Textbox 1.

Becoming Breastfeeding Friendly overview

BBF is an initiative designed to guide countries in scaling up their national breastfeeding policies and programmes. BBF is grounded in the Breastfeeding gear model (BFGM), which takes a complex adaptive systems approach to evidence‐based scaling up of breastfeeding policies and programmes (Pérez‐Escamilla et al., 2012). The BFGM posits that eight gears must work in harmony to achieve large‐scale improvements in scaling up a country's national breastfeeding friendly environment to protect, promote, and support optimal breastfeeding practices The theory of policy change behind BBF implementation is driven by the non‐linear heuristic policy model (HPM) which includes five elements: (a) leadership and partnerships (b) agenda setting; (c) policy formulation and adoption; (d) implementation; (e) evaluation, and (Darmstadt et al., 2014; Figure 1). To operationalize the BFGM into a useful resource for policymakers, BBF includes a toolbox to help countries assess, develop plans, and track breastfeeding scaling up in their specific contexts. The BBF toolbox has three main components: the Becoming Breastfeeding Friendly index (BBFI), case studies, and a five‐meeting process that culminate with policy recommendations. The BBFI assesses the national readiness of countries to scale up breastfeeding policies and programmes. The case‐studies provide clear, evidence‐based real‐world examples to guide the BBFI scoring process as well as the translation of policy recommendations into action. The 5‐meeting process is the activity through which a country committee of breastfeeding and policies experts uses the BBFI and case‐studies to identify gaps, determine needs, plus develop and disseminate evidence‐based recommended actions to collectively advocate for the scaling up of breastfeeding protection, promotion, and support programmes. Although the BBF toolbox consists of a standard process and implementation design, its success relies on flexibility in implementation for diverse contexts. The implementation process of BBF is described in detail elsewhere (Hromi‐Fiedler et al., 2019).