Factors influencing the implementation of the Becoming Breastfeeding Friendly initiative in Ghana

Matern Child Nutr. 2019 Jul;15(3):e12787. doi: 10.1111/mcn.12787. Epub 2019 Feb 11.


Becoming Breastfeeding Friendly (BBF) is an initiative designed to help countries assess their readiness to scale-up breastfeeding programs and develop key recommendations to strengthen their breastfeeding environment. In 2016, Ghana was one of two countries to first pilot BBF. In applying BBF, a committee of 15 Ghanaian nutrition, health, and breastfeeding experts implemented the BBF toolbox over 8 months. Following implementation, semistructured interviews were conducted with 12 committee members (CMs) to (a) identify facilitators and barriers to implement BBF and (b) determine factors needed to strengthen the breastfeeding environment in Ghana. Using a grounded theory approach, five domains were identified. First, a dynamic committee of key stakeholders drove the implementation of BBF. Second, CMs faced some logistical and methodological challenges, including difficulty accessing data and the need for strong in-country technical support for adhering to the BBF process. Third, CMs felt well positioned to facilitate and lead the dissemination and implementation of recommendations. Fourth, accountability would be essential to properly translate recommendations. Fifth, to move recommendations to action, advocacy would be a required first step, and BBF was proposed to facilitate this step. BBF provided an in-depth analysis of Ghana's current breastfeeding environment to help Ghana strengthen its breastfeeding governance, policies, and programs while informing CMs' government and non-governmental organizations' breastfeeding efforts.

Keywords: breastfeeding; health policy; implementation science; nutrition; qualitative research; scale-up.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Breast Feeding*
  • Committee Membership
  • Consumer Advocacy
  • Data Management / organization & administration
  • Female
  • Ghana
  • Government Agencies
  • Grounded Theory
  • Health Policy*
  • Health Promotion / organization & administration*
  • Humans
  • Male
  • Organizations
  • Pilot Projects
  • Program Development*
  • Qualitative Research
  • Stakeholder Participation*