Teresita González de Cosío, Isabel Ferré, Mónica Mazariegos, Rafael Pérez-Escamilla

Given the magnitude of the health and economic burden of inadequate breastfeeding practices in Mexico, there is an urgency to improve breastfeeding practices to increase the health and well-being of children and mothers. The Becoming Breastfeeding Friendly (BBF) Toolbox was recently developed to guide countries in assessing their readiness to and progress with scale-up of breastfeeding protection, promotion, and support and to develop policy recommendations to high-level decision makers. The aim of this study was to document the BBF process in Mexico, which led to evidence-based recommendations for policymakers to improve breastfeeding protection, promotion, and support in the country. We followed the BBF methodology. First, a group of experts, with the use of scientific and gray literature, face-to-face interviews, and their own experience, analyzed and assigned a score to each of the 8 gears from the BBF index and identified scaling-up gaps on the basis of the Breastfeeding Gear Model. Then, we developed and presented evidence-based recommendations to improve breastfeeding protection, promotion, and support. Mexico's BBF score was 1.4 out of a maximum total of 3 points, which indicates that there is a low to moderate scaling-up environment to protect, promote, and support breastfeeding. None of the gears were rated as "outstanding," and the legislation and policies gear was the only one rated as strong. The BBF initiative is a useful tool for assessing the environment for breastfeeding. The Mexican environment for breastfeeding is weak. On the basis of these results, it is strongly recommended to raise national awareness on breastfeeding, incorporate the Code of Marketing of Breastmilk Substitutes in the Mexican legislations, extend maternity leave to 6 mo, and strengthen evidence-based advocacy and hence the political will that is needed to secure stable funding and resources for a successful national strategy for the protection, promotion, and support of breastfeeding in Mexico.