Organizational factors that promote or inhibit the adoption and implementation of the Baby Friendly Hospital Initiative in the United States

Abstract

The Baby-Friendly Hospital Initiative (BFHI) has support from numerous policy and regulatory bodies, and has been shown to be an effective intervention to encourage women to initiate breastfeeding at the time of birth. Uptake of the BFHI has been slow in the United States (US). A significant gap in knowledge of factors that promote or block BFHI adoption and implementation exists. Therefore, the aim of this project was to identify the greatest barriers to and facilitators of the adoption and implementation of the BFHI in the US. This was a cross-sectional study using a purposive sample of perinatal health care specialists in multiple states across the US. Respondents were recruited via statewide or regional breastfeeding organizations and invited to complete an online survey. 256 respondents from twelve states completed the survey. Many organizational and policy factors that support adoption and implementation of the BFHI were identified. Some of the main facilitators of adoption and implementation included sufficient resources, workforce training, participation in statewide perinatal quality improvement collaboratives, and clearly stated goals from organizational leaders. Some of the barriers were a lack of financial support from outside organizations, insufficient organizational resources to support the costs of the program, and lack of buy-in from clinicians. This study lays the groundwork for further inquiries into the targeted identification of the greatest barriers and facilitators of adoption and implementation of the BFHI and can provide guidance to administrators and clinicians.