Déclencher le changement institutionnel : une analyse de l’élaboration et de la mise en œuvre initiale des lignes directrices en allaitement maternel au Québec
Breastfeeding is the optimal way of feeding infants and young children. Nevertheless, breastfeeding rates in Quebec are among the lowest in Canada. Within this context, the government of Quebec included breastfeeding among its public health priorities, and in 2001 published the policy L’allaitement maternel au Québec : Lignes directrices (Breastfeeding in Quebec: Guidelines; LD). Using a qualitative single case study design, this study aimed to understand the processes of emergence, development and implementation of the LD. Institutional theory was adopted as the theoretical framework. Data were collected through individual interviews and a focus group with professionals involved in the process under examination, as well as documentary analysis. Deductive-inductive thematic analysis was performed on transcribed verbatim. The LD emerged from a professional movement which worked in close collaboration with the Ministry of Health and Social Services in the initial phases of policy development and implementation. Over time, however, the decision making was centralized, consultation mechanisms became obsolete, and the relationships between different institutional actors became less cooperative. The discomfort and dissatisfaction with the Ministry’s new way of managing the Quebec breastfeeding policy triggered the emergence of a new parallel professional movement. The study concludes, however, that even in a highly institutionalized domain such as health, those committed to breastfeeding in the province could work together as they aim to reach the same goal, i.e., higher rates of breastfeeding. The initial consensual formulation of the LD proves that, in this particular institutional field, collaboration is possible.
Allaitement Breastfeeding Health policy Institutional change Institutional entrepreneur Strategies of engagement Institutional domain