title: An examination of maternity staff attitudes towards implementing Baby Friendly Health Initiative (BFHI) accreditation in Australia.
abstract: BACKGROUND
  The Baby Friendly Hospital Initiative (BFHI) influences health care practices and increases the initiation and duration of exclusive breastfeeding. Consistent definitions enable the accurate monitoring of breastfeeding rates and behaviour. This information refines policy and helps reach national breastfeeding targets. Only 21% (66/317) of Australian hospitals are BFHI accredited.
  
  
  OBJECTIVE
  To examine the factors perceived to promote or hinder BFHI accreditation.
  
  
  METHODS
  Focus group interviews explored opinions of 31 participants, in differing roles and levels of employment, across midwifery, medical, nursing and ancillary staff at six South Australian maternity hospitals.
  
  
  RESULTS
  The results suggest that staffs' understanding and personal views are often discordant with BFHI aims. Perceived difficulties include the accreditation process, hospital dynamics, and the Ten Steps implementation plus a bottle feeding culture and maternal employment that impact upon continued breastfeeding.
  
  
  CONCLUSIONS
  Upper management support, specific funding, a dedicated co-ordinator with "area leaders", development of a specific breastfeeding policy incorporating various disciplines and staff, containing detailed protocols that comply with the International Code of Marketing of Breast Milk Substitutes and subsequent World Health Assembly (WHA) resolutions, are all required. Staff and mothers require multiple modes of education to understand the BFHI, including sponsorship for training of lactation consultants. Full implementation of BFHI across Australia will assist the development of nationally accepted breastfeeding definitions, improve monitoring and evaluation of rates and practices, and improve breastfeeding outcomes.
authors.affiliation: School of Nursing & Midwifery, University of South Australia, North Terrace, SA 5000, Australia. ava.walsh@postgrads.unisa.edu.au
authors.forename: Ava Deborah
authors.initials: AD
authors.lastname: Walsh
authors.forename: Jan
authors.initials: J
authors.lastname: Pincombe
authors.forename: Ann
authors.initials: A
authors.lastname: Henderson
mesh_terms: D000068:Accreditation; D001291:Attitude of Health Personnel; D001315:Australia; D001942:Breast Feeding; D002983:Clinical Competence; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006291:Health Policy; D006293:Health Promotion; D006801:Humans; D007223:Infant; D007229:Infant Welfare; D008297:Male; D008427:Maternal Health Services / Q000592:standards*; D016134:Organizational Policy; D011247:Pregnancy; D016730:Program Development; D015397:Program Evaluation; D040241:Social Marketing; D013637:Tape Recording; D013997:Time Factors