Features

Breastfeeding: what's blocking the message?

05 July 2018

What’s being done (and what can be done) to improve low breastfeeding rates around the UK? Journalist Radhika Holmström investigates.

Breastfeeding

When it comes to breastfeeding, the UK seems to be at an impasse. Despite continual health messages, its rates of breastfeeding are among the lowest in the world: just 34% of babies in the UK received any breastmilk at six months in 2010 (Cheung, 2018). Broken down across the UK countries, the statistics can be even more stark – although one very significant problem with interpreting them is that up-to-date figures aren’t always kept, and also that they cover ‘all breastfeeding’, both exclusive and partial.

The most recent statistics for breastfeeding at around six weeks show that Northern Ireland is particularly poor, coming at the bottom of the Organisation for Economic Co-operation and Development (OECD) list of countries with 27% (Institute of Public Health in Ireland, 2017); in Wales, 38% (National Community Child Health Database, 2017); in England, it’s 44.4% (Public Health England, 2017); and in Scotland, 55% (Scottish Maternal and Infant Nutrition Survey, 2017).

We asked some of the leading breastfeeding campaigners about what they think the answer is, along with all four governments’ public health bodies about their views on how rates could improve – and vitally, what they’re doing about it. 
Read on to see what they said... ›

 

What the campaigners say...

Francesca Entwistle
‘It all fits together like a jigsaw’

Francesca Entwistle is the professional officer, policy and advocacy, for Unicef UK’s Baby Friendly Initiative 

‘From our perspective it’s about a multifaceted approach. We’ve got entrenched generations of areas where everyone has been bottle-fed; you have to take them on a journey and give them stepping stones to get there. Our aim has been to try and equip health professionals with the skills to support mothers with their choices and adherence.

‘Our UK programme was updated and refreshed in 2012 to incorporate wider standards and covering four areas: hospital and maternity; neonatal; community; and children’s centres. In Scotland and Northern Ireland, 100% of babies are now born in a ‘baby friendly’ environment, but there’s no point in changing the labour ward if the support networks aren’t there when mothers go home. We’re looking at training health professionals, but we also need support such as drop-in centres, peer support programmes, sessions at children’s centres and so on. Of course, in the landscape in which we live, that is dependent on commissioning.

‘We do need to change the culture across the generations too, from school education onwards. All these things fit together like a jigsaw, and for effective change women need ongoing face-to-face support and information they know is reliable, from someone with the knowledge and skills to support them properly. They need breastfeeding to be normalised, in a society where it’s seen as an equivalent to formula milk; and the laws governing the marketing of breastmilk substitutes need to be changed, because the law around ‘follow-on’ milk is much laxer 
and needs to be tightened.’

 

Clare Photo
‘Get baby friendly training on the curriculum’

Clare Meynell is a joint coordinator of the World Breastfeeding Trends Initiative (WBTi) 

‘Improving health professional training is a key issue. At the moment, professionals get themselves trained. Training curricula should align with the Unicef Baby Friendly Initiative standard, with added extras for those who would like to increase their knowledge. Some universities are getting on board with that, but many aren’t.

‘We also want health commissioning bodies to support a range of services, including lactation groups for complex needs, such as HIV-positive mothers. There’s also no support to help women in emergencies, when the water supply is contaminated and they need help with returning to breastfeeding or with building up their milk supply.’ 

 

 


Alison Thewliss
‘We’re focusing on the barriers’

MP Alison Thewliss chairs the All Party Parliamentary Group on Infant-Feeding Inequalities

‘The APPG has been quite good in bringing people together from various different parts of the world with an interest in breastfeeding. We’ve focused on some of the barriers: poverty, inequality, issues to do with milk banking and access to that across the country, the difficulties when women go back to work, formula marketing and so on.

‘One of the developments is the UK’s involvement in the Better Breastfeeding Initiative being coordinated by Yale University. I’m hoping that this will lead to more of a policy focus on infant feeding. We’re very pleased to start getting more government recognition overall already, and I’m hoping that some good things will come out of that strategy, especially funding for support services and local services. However, one thing we’re hearing is that because commissioning has changed, breastfeeding support now falls between health and social care – it’s something nobody thinks is their duty to fund, which means that it becomes a wrangle about funding, not the services that are being funded. It’s important that in areas where those services are being lost, people write to us and to their MPs, because we need to know what is happening and it’s crucial that these services aren’t lost.

‘In the last parliament we had a Ten Minute Rule Bill around formula marketing, which included evidence about the impact on feeding choice. We found that a lot of women were making decisions based on that marketing. We’re currently embarking on an enquiry into the cost of infant formula and we’re very keen to hear from professionals and families. That started in June, and will be hosted on the APPG website because we feel this is an area that has been missed’ (see bit.ly/APPG_inquiry).

