Skip to main content
Top
Published in: International Breastfeeding Journal 1/2007

Open Access 01-04-2007 | Research

Implementing Baby Friendly Hospital Initiative policy: the case of New Zealand public hospitals

Authors: Trinie Moore, Robin Gauld, Sheila Williams

Published in: International Breastfeeding Journal | Issue 1/2007

Login to get access

Abstract

Background

Studies show that when the Baby Friendly Hospital Initiative (BFHI) is implemented breastfeeding rates increase. However, there are likely to be various barriers to BFHI implementation. This article reports on an empirical study of government-directed BFHI implementation in the New Zealand public hospital system. It focuses primarily on the barriers encountered through implementing the first Two Steps of the BFHI: developing BFHI policy and communicating it to staff; and providing necessary staff training.

Methods

Qualitative interview data were collected from six lactation consultants. These interviewees emerged via a purposive sample of public hospitals that represent the full range of New Zealand public hospitals. Using a content analysis technique, key themes were drawn from the transcribed interview data.

Results

Analysis revealed eight themes: the hospitals were in varying stages of BFHI policy development; hospital policy was not necessarily based on government policy; hospital policies were communicated in differing ways and dependent on resources; factors outside of hospital control impacted on capacity to improve breastfeeding rates; and complex organisational matters pose a barrier to educating personnel involved in the birthing process.

