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This systematic review identified 77 studies to examine patterns and determinants of health care access among Hispanic immigrants (HI) living in the United States. In spite of major mental and physical care needs, HI and their families are at very high risk of not having access to health care compared with nonimmigrant Hispanics and non‐Hispanic whites. Noncitizenship status is a major barrier for accessing health care because of program ineligibility and fear of stigma and deportation. Low English proficiency is also an important barrier to health care. Culturally appropriate community outreach programs relying heavily on community health workers, also known as promotoras, have improved health care access and quality. Mexico shares the health care cost for HI living in bordering states, calling for a binational dialogue. Mixed‐methods research is needed to better understand (1) the net influence of acculturation on migrant health; (2) the role of informal (e.g., family) versus formal (e.g., promotoras) social support at facilitating health care access; (3) issues related to 'single' male migrant farm workers; (4) the "Hispanic mortality paradox"; (5) traditional healing and medicine among HI. Comprehensive health and immigration reforms are needed to respect the human right that HI have to gain access to health care.

BACKGROUND: Suboptimal breastfeeding practices are driven by multiple factors. Thus, a multi-sectoral approach is necessary to design and implement appropriate policies and programs that protect, promote, and support breastfeeding. METHODS: This study used Net-Map, an interactive social network interviewing and mapping technique, to: a) identify key institutional actors involved in breastfeeding policy/programs in Ghana, b) identify and describe links between actors (i.e., command, dissemination, funding, and technical assistance (TA)), and c) document actors influence to initiate or modify breastfeeding policy/programs. Ten experts were purposively selected from relevant institutions and were individually interviewed. Interview data was analysed using social networking mapping software, Gephi (version 0.9.2). RESULTS: Forty-six unique actors were identified across six actor categories (government, United Nations agencies, civil society, academia, media, others), with one-third being from government agencies. Dissemination and TA links accounted for two-thirds of the identified links between actors (85/261 links for dissemination; 85/261 for TA). Command links were mainly limited to government agencies, while other link types were observed across all actor groups. Ghana Health Service (GHS) had the greatest in-degree centrality for TA and funding links, primarily from United Nations Children's Fund (UNICEF) and development partners. The World Health Organization, UNICEF, Ministry of Health, and GHS had the highest weighted average relative influence scores. CONCLUSIONS: Although diverse actors are involved in breastfeeding policy and programming in Ghana, GHS plays a central role. United Nations and donor agencies are crucial supporters of GHS providing breastfeeding technical and financial assistance in Ghana.

The Heckman two-stage model for correcting selection bias was applied to analyze the determinants of fertility desire using DHS II (Demographic and Health Survey) data from Senegal. The study concludes that significant differences exist between women that report numeric answers and those who report non-numeric answers to a question relative to fertility desire. Therefore, excluding non-numeric answers from regression models produces biased parameter estimates. Furthermore, this study presents evidence that contraceptive methods in Senegal are primarily used to control undesired births as rural and urban residents share the desire for a large family size.

Becoming Breastfeeding Friendly (BBF) is an initiative designed to track country readiness and progress to effectively scale up breastfeeding programmes. BBF includes a policy toolbox that has three components: the BBF Index (BBFI), case studies, and a five‐meeting process. Mapping pathways of how BBF was implemented and utilized enables contextually grounded interpretation of its impact on breastfeeding outcomes. We conducted a programme impact pathways (PIP) analysis to identify pathways and critical quality control points (CCPs) by which BBF can enable changes in policy, legislation, and implementation of breastfeeding programmes. A BBF PIP diagram was developed, and CCPs were identified through a literature review and an iterative interviewing process with BBF investigators. The PIP was revised after feedback from BBF's Technical Advisory Group. BBF pretesting in Ghana and Mexico informed the formative evaluation of the PIP. PIP analysis identified relevant pathways between BBF activities and outcomes. Eight CCPs that could facilitate or attenuate BBF to fully impact the scaling up of the breastfeeding programmes were identified: (a) committee formed and trained; (b) committee understands BBF and BBFI; (c) committee's ability to acquire data; (d) BBFI scores; (e) criteria used for prioritizing recommendations; (f) dissemination of recommendations; (g) policymaker's reactions and media coverage; (h) committee's motivation and effective teamwork throughout BBF. Ghana and Mexico's pretesting of BBF confirmed the CCPs and provided valuable insights on potential mechanisms of BBF impacts at the country level. To further validate the PIP, a policy analysis framework is being tested in Ghana and Mexico.

