In 2022 we began collaborating with the government to co-develop and test an innovative approach to operationalize the country’s national breastfeeding policy with a project called Breastmilk for Life – Ghana.
The systematic, six phase approach is based on academic knowledge about barriers and drivers of breastfeeding and existing and published breastfeeding interventions. It utilizes a set of resources – frameworks, taxonomies, tools and databases – which will be further developed and tested during the project.
The operationalization resources are geared toward several end-user groups: expert consultants and government planning departments, funders, researchers, corporate organizations, NGOs/advocates/civil societies, and policymakers. They were conceptualized by FLRF and McKinsey in 2020 to support the systematic operationalization of breastfeeding policies with locally appropriate, tailored interventions that can substantially improve a country’s breastfeeding environment.
Operationalization resources presently available are used in these phases:
A transparency phase must be completed for systematic operationalization to effectively begin.
Phase 1 gathers the most comprehensive and accurate background information available on a given country. It outlines the current breastfeeding situation, from scientific publications to interventions and programs completed, and identifies potential project partners and key players in the field of breastfeeding and lactation.
The information gathered here helps prioritize and shape the next phases.
Phase 2 measures the strength of a country’s current breastfeeding friendly environment and assesses its readiness to scale up breastfeeding policies and programs using the Becoming Breastfeeding Friendly (BBF) initiative.
BBF helps identify critical points to facilitate an enabling environment for scaling up breastfeeding programs. If the BBF analysis reveals the country is ready for scale-up, Breastmilk for Life can proceed to the next phase. If the country is not ready, it can address the necessary steps outlined by the BBF analysis.
The Persona Framework combines demographic parameters and qualitative research to segment women into distinct socioeconomic groups, called ‘personas’, that form the basis for later scalability.
It allows a country to see how different groups of women – or personas – share similar breastfeeding realities, and how they will benefit from a tailored set of interventions through a common set of access points.
Persona segmentation is critical for effective, nationwide scale up of breastfeeding interventions.
The Barriers & Drivers Framework and Taxonomy capture end-to-end barriers and drivers along the breastfeeding journey for each identified persona in a country. The so identified key barriers and drivers can then be addressed by interventions to sustainably improve breastfeeding outcomes.
This resource is powered by a collection of 200 known barriers and drivers extracted from approximately 150 peer-reviewed articles on breastfeeding determinants and interventions – negative or positive – relevant to a mother’s breastfeeding journey.
Incorporating a flexible, human-centered design and systems-thinking approach together enable stakeholders to systematically evaluate the breastfeeding journeys and ecosystems of different groups of mothers. The taxonomy allows stakeholders to classify each determinant, making them accessible for operational planning.
FLRF and the University of Ghana School of Public Health launched creation of the Best Practice Interventions Framework and Intervention Database in 2021.
Successful breastfeeding is influenced by numerous complex factors in a mother’s ecosystem. Successful interventions need to target different determinants and influencers within that ecosystem – mothers, families, communities, and society as a whole, to name a few. Choosing the right intervention can be challenging given the array of possibilities.
Professor Richmond Nii Okai Aryeetey is building the Best Practice Interventions Framework and Intervention Database, providing a compendium of already tried and tested interventions to help stakeholders select appropriate, evidence-based interventions.
The living database will offer a selection of academically evaluated interventions. Each intervention is classified by the same taxonomy as the Barriers & Drivers Framework and Taxonomy (Phase 4), allowing an efficient and practical matching of problems with tested solutions.
To build the database, Professor Aryeetey and his team collected, reviewed and classified over 1,400 piloted and published interventions and compiled them. In addition, together with FLRF, a framework for the quality evaluation of each intervention is being developed. It will allow practitioners to identify those that best suit their needs.
FLRF anticipates the database creation process will reconcile the academic literature on breastfeeding determinants with compatible interventions, and also identify critical knowledge gaps.
The easily adaptable Best Practice Interventions Framework and Intervention Database will be freely available to governments and any organization working to improve breastfeeding outcomes in their region.
FLRF and the Institute of Biomedical Ethics and History of Medicine at the University of Zurich (UZH) launched creation of the Ethics of Breastfeeding Interventions Framework in 2021.
It is designed to give health authorities practical guidance for navigating ethical issues around breastfeeding interventions.
In practice, it will flag ethics considerations linked to specific breastfeeding interventions identified in the Best Practice Interventions Framework and Intervention Database. It will help users analyze ethical points relevant to determinants and influencers along the breastfeeding journey, leading to informed decisions and helping prevent unintended unethical practices during scale up.
Once complete, the Ethics of Breastfeeding Interventions Framework will be available as an open access resource:
FLRF and UZH anticipate the Ethics of Breastfeeding Interventions Framework will facilitate responsible, well-considered actions aimed at improving maternal and infant health. The partners believe the novel approach of pairing ethics considerations with the identification of best practice interventions could inspire similar practices and set new standards for scientific excellence in bioethics.
The project, led by Professor Nikola Biller-Andorno, carries forward work on implementation research/health policy and systems research ethics already underway at the Institute of Biomedical Ethics and History of Medicine, a WHO Collaborating Centre for Bioethics.
All operationalization resources together, once completed and tested, will provide a comprehensive resource supporting the systematic operationalization of breastfeeding policies to improve mother and child health.
Phase 6 is under development. It will provide an analysis of funding requirements for the chosen interventions from Phases 4 and 5, identify potential national and international financing sources, and recognize local opportunities that could be targeted by government initiatives.