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Examining the Washington State Breastfeeding-Friendly Policy Development Process Using the Advocacy Coalition Framework

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Abstract

Objectives Breastfeeding promotion is increasingly recognized as a key public health strategy. Policies can promote breastfeeding by creating supportive environments and addressing challenges. In 2014, the Washington State legislature considered bills to create a voluntary recognition system for breastfeeding-friendly hospitals, clinics, worksites and childcare settings. These Breastfeeding-Friendly Washington (BFW) bills (SB 6298 and HB 2329) did not pass. Methods The purpose of this case study was to analyze the policy development process for the BFW bills using the Advocacy Coalition Framework. Data were collected through semi-structured interviews with key stakeholders in the state policy process, and document review. We used thematic analysis to identify deductive and inductive themes. Results Though all policy actors indicated general support for breastfeeding, two main coalitions (proponents and opponents) diverged in their support of the BFW bills as policy solutions to address barriers to breastfeeding. We conducted 29 interviews with mainly bill proponents, and 54 documents confirmed data about bill opponents. Proponents supported the bills given increasingly strong evidence of breastfeeding’s benefits and that public policy could address environmental challenges to breastfeeding. Opponents saw the bills as government overreach into the private matter of choosing to breastfeed. Opposition to the bills came late in the session, and proponents felt opponents’ messaging misconstrued the intent of the legislation. Conclusions for Practice Key learnings for developing breastfeeding-friendly state policies include analyzing differences between proponents’ and opponents’ beliefs, framing advocacy messages beyond individuals and health, expanding the coalition outside of traditional health entities, and anticipating the opposition.

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Adapted from Breton et al. (2006)

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Acknowledgments

We thank the interviewees who offered their time and input to the project and Elizabeth Payne who assisted with data analysis and interpretation of findings. We also appreciate the invaluable feedback from our advisory group members who facilitated participant recruitment and reviewed our findings: Jean O’Leary, Bat-Sheva Stein, and Amy Ellings from the Washington State Department of Health; Alex Sosa from the Breastfeeding Coalition of Washington; Kristen Leng from WithinReach; Carol Wagner from the Washington State Hospital Association; Lynn Gerlach from the Northwest Regional Primary Care Association; Cindy Gamble and Jan Olmstead on behalf of the American Indian Health Commission; and Ginna Wall from the Lactation Journal Club. This project was supported by the Health Resources and Services Administration (HRSA) of the US Department of Health and Human Services (HHS) under grant #R40MC26824 (“Analysis of the policy process to improve comprehensive and coordinated systems for breastfeeding equity”) for $399,725 (0 % was financed with nongovernmental sources). This 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 US Government.

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Authors and Affiliations

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

    Lesley E. Steinman, Victoria Bradford, Emilee Quinn, Jennifer J. Otten & Donna B. Johnson

  2. Washington State Department of Health, PO Box 47890, Olympia, WA, 98504-7890, USA

    Jennifer McNamara

  3. Multnomah County Health Department, 131 NE 102nd Ave, Portland, OR, 97220, USA

    Kari Fisher

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  1. Lesley E. Steinman
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  2. Victoria Bradford
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Correspondence to Lesley E. Steinman.

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Steinman, L.E., Bradford, V., Quinn, E. et al. Examining the Washington State Breastfeeding-Friendly Policy Development Process Using the Advocacy Coalition Framework. Matern Child Health J 21, 659–669 (2017). https://doi.org/10.1007/s10995-016-2154-2

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