Becoming Breastfeeding Friendly Index: Development and application for scaling-up breastfeeding programmes globally

Area of Science:

• Public Health
• Nutrition Science
• Health Systems Strengthening

Background:

• Global exclusive breastfeeding rates remain suboptimal due to a lack of effective scaling-up frameworks.
• National breastfeeding promotion programs require coordinated, multisectoral strategies for successful implementation.

Purpose of the Study:

• To describe the development of the evidence-based Becoming Breastfeeding Friendly Index (BBFI).
• To introduce a tool for guiding and tracking large-scale national breastfeeding promotion programs.

Main Methods:

• The BBFI was developed using the Delphi consensus methodology by the BBF Steering Committee and a Technical Advisory Group.
• Benchmarks and definitions were informed by a comprehensive review of health, nutrition, and newborn survival literature.
• The index is grounded in the Breastfeeding Gear Model complex adaptive systems framework.

Main Results:

• The BBFI comprises 8 gears and 54 benchmarks covering advocacy, political will, policies, funding, training, promotion, research, and coordination.
• Scores are generated for each gear and a total country score to evaluate the scaling-up environment.
• The BBFI provides a quantitative measure of a country's readiness and progress in scaling up breastfeeding initiatives.

Conclusions:

• The BBFI is an evidence-based index designed to assist countries in assessing and monitoring their capacity to scale up national breastfeeding programs.
• This tool supports the development of well-coordinated, multisectoral strategies essential for improving breastfeeding rates globally.