Assuring policies that promote breastfeeding in childcare: A qualitative study from a multi-state sample of childcare facilities

Background: In the United States, over 2.5 million working mothers have a child younger than one year of age. Policies that promote breastfeeding in childcare centers are important to ensure mothers breastfeed for the recommended duration (6-24 months). This study examined how childcare centers improved or created organizational policies for the promotion of breastfeeding.

Methods: Interviews (N=31) with center directors across six states were conducted. Each center had recently participated in a national program aimed at improving policies and practices for physical activity and nutrition, including promotion of breastfeeding. We used a grounded theory approach, conducting semi-structured, qualitative interviews to examine: a.) Motivation to create or change center policy to promote breastfeeding, b.) The process of bringing about this change, and c.) The implementation and enforcement of policy that promotes breastfeeding. After theoretical saturation was reached, a content analysis of breastfeeding policy was conducted. Data were analyzed using NVivo version 10.1.3.

Results: Key themes for motivating change included: internal discussions among staff and participation in external trainings. Change involved educating parents about policy and facilitating staff trainings. Enforcing policy involved retraining and reminding staff about policy when occasions emerged. Few barriers to creating or enhancing policy were identified. Content analysis showed that the majority of breastfeeding policy focuses on handling breast milk, with less emphesis on the promotion of breastfeeding.

Conclusion: While creating or enhancing breastfeeding policy may be fairly straightforward, implementing and enforcing the policy is more challenging and may require various strategies over time.