Examining the Washington State Breastfeeding-Friendly Policy Development Process Using the Advocacy Coalition Framework Lesley E. Steinman 1 • Victoria Bradford 1 • Emilee Quinn 1 • Jennifer J. Otten 1 • Jennifer McNamara 2 • Kari Fisher 3 • Donna B. Johnson 1 Ó Springer Science+Business Media New York 2016 Abstract Objectives Breastfeeding promotion is increas- ingly recognized as a key public health strategy. Policies can promote breastfeeding by creating supportive envi- ronments and addressing challenges. In 2014, the Wash- ington State legislature considered bills to create a voluntary recognition system for breastfeeding-friendly hospitals, clinics, worksites and childcare settings. These Breastfeeding-Friendly Washington (BFW) bills (SB 6298 and HB 2329) did not pass. Methods The purpose of this case study was to analyze the policy development process for the BFW bills using the Advocacy Coalition Frame- work. Data were collected through semi-structured inter- views with key stakeholders in the state policy process, and document review. We used thematic analysis to identify deductive and inductive themes. Results Though all policy actors indicated general support for breastfeeding, two main coalitions (proponents and opponents) diverged in their support of the BFW bills as policy solutions to address barriers to breastfeeding. We conducted 29 inter- views with mainly bill proponents, and 54 documents confirmed data about bill opponents. Proponents supported the bills given increasingly strong evidence of breastfeed- ing’s benefits and that public policy could address envi- ronmental challenges to breastfeeding. Opponents saw the bills as government overreach into the private matter of choosing to breastfeed. Opposition to the bills came late in the session, and proponents felt opponents’ messaging misconstrued the intent of the legislation. Conclusions for Practice Key learnings for developing breastfeeding- friendly state policies include analyzing differences between proponents’ and opponents’ beliefs, framing advocacy messages beyond individuals and health, expanding the coalition outside of traditional health enti- ties, and anticipating the opposition. Keywords Policy and practice Á Breastfeeding support Á U.S. Á Legislation Significance What is already known about the topic? Breastfeeding- friendly policies can improve breastfeeding outcomes such as reducing disparities in initiation rates. There has been opposition to US policies that support breastfeeding, and little is known about the process for developing these policies. & Lesley E. Steinman lesles@uw.edu Victoria Bradford toribrad@uw.edu Emilee Quinn equinn1@uw.edu Jennifer J. Otten jotten@uw.edu Jennifer McNamara Jennifer.McNamara@doh.wa.gov Kari Fisher kari.fisher@multco.us Donna B. Johnson djohn@uw.edu 1 Center for Public Health Nutrition, University of Washington, Box 353410, Seattle, WA 98195, USA 2 Washington State Department of Health, PO Box 47890, Olympia, WA 98504-7890, USA 3 Multnomah County Health Department, 131 NE 102nd Ave, Portland, OR 97220, USA 123 Matern Child Health J DOI 10.1007/s10995-016-2154-2