Is evidence-informed, community-driven advocacy present and active to protect, promote and support breastfeeding?
Global breastfeeding promotion efforts have intensified over the past decades with the release of international, evidence-based infant feeding recommendations in the early 1990s. International and local advocacy groups have been instrumental in translating these recommendations into action to promote breastfeeding.
Scaling-up breastfeeding promotion and support efforts require changing the political climate; by influencing the political will of politicians, legislation and policies supporting breastfeeding can be implemented.
The Breastfeeding Gear Model (BFGM) posits that evidence-informed, community-driven advocacy is necessary to generate political will. The presence of strong evidence-informed advocacy can lead to massive social mobilization and engagement of persons and resources, subsequently generating enough political pressure to influence political will.
Advocacy efforts must be visible, impactful, consistent, and wide-reaching in order to generate enough social concern to push for political change. Media reports and/or social marketing campaigns can be effective delivery tools for disseminating key, appropriate, evidence-based breastfeeding advocacy messages.
The themes for the Advocacy Gear measure the presence and degree of advocacy to protect, promote and support breastfeeding scaling up efforts:
1) public attention
2) individual champions
3) social cohesion/mobilization.
All benchmarks are referenced to “the past year” unless otherwise noted.
AG1: There have been major events that have drawn media attention to breastfeeding issues.
This benchmark measures whether any media attention has been drawn to breastfeeding problems, concerns, or issues through major events to advocate for breastfeeding and, if so, how much media attention has been garnered. Major events can include conferences, gatherings, reports, photos, TV ads, or planned events to galvanize public attention towards advocating for breastfeeding.
Possible data sources: To determine if and how much public attention was drawn to breastfeeding issues by the media through major events in the past year, local/subnational/national media data sources will need to be evaluated to determine the level of coverage. Media data sources can include social media announcements or articles (i.e. Facebook, Twitter, Instagram, etc.), newspaper articles, radio or TV stories, etc. Consider including a table that documents both positive and negative media attention around a planned event and weigh whether it galvanizes public attention towards advocating for breastfeeding.
The scoring for this benchmark assesses the amount of media attention generated by events in the past year.
How to score:
☐ No progress: No major events have drawn national media coverage to breastfeeding issues
☐ Minimal progress: One major event has drawn national media coverage to breastfeeding issues
☐ Partial progress: Two major events have drawn national media attention to breastfeeding issues, at different times during the year
☐ Major progress: Three or more major events have drawn national media coverage on breastfeeding issues, at different times during the year
Example: In 2016, Brazil had organized four major events that drew extensive media attention throughout the year: (1) The 2016 Lancet breastfeeding series (March) (2) National Day of Breastmilk Donation (May), (3) World Breastfeeding Week (August) and (4) National Conference on Breastfeeding (November).
Score: Major Progress
Domain- Existence: Yes
Domain -Volume: Three or more major event have drawn national media coverage to breastfeeding at different times during the year.
Individual Champions Theme
AG2: There are high-level advocates (i.e. 'champions') or influential individuals who have taken on breastfeeding as a cause that they are promoting.
This benchmark assesses whether there are champion(s) that have publicly been promoting breastfeeding as an important cause for the country.
The champion(s) can be non-governmental high-level advocates or influential individuals who are highly visible people, are seen frequently (at least 3 times within the year) promoting breastfeeding, and/or who are recognized/respected people whose opinions are valued and generate advocacy. These individuals can include traditional, religious, social leaders, public figures, social media bloggers, as well as former political figures.
When considering who would qualify as an champion, consider both the number of times (minimally 3 times per year) as well as the level of influence. For example, an influential person that posts to social media, would be considered a champion if:
- Hashtags and/or messages with photos are posted
- Multiple photos (e.g. 20 times a year) with no messages are posted
- A major symbolic gesture is made by a significant, influential person (e.g. Pope Francis) if s/he meets the criteria for number of times within the year
However, if someone posts three photos a year, without hashtags or messages, this person would not be considered a champion.
Possible data sources: To determine if there are high level advocates (i.e. ‘champions’), or influential individuals that have taken on breastfeeding as a cause they are promoting, data may need to be drawn from a few sources. Consulting media data sources (i.e. social media announcements or articles, Facebook, Twitter, Instagram, etc., newspaper articles, radio or TV stories, newsletters, magazines, etc.) and/or commissioning/conducting a media survey can help to identify high-level champions. Written reports from individuals or advocacy groups specifically focused on breastfeeding issues or initiatives can be consulted. Interviews with health officials may also provide detailed information as to the presence and number of individuals championing breastfeeding within the country.
The scoring for this benchmark assesses the number of high level advocates taking on breastfeeding as a cause in the past year.
How to score:☐ No progress: No high-level advocates or influential individuals have taken on breastfeeding as a cause that they are promoting.☐ Minimal progress: One high-level advocate or influential individual has taken on breastfeeding as a cause he/she is promoting.☐ Partial progress: Two high-level advocates or influential individuals have taken on breastfeeding as a cause they are promoting.☐ Major progress: Three or more high-level advocates or influential individuals have taken on breastfeeding as a cause they are promoting.
Example: Alissa Milano, an- actress in the US, uses social media to promote breastfeeding. She calls herself “a breastfeeding advocate” and uses the hashtag #normalizebreastfeeding to tweet and post about breastfeeding issues on Facebook and Instagram. Milan is also vocal about breastfeeding on television shows and popular magazines.
Score: Minimal Progress
Domain- Existence: Yes
Domain - Volume: One individual publicly promoted breastfeeding more than three times in one year. To score as major progress, there would need to be three or more high level advocates, also publicly promoting breastfeeding at least three times in the same year.
