An historical document analysis of the introduction of the Baby Friendly Hospital Initiative into the Australian setting

Marjorie Atchan; Deborah Davis; Maralyn Foureur

doi:10.1016/j.wombi.2016.07.004

An historical document analysis of the introduction of the Baby Friendly Hospital Initiative into the Australian setting

Women Birth. 2017 Feb;30(1):51-62. doi: 10.1016/j.wombi.2016.07.004. Epub 2016 Aug 17.

Authors

Marjorie Atchan¹, Deborah Davis², Maralyn Foureur³

Affiliations

¹ Centre for Midwifery, Child and Family Health, University of Technology Sydney, Ultimo 2007, NSW, Australia. Electronic address: Marjorie.Atchan@canberra.edu.au.
² ACT Health Directorate and University of Canberra, Faculty of Health, University of Canberra, Canberra 2601, ACT, Australia.
³ Centre for Midwifery, Child and Family Health, University of Technology Sydney, Ultimo 2007, NSW, Australia.

PMID: 27544440
DOI: 10.1016/j.wombi.2016.07.004

Abstract

Background: Breastfeeding has many known benefits yet its support across Australian health systems was suboptimal throughout the 20th Century. The World Health Organization launched a global health promotion strategy to help create a 'breastfeeding culture'. Research on the programme has revealed multiple barriers since implementation.

Aim: To analyse the sociopolitical challenges associated with implementing a global programme into a national setting via an examination of the influences on the early period of implementation of the Baby Friendly Hospital Initiative in Australia.

Methods: A focused historical document analysis was attended as part of an instrumental case study. A purposeful sampling strategy obtained a comprehensive sample of public and private documents related to the introduction of the BFHI in Australia. Analysis was informed by a 'documents as commentary' approach to gain insight into individual and collective social practices not otherwise observable.

Findings: Four major themes were identified: "a breastfeeding culture"; "resource implications"; "ambivalent support for breastfeeding and the BFHI" and "business versus advocacy". "A breastfeeding culture" included several subthemes. No tangible support for breastfeeding generally, or the Baby Friendly Hospital Initiative specifically, was identified. Australian policy did not follow international recommendations. There were no financial or policy incentives for BFHI implementation.

Conclusions: Key stakeholders' decisions negatively impacted on the Baby Friendly Hospital Initiative at a crucial time in its implementation in Australia. The potential impact of the programme was not realised, representing a missed opportunity to establish and provide sustainable standardised breastfeeding support to Australian women and their families.

Keywords: Australia; Baby Friendly Health Initiative; Baby Friendly Hospital Initiative; Case study research; Document analysis; Midwifery.

MeSH terms

Australia
Breast Feeding*
Female
Health Promotion / organization & administration*
Hospitals
Humans
Infant
Infant, Newborn
Organizational Policy*
Postnatal Care / organization & administration
Practice Guidelines as Topic
Pregnancy
Translational Research, Biomedical*
World Health Organization