Implementing two national responsibilities of the revised UNICEF/WHO Baby-Friendly Hospital Initiative: A two-country case study.

The 2018 implementation guidance for the Baby-Friendly Hospital Initiative (BFHI) recommends institutionalising the ten Steps through nine national responsibilities for universal coverage and sustainability. As countries adapt BFHI programmes to this paradigm shift away from traditional designation programmes, documenting and sharing policy and programme experience are critical and currently sparse. This qualitative case study included desk reviews of published and grey literature on BFHI programming, national plans and policy documents specific to the selected national responsibilities for universal coverage and key informant (KI) interviews across a range of actors. In the Kyrgyz Republic, the case study explored responsibility 5, development and implementation of incentives and/or sanctions, and responsibility 6 in Malawi, providing technical assistance (TA). In both countries, the three sustainability responsibilities (national monitoring [7] communication and advocacy [8] and financing [9]) as they relate to the universal coverage of the targeted responsibilities were also explored. Thirty-eight respondents in the Kyrgyz Republic described approaches that were used in the health system, including BFHI designation plaques, performance-based financing and financial sanctions. However, currently, there are no formal incentives and sanctions. In Malawi, TA was utilised for national planning and to introduce quality improvement processes. Forty-seven respondents mostly described provisions of TA in building and strengthening the capacity of providers. More programmatic evidence to demonstrate which types of incentives or sanctions can be effective and sustained and more documentation of how TA is provided across multiple aspects of implementation are needed as countries institutionalise BFHI.

Burden of Childhood Malnutrition: A Roadmap of Global and European Policies Promoting Healthy Nutrition for Infants and Young Children.

Childhood malnutrition is a global epidemic with significant public health ramifications. The alarming increase in childhood obesity rates, in conjunction with the COVID-19 pandemic, pose major challenges. The present review aims to critically discuss policies and action plans promoting healthy nutrition among infants and children, globally. Since the Convention on the Rights of the Child in 1989 and the joint consortium held by the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) that led to the "Ten Steps to Successful Breastfeeding", several policymakers and scientific societies have produced relevant reports. Today, the WHO and UNICEF remain the key players on the field, elaborating the guidelines shaped by international expert teams over time, but we still have a long way to go before assuring the health of our children.

Implementation of Breastfeeding Policies at Workplace in Mexico: Analysis of Context Using a Realist Approach.

Return to work is one of the most significant barriers to breastfeeding (BF). Family-friendly policies are critical to ensure that BF and maternal work are not mutually exclusive. This study aims to determine contextual factors and underlying mechanisms influencing the implementation of workplace policies in Mexico. Following a qualitative approach, the study was conducted in the following four cities in Mexico: Mérida, Chihuahua, Guadalajara, and Monterrey. Interviews were conducted in 14 workplaces, and included 49 (potential) beneficiaries, 41 male employees, and 21 managers and human resources personnel. The information collected was analyzed through a deductive thematic analysis and mapped against the Context-Mechanism-Outcome framework of Breastfeeding Interventions at the Workplace. Contextual factors influencing a BF-friendly environment in the workplace were as follows: work-schedule flexibility, provision of lactation services (i.e., BF counseling) other than a lactation room, women's previous experience with BF and family-friendly environments in the workplace. The underlying mechanisms enabling/impeding a BF-friendly environment at the workplace were as follows: awareness of Mexican maternity protection legislation, usage of BF interventions in the workplace, culture, supervisor/co-worker support and BF-friendly physical space. To achieve a BF-friendly environment in the workplace, actions at the level of public policy and workplaces must accompany adherence to Mexican legislation.

Examination of Factors That Contribute to Breastfeeding Disparities and Inequities for Black Women in the US.

Breastmilk is considered the optimal nutrition for newborns. US Black women continue to have the lowest breastfeeding initiation and duration rates. This Perspective examines factors associated with breastfeeding disparities and inequities among Black women through the lens of critical race theory and the social-ecological model. Recommendations to increase breastfeeding rates in this population include increased communication and educational strategies by health care professionals, education to recognize implicit bias and systemic racism in our health care system, early prenatal and ongoing postpartum breastfeeding support, increased community support, and breastfeeding groups developed by and for Black women. In addition, equity policies such as paid maternity leave and work policies that support milk expression would provide needed institutional support for women in the workplace.

