AB095. Scaling up the Baby-Friendly Hospital Initiative in support of maternal and newborn health: study protocol

Background: Optimal breastfeeding practices are essential for improving health outcomes across the lifespan. They protect children from infectious diseases and chronic conditions, while also supporting maternal health by reducing the risk of reproductive cancers and aiding postpartum recovery. The World Health Organization/United Nations Children Fund’s Baby-Friendly Hospital Initiative (BFHI), based on the Ten Steps to Successful Breastfeeding (the Ten Steps), is an evidence-based framework that significantly improves exclusive and sustained breastfeeding rates. Despite global uptake and ‘in principle’ adoption in Australia, BFHI implementation remains very limited in scale. This study aims to assess the equitable availability and accessibility of BFHI-accredited hospitals and the Ten Steps across Australia, and to evaluate the value that maternity care consumers place on BFHI-aligned practices.

Methods: We use geospatial modelling and a social fragmentation index to examine the distribution of BFHI-accredited facilities and their relationship to breastfeeding and health outcomes. Discrete choice experiments are conducted to determine the economic value consumers assign to BFHI practices.

Results: Preliminary analysis suggests disparities in access to BFHI-accredited care, with serious implications for breastfeeding outcomes. Consumers expressed a clear preference for BFHI-aligned maternity care, highlighting the perceived value of supportive hospital practices and community support for breastfeeding.

Conclusions: These insights support the need for targeted resources and system-wide strategies to enhance BFHI implementation. These findings will inform the development of a streamlined “Tenth Step” guide to connect new mothers with breastfeeding support services after hospital discharge. By strengthening the BFHI’s Tenth Step and quantifying the value of its practices, this project supports broader adoption of BFHI across the Australian health system. The anticipated outcomes include improved equity in breastfeeding support, enhanced maternal and child health, and reduced reliance on formula feeding—contributing to both improved public health and environmental sustainability.

Keywords: Baby-Friendly Hospital Initiative (BFHI); scale up; breastfeeding; maternal and child health