 

Four countries’ perspective

Northern Ireland

‘We know that the ones least likely to breastfeed are young mums, and mums from significantly deprived areas; and we’ve had several generations of women when our rates were really low. Our 10-year breastfeeding strategy was implemented in 2013 with four high-level strategic outcomes: creating a supportive environment for breastfeeding (including our public intervention campaign, #NotSorryMums); ensuring that health and social care has the knowledge, skills and leadership to protect, support and normalise breastfeeding (all births now take place in ‘baby-friendly’ hospitals and four out of our five health-visiting services have full Baby Friendly accreditation); high-quality information systems to underpin policy and programmes; and an informed and supportive public.

‘I do think things have improved. The rate of breastfeeding initiation has doubled since 1990, and I think health professionals need to be kind to themselves, because in the end, the decision is up to those families.’

Janet Calvert is the regional breastfeeding lead for Public Health Agency Northern Ireland

 

Wales

‘Last summer I requested that stakeholders and key clinicians review current service provision in relation to breastfeeding in Wales, as I was aware of the static rates. This group has now reported to me and its recommendations are now being taken forward, including an infant-feeding lead in every health board who will have strategic oversight of breastfeeding across services and ensure provision of training and clinical services.

‘Across Wales there are examples of good practice that support women and families, from specialist lactation services to midwifery and health-visiting practice, and trained peer supporters working alongside maternity staff providing supervised support. A Welsh Infant Feeding Network comprising of lead clinicians, peer supporters and mothers enables shared best practice to improve future services.

‘All parents have access to highly skilled professionals to support parents with breastfeeding. Our role as government is to work with practitioners and health boards to deliver a system that responds to need, and the action plan for Wales will enable this to happen.’

Vaughan Gething is the cabinet secretary for health and social services

 

Scotland

‘We have committed to increase resources for breastfeeding. We’ve invested in a national expert post to support the implementation of the maternal and infant nutrition framework who will assist NHS boards to offer the highest standard of support for breastfeeding mothers.

‘National and local work is planned for the next three years to increase public support for breastfeeding generally, so that women feel able to breastfeed for longer and are welcome to breastfeed in public; and to support women who are facing challenges, including mothers with premature and sick babies.

‘The Scottish Government also funds a number of programmes to support breastfeeding, including several peer volunteer breastfeeding support programmes and the National Breastfeeding Helpline. We have produced dedicated resources, including the new feedgood.scot website and carried out the first Scotland-only Maternal and infant nutrition survey in 2017.’

Scottish Government spokesperson

 

England

‘Breastfeeding is one of the six High Impact Areas in our ‘4-5-6’ model for health-visiting services. We are also responsible for the prevention workstream, of the NHS-led Maternity Transformation Programme, which includes an ambition to increase the number of babies breastfed at six months. We have also published an infant-feeding commissioning toolkit, in partnership with Unicef, and data profiles so that local areas see their performance against a range of indicators.

‘We are currently working with partners to review the evidence and develop resources to raise awareness and support local improvements. Part of the evidence review includes reviewing progress against Yale University’s Becoming breastfeeding friendly index. We have new support for breastfeeding as well, in the form of our Start4Life “Breastfeeding Friend”, and the Alexa breastfeeding skill function we launched in partnership with Amazon in March this year.

‘Looking forward, we have a number of strands of work to improve the maternity pathway and to prepare parents for parenthood, including providing a new tool for professionals to support parents’ decision-making regarding infant feeding and strengthening the transition from maternity services to health visiting and primary care.’

Jane Scattergood is the midwifery adviser at Public Health England.

No formula here! Community Practitioner is the only journal in the sector that no longer accepts breastmilk substitute product advertising

Picture Credit | Shutterstock and iStock


 

References

Cheung R. (2018) International comparisons of health and wellbeing in early childhood. See: https://www.nuffieldtrust.org.uk/files/2018-03/1521031084_child-health-international-comparisons-report-web.pdf (accessed 7 June 2018).

PHE. (2017) Breastfeeding at 6 to 8 weeks after birth: annual data. See: https://www.gov.uk/government/statistics/breastfeeding-at-6-to-8-weeks-after-birth-annual-data (accessed 7 June 2018).

Scottish Government. (2018) Scottish maternal and infant nutrition survey 2017. See: https://beta.gov.scot/publications/scottish-maternal-infant-nutrition-survey-2017/pages/8/ (accessed 7 June 2018).

The Institute of Public Health in Ireland. (2017) Breastfeeding on the island of Ireland. See: https://www.publichealth.ie/sites/default/files/2017105%20Breastfeeding%20on%20the%20island%20of%20Ireland%20report%20finalf_0.pdf (accessed 7 June 2018).

Welsh Government. (2017) Births in Wales 2006 - 2016: Data from the National Community Child Health Database. See: https://gov.wales/docs/statistics/2017/170816-births-2016-data-national-community-child-health-database-en.pdf (accessed 7 June 2018).

Yale School of Public Health. (2018) Becoming Breastfeeding Friendly: A Guide to Global Scale Up. See: https://publichealth.yale.edu/bfci/BBF/benchmarks.aspx (accessed 7 June 2018).

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