The Yale School of Public Health (YSPH) with support from the Family Larsson-Rosenquist Foundation (FLRF) developed the Becoming Breastfeeding Friendly (BBF) programme. This is a guide for countries to assess readiness to scale-up breastfeeding promotion. Its long-term goal is to sustainably improve the effectiveness of in-country initiatives which protect, promote and support breastfeeding and the use of breastmilk.

BBF involves three elements: The BBF Index (BBFI), case studies for benchmarking and a recommendation for a five-meeting coordination process to implement initiatives. The BBFI is based around 8 gears and requires an analysis and scoring of 54 benchmarks resulting in an overall country score. This will accurately identify countries’ barriers to achieving their breastfeeding goals and highlights areas for investment to scale-up breastfeeding promotion.

The research project was launched in 2015 (originally called Breastfeeding Country Index, BFCI) and is led by world-renowned Professor for Epidemiology and Public Health at YSPH Rafael Pérez-Escamilla. His research team together with the BBF Steering Committee developed, pretested and thoroughly validated the measurement method (BBFI) with pre-testing studies in Mexico and Ghana.

In 2017, six further countries joined the project and the BBF programme could begin its pilot testing in England, Scotland and Wales (Great Britain), Germany, Myanmar and Samoa.

The BBF programme corresponds to FLRF’s funding strategy to instigate and promote new knowledge about breastmilk, breastfeeding and implementation strategies. FLRF invests globally in high-level research with a clear path to implementation, as well as a sustainable and positive impact on breastfeeding rates. The Foundation financed the development and pilot phase with USD 638,000 and allocated a further USD 1.5 million towards BBF programme’s dissemination.

Related Publications:

“Development and Pretesting of Becoming Breastfeeding Friendly: Empowering Governments for Global Scaling Up of Breastfeeding Programmes” by Hromi-Fiedler AJ et al. (2018); Maternal [&] Child Nutrition: see publication

“Can Becoming Breastfeeding Friendly Impact Breastfeeding Protection, Promotion, and Support in Mexico? A Qualitative Study” by Safon C et al. (2018); Food and Nutrition Bulletin: see abstract

“Perspective: What Will It Cost to Scale-up Breastfeeding Programs? A Comparison of Current Global Costing Methodologies” by Caroll GJ, Buccini GS, Pérez-Escamilla R (2018); Advances in Nutrition: see abstract

“Becoming Breastfeeding Friendly in Germany — an International Research Project to Assess the Readiness to Scale Up Breastfeeding” by Flothkötter M et al. (2018); Bundesgesundheitsblatt: see publication (abstract in English, publication in German)

“Pilot Testing of the Becoming Breastfeeding Friendly Toolbox in Ghana” by Aryeetey R et al. (2018); International Breastfeeding Journal: see publication

“Scaling Up Breastfeeding Programs in Mexico: Lessons Learned from the Becoming Breastfeeding Friendly Initiative” von González de Cosío T et al. (2018); Current Developments in Nutrition: see publication

“Becoming Breastfeeding Friendly Index: Development and Application for Scaling-Up Breastfeeding Programmes Globally” by Pérez-Escamilla R et al. (2018); Maternal [&] Child Nutrition: see abstract

“Scaling Up of Breastfeeding Promotion Programs in Low- and Middle-Income Countries: the ‘Breastfeeding Gear’ Model” by Pérez-Escamilla R et al. (2012); Advances in Nutrition: see publication