Breastfeeding (BF) promotion is one of the most cost-effective interventions to advance mother–child health. Evidence-based frameworks and models to promote the effective scale up and sustainability of BF programs are still lacking. A systematic review of peer-reviewed and gray literature reports was conducted to identify key barriers and facilitators for scale up of BF programs in low- and middle-income countries. The review identified BF programs located in 28 countries in Africa, Latin America and the Caribbean, and Asia. Study designs included case studies, qualitative studies, and observational quantitative studies. Only 1 randomized, controlled trial was identified. A total of 22 enabling factors and 15 barriers were mapped into a scale-up framework termed "AIDED" that was used to build the parsimonious breastfeeding gear model (BFGM). Analogous to a well-oiled engine, the BFGM indicates the need for several key "gears" to be working in synchrony and coordination. Evidence-based advocacy is needed to generate the necessary political will to enact legislation and policies to protect, promote, and support BF at the hospital and community levels. This political-policy axis in turn drives the resources needed to support workforce development, program delivery, and promotion. Research and evaluation are needed to sustain the decentralized program coordination "gear" required for goal setting and system feedback. The BFGM helps explain the different levels of performance in national BF outcomes in Mexico and Brazil. Empirical research is recommended to further test the usefulness of the AIDED framework and BFGM for global scaling up of BF programs.

COVID-19 has imposed unprecedented challenges to society. As the pandemic evolves, the social distancing measures that have been globally enforced, while essential, are having undesirable socioeconomic side effects particularly among vulnerable populations. In Mexico, families who depend upon informal employment face increased threats to their wellbeing, and households who in addition have young children may face long-term consequences. The Mexican government has not yet taken actions, but a coalition of non-governmental organizations is advocating in partnership with academic institutions for social protection actions such as a cash transfer and basic services subsidies for families with young children, subsisting from the informal sector economy. To facilitate governmental action, we estimated the costs for implementation of these recommendations. The methodology used could be replicated in other countries facing similar challenges.

Becoming Breastfeeding Friendly (BBF) is an initiative designed to help countries assess their readiness to scale‐up breastfeeding programs and develop key recommendations to strengthen their breastfeeding environment. In 2016, Ghana was one of two countries to first pilot BBF. In applying BBF, a committee of 15 Ghanaian nutrition, health, and breastfeeding experts implemented the BBF toolbox over 8 months. Following implementation, semistructured interviews were conducted with 12 committee members (CMs) to (a) identify facilitators and barriers to implement BBF and (b) determine factors needed to strengthen the breastfeeding environment in Ghana. Using a grounded theory approach, five domains were identified. First, a dynamic committee of key stakeholders drove the implementation of BBF. Second, CMs faced some logistical and methodological challenges, including difficulty accessing data and the need for strong in‐country technical support for adhering to the BBF process. Third, CMs felt well positioned to facilitate and lead the dissemination and implementation of recommendations. Fourth, accountability would be essential to properly translate recommendations. Fifth, to move recommendations to action, advocacy would be a required first step, and BBF was proposed to facilitate this step. BBF provided an in‐depth analysis of Ghana's current breastfeeding environment to help Ghana strengthen its breastfeeding governance, policies, and programs while informing CMs' government and non‐governmental organizations' breastfeeding efforts.

Scaling up breastfeeding programmes has not been highly prioritized despite overwhelming evidence that breastfeeding benefits the health of mothers and children. Lack of evidence‐based tools for scaling up may deter countries from prioritizing breastfeeding. To fill this gap, Becoming Breastfeeding Friendly (BBF) was developed to guide countries in effectively scaling up programmes to protect, promote, and support breastfeeding. BBF includes an evidence‐based toolbox that consists of a BBF Index, case studies, and a 5‐meeting process. These three interrelated components enable countries to assess their breastfeeding scaling up environment, identify gaps, propose policy recommendations, develop a scaling up plan, and track progress. The toolbox was developed based on current evidence and expert guidance from a Technical Advisory Group, which was composed of global breastfeeding and metric experts with experience in the scaling up of health and nutrition programmes in low‐, middle‐, and high‐income countries. The BBF toolbox required a step‐by‐step iterative approach to describe and systematize each component, thus an operational manual was developed. The BBF toolbox and BBF operational manual underwent intensive pretesting in two countries, Ghana and Mexico, resulting in the modification of each component plus the operational manual. Pretesting continues in six additional countries demonstrating that BBF is a robust and dynamic multi‐sectoral process that, with relatively minor adaptations, can be successfully implemented in countries across world regions.

