Barriers, challenges and facilitators of implementing the UNICEF UK Baby Friendly Initiative (BFI) in a maternity organisation: a qualitative study of the experiences of maternity staff.

Abstract

Title: Barriers, challenges and facilitators to successfully implementing the UNICEF UK Baby Friendly Initiative (BFI) in a maternity organisation: a qualitative study of the experiences of maternity staff. Background: Breastfeeding is widely recognised for its health benefits for both infants and mothers, however it faces significant socio-cultural barriers, particularly in industrialised societies. Many women encounter barriers and challenges that hinder their ability to effectively breastfeed their infants. In 1994 UNICEF UK introduced the UK national accreditation programme named The Baby Friendly Initiative (BFI). It has recognition in numerous government policy documents across all four UK nations. This accreditation programme was developed to assist both hospital and community-based services, such as maternity and neonatal units, health visiting services and children’s centres with promoting close and loving relationships between parents and their infants and supports infant feeding practices. With published evidence demonstrating the benefits of breastfeeding and the UK government making it a requirement for all maternity units to be accredited to BFI standards, it highlighted a need for research in a local maternity that had their accreditation status removed by UNICEF UK. That was the stimulus which provided the rationale for this study. Methods: Maternity and neonatal staff participated in face to face and online semi-structured interviews. A qualitative, case study approach involving reflexive thematic analysis identified barriers, challenges and facilitators to successfully implementing the BFI. Findings: Four themes were developed from the research findings, these are staff training, staff knowledge, time and responsibility for providing infant feeding support. Organisational factors such as lack of staff education, lack of resources and confusion regarding whose role it is to support infant feeding; individual factors such as personal and professional feeding experiences and socio-political factors such as attitudes of women and relatives and the influence of the UK media all present barriers and facilitators to successful implementation of the BFI within the maternity unit. Conclusion: There is a strong formula feeding culture in the UK which requires commitment of staff and the community to change. Derogatory terms are still being applied to proponents of breastfeeding which is compounded by the UK media messaging. Successful implementation of the BFI relies on midwifery management support and funding for the process. One of the main strengths of this work is the applicability of the findings and recommendations to NHS trusts who wish to successfully implement or maintain the UNICEF UK BFI within their maternity service. What has been contributed to the field of knowledge is highlighting the requirement for managerial belief, support and funding for the BFI, alongside supporting a BFI lead role within their maternity service who is supported by passionate, proactive and educated staff. Transparency of the accreditation process and job expectations of all staff is essential.