shown a positive effect on breastfeeding practices, more so on initiation than duration. Currently
seventy-four maternity facilities (19%) are accredited as ‘baby friendly’; there is ongoing interest in initial accreditation and many facilities have achieved multiple reaccreditations; however there is an unknown degree of implementation by individual hospitals. The numbers of currently accredited facilities across states/territories also varies. Several Australian studies have revealed the existence of multi-level barriers. Competition for health funding, selective prioritisation by managers, plus skill deficits and negative attitudes of individual health professionals appears to hamper widespread knowledge translation into practice. Aim: to examine the factors influencing the operationalising of an evidence-based, global, health-promotion strategy, in a national setting, twenty years post-implementation. Methods: a case study research (CSR) approach was used to examine the influences on BFHI operationalisation twenty years post-implementation. CSR requires a range of data to be collected to confirm findings. In this study relevant literature, archival data and in depth individual interviews with key stakeholders have been analysed. Findings: stakeholders shared their unique perspective and assessment of the challenges that have influenced the sustainability of the Initiative in Australia. There was consensus on the lack of commitment to and understanding of the Initiative by policy makers, health professionals, health administrators and clinicians. Opinion differed however on the currency and usefulness of the BFHI to the Australian context, in its current form.
Implications: the BFHI is a well evidenced strategy which continues to be hampered by a lack of comprehensive support. Implementing strategies to improve BFHI’s ‘fit’ in the Australian context may better facilitate the translation of research into practice.