Conclusion

The findings of this study provide empirical support for prior articles about the process of BFHI policy development and implementation. The study also shows that implementation is multi-faceted and complex.
Literature
1.
go back to reference Wright AL, Bauer M, Naylor A, Sutcliffe E, Clark L: Increasing breastfeeding rates to reduce infant illness at the community level. Pediatrics. 1998, 101 (5): 837-844. 10.1542/peds.101.5.837.CrossRefPubMed Wright AL, Bauer M, Naylor A, Sutcliffe E, Clark L: Increasing breastfeeding rates to reduce infant illness at the community level. Pediatrics. 1998, 101 (5): 837-844. 10.1542/peds.101.5.837.CrossRefPubMed
2.
go back to reference Sullivan FM, Barlow SM: Review of the risk factors for sudden infant death syndrome. Pediatric Perinatal Epidemiology. 2001, 15 (2): 144-150. 10.1046/j.1365-3016.2001.00330.x.CrossRefPubMed Sullivan FM, Barlow SM: Review of the risk factors for sudden infant death syndrome. Pediatric Perinatal Epidemiology. 2001, 15 (2): 144-150. 10.1046/j.1365-3016.2001.00330.x.CrossRefPubMed
3.
go back to reference Anderson JW, Johnstone BM, Remley DT: Breast-feeding and cognitive development: a meta-analysis. American Journal of Clinical Nutrition. 1999, 70 (4): 525-535.PubMed Anderson JW, Johnstone BM, Remley DT: Breast-feeding and cognitive development: a meta-analysis. American Journal of Clinical Nutrition. 1999, 70 (4): 525-535.PubMed
4.
go back to reference Rosenblatt KA, Thomas DB: Lactation and the risk of epithelial ovarian cancer: the WHO collaborative study of neoplasia and steriod contraceptives. International Journal of Epidemiology. 1993, 22 (2): 192-197. 10.1093/ije/22.2.192.CrossRefPubMed Rosenblatt KA, Thomas DB: Lactation and the risk of epithelial ovarian cancer: the WHO collaborative study of neoplasia and steriod contraceptives. International Journal of Epidemiology. 1993, 22 (2): 192-197. 10.1093/ije/22.2.192.CrossRefPubMed
5.
go back to reference Bernier MO, Plu-Bureau G, Bossard N, Ayzac L, Thalabard JC: Breastfeeding and risk of breast cancer: a meta-analysis of published studies. Human Reproduction Update. 2000, 6 (4): 374-386. 10.1093/humupd/6.4.374.CrossRefPubMed Bernier MO, Plu-Bureau G, Bossard N, Ayzac L, Thalabard JC: Breastfeeding and risk of breast cancer: a meta-analysis of published studies. Human Reproduction Update. 2000, 6 (4): 374-386. 10.1093/humupd/6.4.374.CrossRefPubMed
6.
go back to reference Yen ML, Yen BL, Bai CH, Lin RS: Risk factors for ovarian cancer in Taiwan: a case-control study in a low-incidence population. Gynecological Oncology. 2003, 89 (2): 318-324. 10.1016/S0090-8258(03)00088-X.CrossRef Yen ML, Yen BL, Bai CH, Lin RS: Risk factors for ovarian cancer in Taiwan: a case-control study in a low-incidence population. Gynecological Oncology. 2003, 89 (2): 318-324. 10.1016/S0090-8258(03)00088-X.CrossRef
7.
go back to reference American Academy of Pediatrics Work Group on Breastfeeding: Breastfeeding and the use of human milk. Pediatrics. 1997, 100 (6): 1035-1039. 10.1542/peds.100.6.1035.CrossRef American Academy of Pediatrics Work Group on Breastfeeding: Breastfeeding and the use of human milk. Pediatrics. 1997, 100 (6): 1035-1039. 10.1542/peds.100.6.1035.CrossRef
8.
go back to reference World Health Organization: Protecting, promoting and supporting breastfeeding: the special role of maternity services. 1989, Geneva , World Health Organization World Health Organization: Protecting, promoting and supporting breastfeeding: the special role of maternity services. 1989, Geneva , World Health Organization
9.
go back to reference World Health Organization: Evidence for the ten steps to successful breastfeeding. 1998, Geneva , World Health Organization World Health Organization: Evidence for the ten steps to successful breastfeeding. 1998, Geneva , World Health Organization
10.
go back to reference Merten S, Dratva J, Ackerman-Liebrich U: Do baby-friendly hospitals influence breastfeeding duration on a national level?. Pediatrics. 2005, 116 (5): 702-708. 10.1542/peds.2005-0537.CrossRef Merten S, Dratva J, Ackerman-Liebrich U: Do baby-friendly hospitals influence breastfeeding duration on a national level?. Pediatrics. 2005, 116 (5): 702-708. 10.1542/peds.2005-0537.CrossRef
