Can "Becoming Breastfeeding Friendly" Impact Breastfeeding Protection, Promotion, and Support in Mexico? A Qualitative Study

Background: The Becoming Breastfeeding Friendly (BBF) initiative includes a guide that helps countries worldwide assess their readiness to scale up national breastfeeding programs. Country committees of breastfeeding experts across government, academia, and civil society engage with BBF by applying the BBF toolbox that includes (1) the BBF Index (BBFI) to measure and score a country's breastfeeding environment, (2) case studies that illustrate how countries have created enabling environments for breastfeeding, and (3) a 5-meeting process, during which country committees develop policy recommendations intended to improve breastfeeding outcomes based on the BBFI scores. Objective: This study seeks to understand how the application of the BBF toolbox impacted plans to improve the enabling environment for breastfeeding in Mexico. Methods: Semi-structured interviews were conducted with Mexico's 11 BBF country committee members about the 5-meeting process between May and June 2017. Audio recordings were transcribed and were coded and analyzed using a grounded theory approach. Results: Three major themes emerged: (1) the unique enabling environment for breastfeeding consisted of obstacles and opportunities for improvement, (2) favorable country committee member dynamics positively affected the utility of the BBF toolbox, and (3) BBF revealed and shaped country committee members' shared vision of change that laid the foundation for a shared public policy agenda. Conclusions: Becoming Breastfeeding Friendly can generate multisectoral breastfeeding champions who can advance the public policy agenda to improve breastfeeding outcomes at the national level both in Mexico and elsewhere.