Assess, address and proceed: Moving beyond naïve impressions of the Baby Friendly Hospital Initiative among hospital administrators

Background/Purpose: The Surgeon General's Call to Action to Support Breastfeeding and Healthy People 2020 call upon hospitals to implement the Ten Steps to Successful Breastfeeding. Nonetheless, many hospitals delay or avoid implementation, citing multiple barriers. Some of these barriers are real, but others are misconceptions. This study assesses an intervention to change perceptions in a sample of maternities in North Carolina.

Data & Methods: We conducted a survey of healthcare providers as part of baseline and mid-point assessment for the Breastfeeding-Friendly Healthcare Project. The survey assessed knowledge, attitudes and practices concerning the Ten Steps. We also conducted semi-structured key informant interviews, and semi-structured group discussions.

Results: Multiple naïve perceptions were expressed prior to intervention, such as:1) Baby Friendly hospitals cannot stock formula; 2) Formula manufacturers always require distribution of advertising materials in exchange for free formula; 3) The cost of purchasing formula is highly prohibitive; 4) The required training is prohibitively expensive. Following educational and consultative intervention, many of these misperceptions were replaced with accurate understandings. Most perceptions of cost barriers were alleviated, with perception of the high cost of purchasing formula less affected. Once these misperceptions were addressed, all participants engaged in developing creative solutions to implementing the Ten Steps for quality improvement.

Conclusions: Hospital staff members' impressions of Baby Friendly and the Ten Steps are amenable to change through education. Expert guidance, print materials and inter-hospital consultation support the transition to learned understandings. We hypothesize that this paradigm shift must occur before significant practice change will occur.