11.
go back to reference Schubiger G, Schwarz U, Tonz O: UNICEF/WHO baby-friendly hospital initiative: does the use of bottles and pacifiers in the neonatal nursery prevent successful breastfeeding?. European Journal of Pediatrics. 1997, 156 (11): 874-877. 10.1007/s004310050734.CrossRefPubMed Schubiger G, Schwarz U, Tonz O: UNICEF/WHO baby-friendly hospital initiative: does the use of bottles and pacifiers in the neonatal nursery prevent successful breastfeeding?. European Journal of Pediatrics. 1997, 156 (11): 874-877. 10.1007/s004310050734.CrossRefPubMed
12.
go back to reference Becker GE: Breastfeeding knowledge of hospital staff in rural maternity units in Ireland. Journal of Human Lactation. 1992, 8: 137-142. 10.1177/089033449200800318.CrossRefPubMed Becker GE: Breastfeeding knowledge of hospital staff in rural maternity units in Ireland. Journal of Human Lactation. 1992, 8: 137-142. 10.1177/089033449200800318.CrossRefPubMed
13.
go back to reference Williams EL, Hammer LD: Breastfeeding attitudes and knowledge of pediatricians-in-training. American Journal of Preventive Medicine. 1995, 11: 26-33.PubMed Williams EL, Hammer LD: Breastfeeding attitudes and knowledge of pediatricians-in-training. American Journal of Preventive Medicine. 1995, 11: 26-33.PubMed
14.
go back to reference Freed GL, Clark SJ, Sorenson J, Lohr JA, Cefalo R, Curtis P: National assessment of physicians' breast-feeding knowledge, attitudes, training and experience. Journal of the American Medical Association. 1995, 273: 472-476. 10.1001/jama.273.6.472.CrossRefPubMed Freed GL, Clark SJ, Sorenson J, Lohr JA, Cefalo R, Curtis P: National assessment of physicians' breast-feeding knowledge, attitudes, training and experience. Journal of the American Medical Association. 1995, 273: 472-476. 10.1001/jama.273.6.472.CrossRefPubMed
15.
go back to reference Cattaneo A, Buzzetti R: Effect on rates of breast feeding of training for the Baby Friendly Hospital Initiative. British Medical Journal. 2001, 323: 1358-1362. 10.1136/bmj.323.7325.1358.PubMedCentralCrossRefPubMed Cattaneo A, Buzzetti R: Effect on rates of breast feeding of training for the Baby Friendly Hospital Initiative. British Medical Journal. 2001, 323: 1358-1362. 10.1136/bmj.323.7325.1358.PubMedCentralCrossRefPubMed
16.
go back to reference Kramer MS, Chalmers B, Hodnett ED, Sevkovskaya Z, Dzikovich I, Shapiro S, Colleet JP, Vanilovich I, Mezen I, Ducruet T, Shishko G, Zubovich V, Mknuik D, Gluchanina E, Dombrovskiy V, Ustinovitch A, Kot T, Bogdanovich N, Ovchinikova L, Helsing E: Promotion of breastfeeding intervention trial (PROBIT): a randomized trial in the Republic of Belarus. Journal of the American Medical Association. 2001, 285: 413-420. 10.1001/jama.285.4.413.CrossRefPubMed Kramer MS, Chalmers B, Hodnett ED, Sevkovskaya Z, Dzikovich I, Shapiro S, Colleet JP, Vanilovich I, Mezen I, Ducruet T, Shishko G, Zubovich V, Mknuik D, Gluchanina E, Dombrovskiy V, Ustinovitch A, Kot T, Bogdanovich N, Ovchinikova L, Helsing E: Promotion of breastfeeding intervention trial (PROBIT): a randomized trial in the Republic of Belarus. Journal of the American Medical Association. 2001, 285: 413-420. 10.1001/jama.285.4.413.CrossRefPubMed
17.
go back to reference Braun M, Giugliani E, Soares M, Giugliani C, de Oliveira P, Danelon C: Evaluation of the impact of the Baby-Friendly Hospital Initiative on rates of breastfeeding. American Journal of Public Health. 2003, 93 (8): 1277-1279.PubMedCentralCrossRefPubMed Braun M, Giugliani E, Soares M, Giugliani C, de Oliveira P, Danelon C: Evaluation of the impact of the Baby-Friendly Hospital Initiative on rates of breastfeeding. American Journal of Public Health. 2003, 93 (8): 1277-1279.PubMedCentralCrossRefPubMed
18.
go back to reference Merewood A, Philipp B: Implementing change: becoming baby-friendly in an inner city hospital. Birth. 2001, 28 (1): 36-40. 10.1046/j.1523-536x.2001.00036.x.CrossRefPubMed Merewood A, Philipp B: Implementing change: becoming baby-friendly in an inner city hospital. Birth. 2001, 28 (1): 36-40. 10.1046/j.1523-536x.2001.00036.x.CrossRefPubMed
19.
