Abstract

The UNICEF UK Baby Friendly Initiative (UNICEF UK BFI) is based on the Baby Friendly Hospital Initiative (BFHI), a global accreditation programme between UNICEF and the World Health Organization (WHO). Following a major review of the standards and to incorporate new evidence, UNICEF UK BFI introduced revised standards in 2012. These revised standards emphasise the importance of supporting and valuing the mother-baby relationship and promoting safe and informed infant feeding behaviours irrespective of infant feeding method. However, there is no research relating to how women experience the revised BFI standards over time and whether the woman’s background influences the care she receives. Therefore, this qualitative longitudinal study using a narrative methodology was undertaken to understand how a diverse sample of women experience infant feeding care from UNICEF UK BFI Gold accredited maternity and community health services.

This research was underpinned by social constructionism and guided by public advisors and an advisory group comprising of a member of the UNICEF UK BFI team, local clinicians, and an academic. A systematic literature review and meta-ethnography which included fourteen papers, representing the views of 696 women, found that infant feeding communication which considers both the mother’s context and individual circumstances is key to facilitate the equitable infant feeding communication women and birthing people want.

The empirical study was undertaken in an area in Northwest England where all services (maternity, health visiting and Children’s Centres) providing infant feeding care have been awarded BFI Gold accreditation. Ethics approval was obtained from the NHS Health Research Authority. Diaries and interviews were used to collect stories from a diverse sample of women (n=8), from 28 weeks gestation until around six months after birth.

After a full record of each participant’s story had been obtained, re-storying identified sequence, content, and consequence for each story. From the women’s stories, four meta-narratives were identified. These meta-narratives illustrate how interacting factors operating at the different levels of the Socio-Ecological Model (SEM) influenced women’s infant feeding experiences and outcomes. When the women’s stories were considered in relation to the revised UNICEF UK BFI standards, three constructs which enable positive infant feeding care were emphasised: a supportive health professional, personalised infant feeding care and an understanding of the woman’s individual circumstances. To communicate the results of this research to organisations currently embedding the BFI standards a visual metaphor was created.

This research marks a unique contribution to knowledge by providing evidence of how a diverse sample of women experience infant feeding care from gold accredited UNICEF UK BFI organisations. Whilst the standards have been updated in 2024, this research suggests that incorporating a strengths-based approach which identifies the resources women have available to them could facilitate more equitable baby friendly care in the future. Further research is needed to confirm the findings and to explore how health professionals can provide more equitable and woman-centred care.