Implementation Analysis of Mexico's Becoming Breastfeeding Friendly Initiative: 2016-2023

The Becoming Breastfeeding Friendly (BBF) initiative is an evidence-based decision-making toolbox to support countries in assessing readiness and identifying policies needed to scale up breastfeeding (BF) protection, promotion, and support programs. Mexico has implemented BBF four times, providing an opportunity to examine how adaptations influenced the implementation processes and outcomes. This study aimed to document how BBF implementation evolved across four BBF implementation waves in Mexico (2016-2023), identify core functions and key adaptations, and examine perceived outcomes from Committee members' perspectives. A mixed-methods implementation analysis was conducted using BBF process records and qualitative data from interviews and questionnaires with BBF Committee members who had participated since earlier waves as well as those involved more recently. Adaptations were examined using the Model for Adaptation Design and Impact (MADI). Data were analyzed through thematic analysis and integrated using the SWOT framework. Multiple adaptations over time enhanced the operational efficiency of the BBF process without compromising its core functions. Key improvements included strengthened coordination structures, diversified funding, a shift to hybrid and virtual modalities, streamlined subcommittees, and expanded use of digital tools for data collection, coordination, and management. These adaptations improved BBF process coordination and transparency. Committee members reported increased intersectoral collaboration with key policy actors and uptake of BBF recommendations, while political transitions and limited advocacy follow-up were identified as shortcomings of the BBF process. The BBF process was successfully implemented in and adopted by Mexico. Context-sensitive adaptations identified over time strengthened the BBF implementation process while maintaining its core functions, offering lessons for sustaining breastfeeding policy decision-making in Mexico and beyond.