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Creating Environments to Support Breastfeeding: The Challenges and Facilitators of Policy Development in Hospitals, Clinics, Early Care and Education, and Worksites

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Abstract

Objectives Supportive organizational breastfeeding policies can establish enabling environments for breastfeeding. In this qualitative study we identify facilitators and barriers to the development, adoption, and implementation of supportive breastfeeding policies and practices in four influential sectors for breastfeeding women: hospitals, clinics, early care and education settings, and worksites. Methods We interviewed 125 individuals representing 110 organizations in Washington State about their breastfeeding policy development and implementation process between August 2014 and February 2015. Greenhalgh’s diffusion of innovations framework guided the interviews and qualitative analysis. Results Breastfeeding policy facilitators across the sectors include national and state laws and regulations, performance tracking requirements, and an increasingly supportive sociopolitical climate; barriers include limited resources and appreciation about the need for breastfeeding policies, and certain organizational characteristics such as workforce age. Despite broad support for breastfeeding, organizations differed on perceptions about the usefulness of written breastfeeding policies. Personal breastfeeding experiences of policy makers and staff affect organizational breastfeeding policies and practices. Conclusions for Practice Supportive organizational systems and environments are built through effective policy development processes; public health can support breastfeeding policy development and assure a coordinated continuum of care by leveraging federal health care policy requirements, building networks to support training and collaboration, and disseminating strategies that reflect the personal nature of breastfeeding.

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Acknowledgements

We thank the interviewees who offered their time and perspectives, Shelly Johnston and Kayla Bell who assisted with data analysis, and our advisory group members who informed the project. This project is/was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under Grant #R40MC26824 (“Analysis of the policy process to improve comprehensive and coordinated systems for breastfeeding equity”). This information or content and conclusions are those of the authors and should not be construed as the official position or policy of, nor should any endorsements be inferred by, HRSA, HHS or the U.S. Government.

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Authors and Affiliations

  1. Center for Public Health Nutrition, University of Washington, Box 353410, 305 Raitt, Seattle, WA, 98195, USA

    Victoria A. Bradford, Lina P. Walkinshaw, Lesley Steinman, Jennifer J. Otten & Donna B. Johnson

  2. Multnomah County Health Department, 5329 NE Martin Luther King Jr Blvd, Portland, OR, 97211, USA

    Kari Fisher

  3. Washington State Department of Health, 310 Israel Rd SE, Tumwater, WA, 98501, USA

    Amy Ellings & Jean O’Leary

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  1. Victoria A. Bradford
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Correspondence to Victoria A. Bradford.

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Bradford, V.A., Walkinshaw, L.P., Steinman, L. et al. Creating Environments to Support Breastfeeding: The Challenges and Facilitators of Policy Development in Hospitals, Clinics, Early Care and Education, and Worksites. Matern Child Health J 21, 2188–2198 (2017). https://doi.org/10.1007/s10995-017-2338-4

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  • DOI: https://doi.org/10.1007/s10995-017-2338-4

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