Opinion

Feeding the cycle

05 June 2017

The World Breastfeeding Trends Initiative UK offers its expert comment on the state of the nation’s breastfeeding rates.

The number of women starting to breastfeed their babies in the UK has been climbing slowly since the 1980s, when initiation was around 65%, and is now around 73% in England (NHS England, 2017). Yet there is still the same steep drop-off in the first few weeks, as mothers face problems they cannot resolve themselves.

Emphatically this is not a matter of ‘choosing’ to switch to formula or mixed feeding. Many women grieve deeply for the loss of this fundamental aspect of their mothering experience, and are at a significantly increased risk of postnatal depression (Borra et al, 2015).

WBTi assessment

Using the World Breastfeeding Trends Initiative (WBTi) toolkit, a core group of organisations in maternal and infant health and infant feeding, independent of industry funding, reviews the current state of breastfeeding support in a country. It reviews the extent of implementation of the WHO Global strategy for infant and young child feeding (WBTi, 2014). Through collaboration and consensus, the core group agrees the scores, identifies gaps and generates recommendations for action. The monitoring teams contact relevant agencies and organisations to assess the 10 policy and practice indicators, while the five outcome indicators covering feeding practices use existing monitoring data.

The first WBTi UK report was launched at the Houses of Parliament in November 2016 (see full report at ukbreastfeeding.org/wbtiuk2016, and key recommendations in the table, below).

Key findings

The data reinforces what women have been saying for years: that although staff are usually kind, compassionate and well meaning, they may lack the skills and time to help a new mother feed her baby comfortably, recognise effective milk transfer and identify and resolve any issues.

The WBTi UK 2016 report highlights this skills gap and others. Many gaps are in the minimum standards of training in infant and young child feeding for nurses, specialist community public health nurses/health visitors, GPs, obstetricians, dietitians and paediatricians. These are the very professionals who deal with new mothers and babies on a daily basis.

The Unicef UK Baby Friendly Initiative training meets the NICE minimum standards (NICE, 2015), while more complex situations require a fast care pathway to a breastfeeding specialist. However, some NHS maternity and community services have not yet even engaged with the Baby Friendly accreditation process (Unicef UK Baby Friendly Initiative, 2017).

A point that seems to be regularly overlooked is the cost of admittance to hospital and associated suffering in the paediatric wards further down the line. Gastroenteritis, respiratory illness, ear infections and many other short- and long-term diseases are linked to artificial feeding, but that care is covered under a different budget. Much more joined-up financial thinking is required. Longer term, by increasing breastfeeding rates, the rise of non-communicable diseases, such as obesity and type 2 diabetes, could be significantly reduced (Renfrew et al, 2012).

What’s wrong in the UK?

It’s essential to look at the context of breastfeeding in the UK. There is a common misconception, deeply ingrained in British culture, that bottlefeeding is close to or even equivalent to breastfeeding. Formula milk advertising is likely to contribute to this perception. Once more than half the babies in an area are formula fed, bottlefeeding is in effect the social norm (Public Health England, 2017). This occurs on average in England by six to eight weeks after birth (Public Health England, 2017). There is also a massive lack of confidence in the process of breastfeeding; for example, the assumed ‘solution’ for night waking is to stop breastfeeding and substitute with formula. Some families have no recent history of breastfeeding, so for them it is an unfamiliar behaviour. Some people perceive breastfeeding as embarrassing because it involves breasts, thus confusing the sexual and nurturing functions. There have been many hostile articles in the press and, despite the 2010 Equality Act, mothers can feel very anxious, even intimidated, about feeding in public places (Public Health England and Unicef UK Baby Friendly Initiative, 2016).


