What works? A framework analysis of breastfeeding support provider perspectives in a low-breastfeeding region with baby friendly accreditation

Background Evidence-based breastfeeding support interventions can improve breastfeeding rates. However, in Northern Ireland breastfeeding rates remain amongst the lowest worldwide despite 100% UNICEF BFI accreditation of maternity units, and the availability of community and private breastfeeding support. There is limited understanding of the provider perspective on factors that influence their ability to provide effective support in such contexts. This study aimed to explore the provider perspective of supporting women to breastfeed across a range of role-types in a context with low breastfeeding rates, yet high rates of UNICEF BFI accreditation across maternity and family settings. Methods Semi-structured interviews were conducted with trained breastfeeding support providers employed in healthcare roles ( n = 12) and lay trained providers ( n = 9). A thematic framework analysis was undertaken. Results Three key themes were developed from the dataset: Role development through active engagement , Positivity: Breastfeeding support as meaningful work , and Negativity: Precarity in quality support provision . Findings suggest a range of positive and negative factors underpinning support provision. Positive factors were most evident when providers were regularly exposed to positive breastfeeding support encounters with women, and where breastfeeding was normalised, understood and valued within healthcare systems and by individuals. Conclusions Breastfeeding support providers develop confidence and skill through experiential learning and collaboration with others who value breastfeeding. This can be undermined by limited exposure to breastfeeding in low-breastfeeding contexts, and a lack of support for providers themselves in practice despite a system’s BFI accreditation status. Providers can therefore struggle to fully enact their breastfeeding support role despite UNICEF BFI accreditation. What works best for providers to support breastfeeding women is continued exposure to breastfeeding dyads, ongoing peer learning from other providers who value and understand breastfeeding practices, and strong team cohesion across professional and lay-trained roles.