Breastfeeding Support Rooms and Their Contribution to Sustainable Development Goals: A Qualitative Study.

Objectives: Breastfeeding support rooms are low-cost interventions that may prolong breastfeeding and improve work performance. Thus, we sought to understand the experiences and perceptions of working women who use breastfeeding support rooms and the potential contribution to sustainable development goals. Methods: Descriptive and exploratory research was conducted through convenience sampling of women working in companies with breastfeeding support rooms in the state of Paraná, Brazil. A semi-structured questionnaire was applied through interviews and online self-completion. Results: Fifty-three women between 28 and 41 years old participated in the study. In addition, 88.7% had graduated from college, and 96% were married. From the women's experiences and perceptions, we identified that breastfeeding support rooms contribute to prolonged breastfeeding, improve physical and emotional well-being, allow women to exercise their professional activities comfortably, contribute to women's professional appreciation for the excellent relationship between employees and employers. Conclusion: In this novel study, we demonstrate how, from a female point of view, breastfeeding support rooms can contribute to 8 of the 17 sustainable development goals and should therefore be encouraged and promoted.

Impact of an Infant Friendly Business Designation.

In response to suboptimal breastfeeding rates, North Dakota added a provision to SB 2344 (public indecency legislation) creating an Infant Friendly business designation for employers providing specified lactation accommodations to employees. However, there has been no evaluation of this designation to determine effectiveness. The purpose of this article is to examine the impact of the Infant Friendly business designation in North Dakota on breastfeeding continuation rates within the context of the social ecological model (SEM). Between November 2016 and March 2017, an 85-item online questionnaire, designed using the SEM, was distributed to working women across the state using various sampling methods. T tests, analysis of variance, and regression were used to analyze results. Designated (intervention) and nondesignated (control) businesses were targeted. There was no statistically significant difference in breastfeeding duration between designated and nondesignated businesses. There was a 2-month difference in duration between continually designated businesses and those with lapsing designations. Twenty-eight percent of the women working for Infant Friendly businesses were aware that their businesses were designated, indicating a lack of awareness regarding the designation. The designation is a starting point for worksite breastfeeding support. A policy promotion plan based on the SEM targeting individual awareness and employee education may improve the designation's effectiveness.

Breastfeeding-Friendly Environmental Factors and Continuing Breastfeeding Until 6 Months Postpartum: 2008-2011 National Surveys in Taiwan.

BACKGROUND: Although policies have been implemented to improve a breastfeeding-friendly environment, few studies have examined the effectiveness of these policies in Taiwan. We examined progress in breastfeeding environmental factors from 2008 through 2011 in Taiwan and their association with continuing exclusive and any breastfeeding until 6 months postpartum. METHODS: This study was a secondary data analysis, using four cross-sectional and national surveys of 1,453-12,410 postpartum women in the years 2008 through 2011. Data were collected by telephone interviews, using structured questionnaires with randomly selected postpartum women who gave birth in the indicated years. Results were weighted to enhance representativeness. Logistic regression was used to compute adjusted odds ratios for the use of breastfeeding-friendly services on breastfeeding continuation. RESULTS: The rates of breastfeeding at 6 months postpartum generally increased from 2008 to 2011, despite a drop in 2010. The use of breastfeeding-friendly environmental factors, including breastfeeding rooms in public places or workplaces, breastfeeding consultation phone lines/websites, breastfeeding volunteers, and delivery in baby-friendly hospitals, increased from 2008 to 2011. However, the percentage of women participating in breastfeeding support groups decreased during that period. After controlling for maternal characteristics, use of each of the breastfeeding-friendly environmental factors was significantly and positively associated with continuing breastfeeding until 6 months postpartum. The adjusted odds ratios for breastfeeding-friendly environmental factors ranged from 1.15 to 5.04. CONCLUSIONS: The breastfeeding-friendly environment and long-term breastfeeding rates in Taiwan improved from 2008 to 2011, supporting the effectiveness of policy and public health efforts.