Social Cohesion/Mobilization Theme
AG3: There is a national advocacy strategy based on sound formative research.
This benchmark evaluates the presence and content of a national advocacy strategy. A national advocacy strategy is a governmental or non-governmental document or initiative that aims to organize and/or systematize breastfeeding advocacy actions within the country. If a national advocacy strategy exists then it must be based on sound formative research. Formative research helps to systematically understand characteristics, needs, preferences, etc. of different communities to then effectively build strategies and interventions. Sound formative research is grounded in theory and the country’s context. A national advocacy strategy should be based on the country-level characteristics and needs.
Possible data sources: If a national advocacy strategy exists, it should be available through a formal document from the entity in charge of coordinating the strategy. Accessing the national advocacy strategy is necessary to evaluate its content and determine if it is based on formative research or not.
The scoring for this benchmark reflects the existence and effectiveness of a national advocacy strategy. To score this benchmark, “effective” the national advocacy strategy must have been strategically implemented and generated support for breastfeeding protection, promotion and support.
How to score:☐ No progress: There is no national advocacy strategy.☐ Minimal progress: There is a national advocacy strategy but it is not based on sound formative research.☐ Partial progress: There is a national advocacy strategy that is based on sound formative research but it is not effective.☐ Major progress: There is a national advocacy strategy that is based on sound formative research and is effective.
Example: One NGO, Alive & Thrive, who has a strong presence in Bangladesh and Vietnam, developed advocacy strategies using an evidence-based approach, which drew on global and national evidence, stakeholder mapping, and opinion leader research to inform breastfeeding advocacy policy strategies. Experience demonstrates that an evidence-based advocacy program design is feasible and can contribute to policy and advocacy goals ranging from the adoption and strengthening of national laws to increasing investments in IYCF.
In Viet Nam, A&T had four prongs to their advocacy strategy based on their extensive research: Develop and sustain partnerships, Build a continuous evidence base, Strategic Communication and Interpersonal and Group Communication. To understand the quality of the implementation, they compared baseline data against data collected again three years into the strategy. They used Event Tracking to analyze and understand the causes of any shifts in the overall policy environment during the strategy’s timeframe.
To capture the impact of these strategies, additional evaluations were carried out, such as stakeholder interviews and content analysis of provincial nutrition plans in Viet Nam and media content analysis and stakeholder interviews in Bangladesh.
In 2012, Viet Nam’s National Assembly extended paid maternity leave from 4 to 6 months – and it passed with more than 90% of votes and in Bangladesh, there was a marked increase in in-depth and frequent IYCF news coverage.
Score: Major Progress
Domain -Existence: Yes
Domain -Quality: National advocacy strategies developed by A&T were based on sound formative research
Domain -Effective: Strategies were operational, i.e. they were implemented and generated support for breastfeeding protection, promotion and support.
AG4: A national cohesive network(s) of advocates exists to increase political and financial commitments to breastfeeding.
This benchmark assesses the presence or absence of a national cohesive network(s) of advocates that specifically works to increase political and financial commitments to breastfeeding. A network is formed by two or more advocacy groups and is considered cohesive when they work collectively. The network activity must be proportional to its coverage (national, sub-national, and/or local). The network needs to include breastfeeding advocacy as a key focus, but it does not need to be the only advocacy issue it defends.
Possible data sources: Media sources should be consulted to see if this type of network has emerged in the past year. Interviews with government officials on the local, subnational, and national level may also help to determine if there is this type of network. Written reports from individuals or advocacy groups specifically focused on breastfeeding issues or initiatives may be consulted.
The scoring for this benchmark reflects the existence and coverage of a national network of advocates dedicated to breastfeeding in the past year.
How to Score:☐ No progress: There is no national cohesive network(s) of advocates to increase political and financial commitments to breastfeeding.☐ Minimal progress: A cohesive network(s) of advocates exists to increase political and financial commitments to breastfeeding but only to a limited extent, i.e. they only have local coverage.☐ Partial progress: A cohesive network(s) of advocates exists to increase political and financial commitments to breastfeeding to some extent, i.e. they have subnational coverage.☐ Major progress: A national cohesive network(s) of advocates exists to increase political and financial commitments to breastfeeding nationwide.
Example: The Breastfeeding Promotion Network of India (BPNI) is a registered, independent, nonprofit and national network of 57 organizations within the country working together to protect, promote and support breastfeeding and optimal infant feeding practices. Their founder and Central Coordinator is the highly visible and respected doctor, Arun Gupta. BPNI has representation on the National Infant and Young Child Feeding Coordination Committee and the National Infant and Young Child Feeding Steering Committee (both government bodies), the Working Group on Children's Right to Food, and the National Coordination Committee of Jan SwasthyaAbhiyan (People’s Health Movement). Their advocacy activities include: media campaigns (https://www.facebook.com/Babies-Need-Mom-Made-Not-Man-Made-301758009914509/), parliamentary questions and direct advocacy with government ministries, newsletters, academic papers, magazine and newspaper articles, presentations nationally and internationally and an app for the public to report Code violations.
BPNI is a part of a global network, the International Baby Food Action Network (IBFAN), an umbrella organization comprising advocacy groups working, “through programmes designed for increasing its outreach by building alliances, protecting people from baby food corporations’ misleading propaganda, advocating with governments to hold the baby food corporations accountable, providing technical and planning support to governments, campaigning, training and capacity building.”
Score: Major Progress
Domain -Existence: Yes, BPNI includes more than two advocate groups.
Domain-Coverage: BPNI has national coverage