go back to reference Hannon P, Ehlert-Abler P, Aberman S, Williams R, Carlos M: A multidisciplinary approach to promoting a baby friendly environment at an urban university medical center. Journal of Human Lactation. 1999, 15 (4): 289-296. 10.1177/089033449901500403.CrossRefPubMed Hannon P, Ehlert-Abler P, Aberman S, Williams R, Carlos M: A multidisciplinary approach to promoting a baby friendly environment at an urban university medical center. Journal of Human Lactation. 1999, 15 (4): 289-296. 10.1177/089033449901500403.CrossRefPubMed
20.
go back to reference Gokay G, Uzel N, Kayaturk F, Neyzi O: Ten steps for successful breast-feeding: assessment of hospital performance, its determinants and planning for improvement. Child: Care, Health and Development. 1997, 23 (2): 187-200. 10.1111/j.1365-2214.1997.tb00892.x. Gokay G, Uzel N, Kayaturk F, Neyzi O: Ten steps for successful breast-feeding: assessment of hospital performance, its determinants and planning for improvement. Child: Care, Health and Development. 1997, 23 (2): 187-200. 10.1111/j.1365-2214.1997.tb00892.x.
21.
go back to reference Hofvander Y: Breastfeeding and the Baby Friendly Hospital Initiative (BFHI): Organization, Response and Outcome in Sweden and Other Countries. Acta Paediatrica. 2005, 94: 1012-1016. 10.1080/08035250510032781.CrossRefPubMed Hofvander Y: Breastfeeding and the Baby Friendly Hospital Initiative (BFHI): Organization, Response and Outcome in Sweden and Other Countries. Acta Paediatrica. 2005, 94: 1012-1016. 10.1080/08035250510032781.CrossRefPubMed
22.
go back to reference Ministry of Health: Infant Feeding: Guidelines for New Zealand Health Workers. 1997, Wellington , Ministry of Health Ministry of Health: Infant Feeding: Guidelines for New Zealand Health Workers. 1997, Wellington , Ministry of Health
23.
go back to reference Lamb B: Baby Friendly Hospital Initiative. Plunket In Touch. 2001, 10- Lamb B: Baby Friendly Hospital Initiative. Plunket In Touch. 2001, 10-
24.
go back to reference Ministry of Health: Breastfeeding: A Guide to Action. 2002, Wellington , Ministry of Health Ministry of Health: Breastfeeding: A Guide to Action. 2002, Wellington , Ministry of Health
25.
go back to reference Patton MQ: Qualitative Evaluation and Research Methods. 1990, Newbury Park , Sage Publications Patton MQ: Qualitative Evaluation and Research Methods. 1990, Newbury Park , Sage Publications
26.
go back to reference Rice P, Ezzy D: Qualitative Research Methods: A Health Focus. 1999, Melbourne , Oxford University Press Rice P, Ezzy D: Qualitative Research Methods: A Health Focus. 1999, Melbourne , Oxford University Press
27.
go back to reference Hogwood B, Gunn L: Policy Analysis for the Real World. 1984, Oxford , Oxford University Press Hogwood B, Gunn L: Policy Analysis for the Real World. 1984, Oxford , Oxford University Press
28.
go back to reference Hill M, Hupe P: Implementing Public Policy. 2002, London , Sage Publications Hill M, Hupe P: Implementing Public Policy. 2002, London , Sage Publications
29.
go back to reference Collins C, Green A, Hunter D: Health sector reform and the interpretation of policy context. Health Policy. 1999, 47 (1): 68-83. 10.1016/S0168-8510(99)00003-2.CrossRef Collins C, Green A, Hunter D: Health sector reform and the interpretation of policy context. Health Policy. 1999, 47 (1): 68-83. 10.1016/S0168-8510(99)00003-2.CrossRef
30.
go back to reference Blank RH, Burau V: Comparative Health Policy. 2004, Houndmills , Palgrave Macmillan Blank RH, Burau V: Comparative Health Policy. 2004, Houndmills , Palgrave Macmillan
31.
go back to reference Gauld R: Comparative Health Policy in the Asia-Pacific. 2005, Maidenhead , Open University Press Gauld R: Comparative Health Policy in the Asia-Pacific. 2005, Maidenhead , Open University Press
Metadata
Title
Implementing Baby Friendly Hospital Initiative policy: the case of New Zealand public hospitals
Authors
Trinie Moore
Robin Gauld
Sheila Williams
Publication date
01-04-2007
Publisher
BioMed Central
Published in
International Breastfeeding Journal / Issue 1/2007
Electronic ISSN: 1746-4358
DOI
https://doi.org/10.1186/1746-4358-2-8

Other articles of this Issue 1/2007

International Breastfeeding Journal 1/2007 Go to the issue