WBTi UK 2016 report: key reccomendations

  • UK government to set up a permanent multi-sectoral infant-feeding body in England to develop national strategy, and the home nations to have a formal arrangement to share best practice.
  • All governments to achieve and maintain full implementation, with funding, of the Unicef UK Baby Friendly Initiative in all relevant healthcare settings.
  • All governments to fully implement and robustly enforce the International Code of Marketing of Breastmilk Substitutes and subsequent Resolutions.
  • All governments to update legislation to include breaks for breastfeeding/expressing milk and associated facilities in the workplace.
  • All health professional training bodies to set standards for health professionals that meet WHO/Baby Friendly Initiative guidelines.
  • Commissioners throughout the UK to ensure full access to skilled breastfeeding support.
  • All national infant-feeding strategies to include the collection of quality data built into health systems.

What is needed?

Families need seamless policies and programmes in place to provide support whenever needed on mothers’ breastfeeding journeys, otherwise they can fall through the gaps in services.

Streamlined support would start with birth in an accredited Baby Friendly hospital, followed by further good support in the community from well-trained health professionals – community midwives, health visitors, specialist infant-feeding leads – plus access to peer supporters and drop-in groups. These teams would work closely within an integrated network. If and when a mother goes back to paid work, there would be support from employers with breaks and facilities so that mothers can continue to breastfeed as they wish.

In the WBTi report, the low scores in so many of the key indicators for the UK show why continuation rates for breastfeeding are so poor (WBTi, 2016). There is no national policy; only partial adoption of the Baby Friendly Initiative in England and Wales, lack of health professional training and dwindling community support, to name just a few. Scotland and Northern Ireland score much higher with national policies, and all their NHS maternity units are accredited as Baby Friendly.

Acting on the WBTi recommendations (see table, left) will help to close the gaps. This involves challenging the status quo that has failed our mothers and babies (and our practitioners) for so long – and building a different future where we can support all mothers to feed their babies as they intend.


Breastfeeding in the UK

44% are breastfeeding in six weeks

74% of mothers start to breastfeed

1% of babies are exclusively breastfed until they are six months old

36% are breastfeeding at six months


References

Borra C, Iacovou M, Sevilla A. (2015) New evidence on breastfeeding and postpartum depression: the importance of understanding women’s intentions. Maternal and Child Health Journal 19(4): 897-907.

NHS England. (2017) Statistical commentary. See: england.nhs.uk/statistics/wp-content/uploads/sites/2/2014/03/STATISTICAL-COMMENTARY-Q3-201617.pdf (accessed 24 May 2017).

NICE. (2015) Postnatal care – quality standard 5: breastfeeding. See: nice.org.uk/guidance/qs37/chapter/quality-statement-5-breastfeeding (accessed 24 May 2017).

Public Health England. (2017) Official statistics. See: gov.uk/government/uploads/system/uploads/attachment_data/file/610592/2016_2017_Q3_Breastfeeding_Statistical_Commentary.pdf (accessed 24 May 2017).

Public Health England and Unicef UK Baby Friendly Initiative. (2016) Commissioning infant feeding services: part 1. See: gov.uk/governmentuploads/system/uploads/attachment_data/file/534160/Commissioning_infant_feeding_services_infographics__Part_1_.pdf (accessed 24 May 2017).

Renfrew MJ, Pokhrel S, Quigley M, McCormick F, Fox-Rushby J, Dodds R, Duffy S, Trueman P, Williams A. (2012) Preventing disease and saving resources: the potential contribution of increasing breastfeeding rates in the UK. See: unicef.org.uk/wp-content/uploads/sites/2/2012/11/Preventing_disease_saving_resources.pdf (accessed 24 May 2017).

Unicef UK Baby Friendly Initiative. (2017) Awards. See: unicefbfi.secure.force.com/Events/Awards (accessed 24 May 2017).

WBTi. (2014) WBTi assessment tool. See: worldbreastfeedingtrends.org/wp-content/uploads/2015/03/docs/questionnaire-WBTi-September2014.pdf (accessed 24 May 2017).

WBTi. (2016) WBTi UK report 2016. See: ukbreastfeeding.org/wbtiuk2016 (accessed 24 May 2017).

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