title: Examining the Washington State Breastfeeding-Friendly Policy Development Process Using the Advocacy Coalition Framework.
abstract: Objectives Breastfeeding promotion is increasingly recognized as a key public health strategy. Policies can promote breastfeeding by creating supportive environments and addressing challenges. In 2014, the Washington State legislature considered bills to create a voluntary recognition system for breastfeeding-friendly hospitals, clinics, worksites and childcare settings. These Breastfeeding-Friendly Washington (BFW) bills (SB 6298 and HB 2329) did not pass. Methods The purpose of this case study was to analyze the policy development process for the BFW bills using the Advocacy Coalition Framework. Data were collected through semi-structured interviews with key stakeholders in the state policy process, and document review. We used thematic analysis to identify deductive and inductive themes. Results Though all policy actors indicated general support for breastfeeding, two main coalitions (proponents and opponents) diverged in their support of the BFW bills as policy solutions to address barriers to breastfeeding. We conducted 29 interviews with mainly bill proponents, and 54 documents confirmed data about bill opponents. Proponents supported the bills given increasingly strong evidence of breastfeeding's benefits and that public policy could address environmental challenges to breastfeeding. Opponents saw the bills as government overreach into the private matter of choosing to breastfeed. Opposition to the bills came late in the session, and proponents felt opponents' messaging misconstrued the intent of the legislation. Conclusions for Practice Key learnings for developing breastfeeding-friendly state policies include analyzing differences between proponents' and opponents' beliefs, framing advocacy messages beyond individuals and health, expanding the coalition outside of traditional health entities, and anticipating the opposition.
authors: Center for Public Health Nutrition, University of Washington, Box 353410, Seattle, WA, 98195, USA. lesles@uw.edu.
authors: Lesley E
authors: LE
authors: Steinman
authors: Center for Public Health Nutrition, University of Washington, Box 353410, Seattle, WA, 98195, USA.
authors: Victoria
authors: V
authors: Bradford
authors: Center for Public Health Nutrition, University of Washington, Box 353410, Seattle, WA, 98195, USA.
authors: Emilee
authors: E
authors: Quinn
authors: Center for Public Health Nutrition, University of Washington, Box 353410, Seattle, WA, 98195, USA.
authors: Jennifer J
authors: JJ
authors: Otten
authors: Washington State Department of Health, PO Box 47890, Olympia, WA, 98504-7890, USA.
authors: Jennifer
authors: J
authors: McNamara
authors: Multnomah County Health Department, 131 NE 102nd Ave, Portland, OR, 97220, USA.
authors: Kari
authors: K
authors: Fisher
authors: Center for Public Health Nutrition, University of Washington, Box 353410, Seattle, WA, 98195, USA.
authors: Donna B
authors: DB
authors: Johnson
mesh_terms: D000328:Adult; D001942:Breast Feeding / Q000639:trends*; D005260:Female; D006291:Health Policy / Q000639:trends*; D006293:Health Promotion / Q000379:methods* / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D011050:Policy Making; D011247:Pregnancy; D011634:Public Health / Q000379:methods; D036301:Qualitative Research; D014861:Washington
keywords: Breastfeeding support; Legislation; Policy and practice; U.S.