Examining the Application and Use of the Baby-Friendly Initiative within Rural and Urban Health Facilities in Canada among Indigenous Mothers
Bibliographic record
Abstract
Background: To prevent infant mortality and morbidity, 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 BFI (Baby-Friendly Initiative) within Canada to support Indigenous women. \nResearch Questions: This study sought to answer: 1) How is the BFI implemented and utilized among health facilities that service Indigenous women in Canada? 2) What is the availability and utilization of the BFI among Indigenous women? 3) Are there differences in the uptake of the BFI between rural and urban health facilities? \nMethods: Qualitative methodologies and methods, including semi-structured interviews, case study research, and document analysis were implemented to examine the experiences of policymakers, health service providers, and health organizations. Seven participants were recruited from international and national health organizations, bodies of the Canadian government, and Canadian health facilities. Inuvik Regional Hospital and Grey Nuns Hospital were reviewed as the case studies through using documentary analysis. The Interactive Theory of Breastfeeding was used to inform the study design and frame the results. \nResults: A conceptual model utilizing the social-ecological framework was created to expand the Interactive Theory of Breastfeeding, and contextualize the participant experiences of implementing the BFI, decisions to breastfeed, and the cultural appropriateness of the BFI for Indigenous women. Through the adapted model, a unique contribution includes the incorporation of Indigenous traditions and context. Previous models have not specifically examined policy and environmental influences relating to breastfeeding and Indigenous women within Canada. \nConclusion: There is an opportunity for the BFI to be a culturally appropriate initiative for Indigenous mothers if the facility/health center implementing the initiative understands and incorporates the local context at a variety of levels, including interpersonal, organizational, and in the environment and policy layers. Collaborating with key stakeholders and the community is one method to understand and incorporate local context. The BFI as a stand-alone initiative is not culturally appropriate, and steps need to be completed to ensure that during implementation there is a focus on empowering women with education and informed choice in their infant feeding decisions. There are a variety of factors that influence an Indigenous women’s decision to breastfeed, and there is a need for culturally appropriate and gender inclusive educational materials, supports, and health services to be available.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.007 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.013 | 0.004 |
| Scholarly communication | 0.003 | 0.001 |
| Open science | 0.002 | 0.004 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".