Transforming Breastfeeding Culture: Implementation of Breastfeeding-Friendly Community Initiative (BFCI)

Abstract

<p>Background</p><p>The global WHO/UNICEF Baby Friendly Hospital Initiative (BFHI) is a set of maternity practices that hospitals should implement to support breastfeeding. The BFHI is an evidence-based effective intervention that contributes to increasing the initiation, exclusivity and duration of breastfeeding. In 2009, WHO encouraged health care systems to scale up the protection, promotion, and support of breastfeeding at the community level. Community support through training and social marketing is a vital link in an effective and sustainable program. The aim is to provide training based on an accredited framework (BFCI) for staff, management and mothers among public places in the community to promulgate breastfeeding friendly attitudes.</p><p>Methods</p><p>This study used a quasi-experimental pretest-post test design. From 2020 to 2022, we conducted 70 midwife led breastfeeding workshops online and recruited 2330 pregnant women from social media platform. Participants completed questionnaires before, immediately after, and 1 month after the workshop. Breastfeeding self-efficacy and attitude were measured by the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF) and Iowa Infant Feeding Attitude Scale (IIFAS), respectively. In addition, we recruited 1339 staff and management among public places in the community. Participants completed questionnaires on breastfeeding knowledge and attitudes pre and post workshop.</p><p><br></p><p>Results/findings</p><p>Among staff there was a significant improvement in both breastfeeding knowledge (p<0.001) and staff attitude towards breastfeeding (p<0.001) after the training workshops. The staff considered that the programme raised awareness of breastfeeding benefits, with 88.4% reported that they feel more confident supporting mothers in breastfeeding after the training. Among mother participants’ who have completed the pre- and post-workshop questionnaires, both the breastfeeding self-efficacy (p<0.001) and breastfeeding attitude (p<0.001) have improved significantly after the training workshops. The improvement in self-efficacy and breastfeeding attitude appeared to maintain one month after the workshop. There were 93.9% of the mother participants’ breastfeeding at the 1-month post-training follow-up, among which half were still exclusively breastfeeding (48.3%).</p><p><br></p><p>Conclusion</p><p>Our findings highlight how the BFCI was provided and the positive experiences implementing BFCI is consistent with other developed countries. The next step is mapping this based on Complex Adaptive system based Breastfeeding Gear Model and provide additional evidence to inform breastfeeding policy based to advance or extend the breastfeeding protection, promotion and support globally in the community.</p>