Examining the Application and Use of the Baby-Friendly Hospital Initiative Within Rural and Urban Health Facilities in Canada and Australia among Indigenous Mothers

To prevent infant mortality and morbidity, the WHO and UNICEF established the Baby-Friendly Hospital Initiative (BFHI) to support breastfeeding initiation and duration by improving the quality of care provided in health facilities globally. Indigenous communities across the world report lower breastfeeding rates compared to non-Indigenous populations. There is very limited research surrounding the implementation of the BFHI to support Indigenous women. The objectives of this research are: to gather firsthand experiences of policymakers, administrators, and health care providers on implementing and supporting access among Indigenous mothers; and apply and adapt the Interactive Theory of Breastfeeding to explore theoretical concepts influencing breastfeeding practices among Indigenous women within Canada and Australia. A case study research design will be implemented to explore the experiences of policymakers, health service providers, and advocates in implementing the BFHI in health facilities servicing Indigenous women. Targeted emails and flyers will be posted on social media to recruit participants with expertise in Indigenous maternal health and infant feeding. Participants will be recruited from four health facilities, either from a small, rural location or a large urban facility. Examining facilities with different resources available will help shine light on how the implementation of the BFHI may differ. In addition, representatives of local, provincial, and territorial governments, and international organizations such as WHO will be recruited to participate in virtual semi-structured interviews. In total, 15 to 20 participants will be included in this research. Thematic analysis and line-by-line coding will then be utilized to identify themes and patterns. It is anticipated the results from this study will highlight current gaps in care surrounding the BFI and its availability and use among Indigenous women within Canada and Australia. This research has national and international policy implications as it will help uncover whether the BFHI can be used as a tool to promote and support Indigenous maternal-child health through culturally safe infant feeding practice. Canadian Institutes of Health Research.