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Matern Child Nutr. 2017 Oct;13(4). doi: 10.1111/mcn.12370. Epub 2016 Nov 29.

Empowering women to breastfeed: Does the Baby Friendly Initiative make a difference?

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Division of Social and Transcultural Psychiatry, McGill University, 1033 Avenue des Pins, Montréal, Québec, Canada.
Culture and Mental Health Research Unit, Lady Davis Medical Institute, Jewish General Hospital, 4333 Chemin de la Côte-Ste-Catherine, Montréal, Québec, Canada.
Simone de Beauvoir Institute, Concordia University, 2170 Rue Bishop, Montréal, Québec, Canada.
School of Dietetics and Human Nutrition, McGill University, 21111 Rue Lakeshore, Ste-Anne-de-Bellevue, Québec, Canada.
Ingram School of Nursing, McGill University, 3506 Rue University, Montréal, Québec, Canada.
McGill University Health Center, 1001 Boulevard Décarie, Montréal, Québec, Canada.


The Baby-Friendly Hospital Initiative (BFI) is currently presented worldwide as the gold standard model of care for promoting and supporting breastfeeding. However, there is a lack of understanding about the ways in which health services, including the BFI, address the cultural change from a disembodied practice (formula feeding) to an embodied one (breastfeeding) in contexts where formula feeding is the norm. We used a qualitative case study methodology to compare the embodied experience of breastfeeding and the maternal experience of breastfeeding promotion and support services between mothers receiving care from institutions with low and high levels of BFI implementation in Québec, Canada. A total of 11 focus groups were conducted with mothers from six institutions-three with high and three with low levels of BFI implementation. We found the flexible approach to breastfeeding duration, characteristic of BFI services in our study, helped to avoid maternal guilt and shame; the shift to focusing on potential barriers and strategies for overcoming them empowered women to negotiate changes in infant feeding with others and self by addressing the embodied experience of a practice that may not feel natural at the beginning. Findings have implications for the concept of habitus and the construction of the breastfeeding body; we suggest that habitus can change if agents are provided with discursive tools to negotiate this embodied change. Implications for BFI services include the need to implement the 10 steps in a flexible, family-centred way that focuses on empowering women rather than simply reaching outcomes.


Baby-friendly Hospital Initiative; breastfeeding; empowerment; evaluation; habitus; maternal experience

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