Progress has been made in the development and widespread implementation of effective interventions to address childhood obesity, yet important challenges remain. To understand how the United States and Latin American countries achieved success in implementing obesity policies and programs (PAPs) and identify improvement opportunities using implementation science principles. We identified three comparative case studies: (1) front‐of‐food package labeling (Mexico and Chile); (2) Open Streets/play streets (Colombia and the United States); and (3) the Baby‐Friendly Hospital Initiative (Brazil and the United States). Information from multiple sources (e.g., scientific and gray literature and key informant interviews) was synthesized to describe barriers, facilitators, and progress of PAPs across RE‐AIM framework dimensions. Evidence‐based advocacy along with political will and evidence of scalability and impact were key for successful launch and implementation of all PAPs. Diverse adaptations of PAP design and implementation had to be done across contexts. Stronger process and impact monitoring and evaluation systems that track equity indicators are needed to maximize the population benefits of these PAPs. Implementation science offers an important contribution toward addressing knowledge gaps, enhancing obesity policy dialogue, and producing transferable lessons across the Americas and, therefore, should be used for research and evaluation during PAP development and throughout the implementation and maintenance phases.

Global efforts to further improve exclusive breastfeeding rates have not been successful, in part because effective scaling‐up frameworks and roadmaps have not been developed. The Becoming Breastfeeding Friendly (BBF) toolbox includes an evidence‐based index, the BBF Index (BBFI), to guide the development and tracking of large scale, well‐coordinated, multisector national breastfeeding promotion programmes. This paper describes the development of the BBFI, which is grounded in the Breastfeeding Gear Model complex adaptive systems framework. The BBFI was developed by the BBF Steering Committee in collaboration with a high‐level Technical Advisory Group following the Delphi consensus methodology. Key benchmarks and definitions were informed by evidence‐based health, nutrition, and newborn survival initiatives identified from the academic and grey literature. The BBFI consists of 8 gears (54 benchmarks): Advocacy (4); Political Will (3); Legislation and Policies (10); Funding and Resources (4); Training and Program Delivery (17); Promotion (3); Research and Evaluation (10); and Coordination, Goals, and Monitoring (3). Scores are generated for 8 gear scores plus a total country score to gauge the scaling‐up enabling environment. The BBFI provides an evidence‐based index to assist countries in (a) assessing their readiness to scale up breastfeeding programmes and (b) tracking scaling‐up progress.

Progress has been made in the development and widespread implementation of effective interventions to address childhood obesity, yet important challenges remain. To understand how the United States and Latin American countries achieved success in implementing obesity policies and programs (PAPs) and identify improvement opportunities using implementation science principles. We identified three comparative case studies: (1) front-of-food package labeling (Mexico and Chile); (2) Open Streets/play streets (Colombia and the United States); and (3) the Baby- Friendly Hospital Initiative (Brazil and the United States). Information from multiple sources (e.g., scientific and gray literature and key informant interviews) was synthesized to describe barriers, facilitators, and progress of PAPs across RE-AIM framework dimensions. Evidence-based advocacy along with political will and evidence of scalability and impact were key for successful launch and implementation of all PAPs. Diverse adaptations of PAP design and implementation had to be done across contexts. Stronger process and impact monitoring and evaluation systems that track equity indicators are needed to maximize the population benefits of these PAPs. Implementation science offers an important contribution toward addressing knowledge gaps, enhancing obesity policy dialogue, and producing transferable lessons across the Americas and, therefore, should be used for research and evaluation during PAP development and throughout the implementation and maintenance phases. ; United States Department of Health & Human Services National Institutes of Health (NIH) - USA NIH National Heart Lung & Blood Institute (NHLBI) K12HL138037 United States Department of Health & Human Services Centers for Disease Control & Prevention - USA 5 U48DP006380-02-00 ; Versión publicada - versión final del editor

