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Welcome to Becoming Breastfeeding Friendly

A guide to global scale up


Breastfeeding is a proven, natural intervention that gives children the healthiest start in life as well as a promising future. However, breastfeeding prevalence remains low globally, with only 37% of children under six months of age in low- and middle-income countries being breastfed exclusively. The 2016 Lancet series on breastfeeding estimated that 823,000 children’s lives would be saved annually in 75 high-mortality low- and middle income countries if breastfeeding was scaled up to near universal levels. This is 13.8% of the deaths of children under 2 years of age.

Becoming Breastfeeding Friendly (BBF) is an evidence-informed global initiative that is designed to help countries identify the strength of their breastfeeding friendly environment and develop recommendations as well as plans for scaling up their breastfeeding policies and programs. The long-term objective of this initiative is to identify the concrete measures a country can take to sustainably increase its breastfeeding rates.

BBF is grounded in the framework of the Breastfeeding Gear Model (BFGM). The BFGM stipulates that eight “gears” must be at work and in harmony for large-scale improvement in a country’s national breastfeeding program.

Breastfeeding gear model

Those eight gears are:

  • Advocacy
  • Political Will
  • Legislation & Policies
  • Funding & Resources
  • Training & Program Delivery
  • Promotion
  • Research & Evaluation
  • Coordination, Goals & Monitoring

The BFGM states that:

  • Evidence-based advocacy generates political will to enact policies and legislation that are needed to protect, promote and support healthy breastfeeding practices
  • These generate the necessary resources to encourage workforce training and program delivery, as well as promotion through various media outlets.
  • Research and evaluations are conducted to maintain the quality and success of the programs
  • A coordinating master gear keeps the multisectorial program(s) on track by setting and monitoring goals, facilitating the flow of information across gears, and providing timely feedback on actions needed to improve or sustain the quality of large scale programs.

Using the BFGM as the underlying framework for BBF, a toolbox was developed between March 2015 and September 2016 based on current evidence and expert guidance from a Technical Advisory Group comprised of global breastfeeding and metric experts with strong expertise in the scaling up of health and nutrition programs. The toolbox is designed to help countries assess the strength of the eight gears, identify gaps, propose actions, and provide guidance on how to use data for decision making.

There are three complementary components deemed critical to the goal of empowering countries to scale up their breastfeeding environments:

  • BBF index
  • Experienced-based briefs/Case Studies
  • 5-meeting process

Details for each of these components are provided on this website to guide the use and application of the toolbox components. I hope you will look through our website, and follow the steps to becoming breastfeeding friendly.

Warm Regards,

Dr. Rafael Pérez-Escamilla
Yale School of Public Health

Becoming Breastfeeding Friendly

A guide to global scale up