BACKGROUND: The Brazilian Household Food Insecurity Measurement Scale (EBIA) is the main tool for assessing household food insecurity (FI) in Brazil and facilitates the monitoring and improvement of national public policies to promote food security. Since 2004, the Brazilian government has conducted National Household Sample Surveys, and in 2018, the government carried out the last national evaluation of FI. OBJECTIVES: To describe trends in severe FI in Brazil from 2004 to 2018. METHODS: Data from 3 cross-sectional Brazilian National Household Sample Surveys (sample sizes: 2004 = 112,530; 2009 = 120,910; 2013 = 116,196) and from the last Household Budget Survey (sample size = 57,920) that assessed the status of FI using the EBIA were analyzed. Changes in severe FI during 2 periods (2004–2013; 2013–2018) were estimated while considering sociodemographic factors. RESULTS: The period between 2004 and 2013 was marked by a significant decrease in severe FI (–53.6%), but this trend reversed in 2013–2018 (+43.8%). The greatest decrease in severe FI occurred in the Northeast (–57.6%) among households where the reference person was a man (–57.6%) and self-identified as white (–58.1%) (2004–2013). In 2013–2018, households with children aged ≤4 y (+6.3%) and members aged ≥65 y (+12.5%) experienced the lowest increases in severe FI. CONCLUSIONS: After a significant reduction from 2004 to 2013, severe FI increased sharply from 2013 to 2018, likely due to disruptions in public policies aimed at reducing hunger and unemployment rates.

OBJECTIVES: UNICEF's Community Infant and Young Child Feeding (C-IYCF) Counselling Package (the Package), was launched by in 2010 to equip community workers for IYCF promotion. Though the Package was in use in at least 68 countries at the end of 2014, no formal evaluation of the Package had been conducted. In response, we evaluated the impact of the Package, when implemented at scale, on priority IYCF practices in Nigeria. METHODS: In collaboration with the Kaduna State Ministry of Health, two local government areas (LGA) (one intervention and one comparison) were selected. Intervention planning and implementation followed guidance provided in the Package. The Package was implemented in every ward of the intervention LGA for 18 months. It involved training 78 health workers and 238 community volunteers, community sensitization and mobilization events, support group meetings, home visits, review meetings, and supportive supervision. A baseline survey of mothers of children under two was conducted in early 2015 and the endline 2 years later in both LGAs. Survey instruments included modules on household characteristics and socioeconomic status, women's agency, as well as breastfeeding knowledge, attitudes, and practices. RESULTS: In the intervention LGA, the rate of early initiation of breastfeeding had increased by 10.4 percentage points more than in the comparison LGA, even after controlling for child, mother and household level covariates (P < 0.001). Similarly, the net adjusted change in the exclusive breastfeeding rate was 10.8 percentage points in favor of the intervention LGA (P < 0.01). No significant changes were observed on other IYCF practices CONCLUSIONS: The Package was effective at improving early breastfeeding initiation and exclusive breastfeeding. Other IYCF practices that are more sensitive to economic downturns and food prices may require a more sustained multi-sectoral investment with greater saturation. Additional research studying the impact of the Package, when implemented at scale in ...

Media can be a powerful communication tool to promote breastfeeding programs, influence mother's breastfeeding behaviour, and generate support among stakeholders for breastfeeding. Yet, there is little information on how media coverage influences a country's breastfeeding enabling environment. This study addressed this gap by conducting a retrospective content analysis of documents published between January 1, 2017 and January 1, 2018 to analyse the media coverage related to breastfeeding in Mexico. Content analysis was based on the breastfeeding gear model and a strategic planning technique to identify strengths, weaknesses, opportunities, and threats for enabling the national breastfeeding environment. Media coverage of breastfeeding was more frequent in August (36% of all documents). The top three topics commonly covered by the media were advocacy events promoting breastfeeding, promotion campaigns, and changes in breastfeeding legislation and policy. In general, the media coverage focused on strengths of specific breastfeeding policies. There was limited news coverage of key factors that negatively influenced or threatened the breastfeeding environment. Findings support the need to design strategies to engage the media covering in more depth and breadth diverse aspects of breastfeeding protection, promotion, and support efforts in Mexico.