Infant feeding: the Covid effect

22 July 2020

The pandemic has caused breastfeeding support in some areas of the UK to be stripped back to the bare minimum, writes Francesca Entwistle of the Unicef UK Baby Friendly Initiative. But it’s still crucial for infant health.

reastfeeding saves lives, improves health and cuts costs in every country worldwide, rich and poor alike (Victora et al, 2016). The numerous live constituents in human milk include immunoglobulins, antiviral factors, cytokines and leucocytes, which help to destroy harmful pathogens and boost the baby’s immune system. This reduces the risk of babies developing infectious diseases.

Breastfeeding: a crisis

In April, WHO released guidance for healthcare workers on the importance of continuing to breastfeed during the pandemic, showing there is currently no conclusive evidence that the Covid-19 infection can be passed through breastmilk (WHO, 2020). Human milk is particularly important for babies on the neonatal unit as it significantly reduces the risk of serious complications related to prematurity in the short and long term.

As the effects of the crisis continue to unfold, it is clear that breastfeeding support services have been severely affected, often operating with fewer staff, restricted access and less face-to-face contact and training support. A report by Unicef, WHO and the International Baby Food Action Network (2020) highlights how countries are still falling short in protecting parents from misleading information and harmful promotion of breastmilk substitutes. This is particularly important during the pandemic when breastfeeding is vital and health systems are working hard to maintain minimum standards.

The cancellation of all face-to-face groups raised concerns that some parents may be missing out on the vital support needed to maintain breastfeeding

Feedback from CPs

The Covid-19 crisis has created new challenges for health visitors and community nursery nurses to navigate, from reduced staffing and redeployment to the replacement of face-to-face clinics with virtual appointments.

In May 2020, we conducted a survey with the National Infant Feeding Network (NIFN), a network of more than 700 infant-feeding specialists, to help us understand the changes. Staff were responding and adapting their services quickly and efficiently to provide the best possible care, but concerns remained. For example, some health professionals reported struggles in keeping up with the demand for breastfeeding support and being able to provide the care that mothers deserved. Others said that while parents regularly attended breastfeeding support clinics for reassurance and guidance before the pandemic, the cancellation of all face-to-face groups had raised concerns that some parents may be missing out on the vital support needed to maintain breastfeeding.

Coupled with reports of higher rates of early discharge from the delivery or postnatal units without sufficient face-to-face time to establish breastfeeding and/or instances of parents declining face-to-face contact entirely due to infection control concerns, understanding how these challenges posed during the pandemic will affect breastfeeding rates in both the short and long term is going to be vital.

Overcoming the challenges

To help health visitors to continue to provide the best levels of care they can in these difficult times and to ensure that mothers receive the support they deserve, the Unicef UK Baby Friendly Initiative has produced a suite of reference guides and educational updates designed to be quick and easy-to-use and which allow staff to deliver evidence-based infant feeding care remotely. These include statements, guidance documents, education refresher sheets and frequently asked questions for health professionals to help them support families.  

These resources centre around helping health professionals to provide remote care, including planning and carrying out virtual conversations on infant feeding in the antenatal and postnatal periods and assessing and offering solutions for common challenges. These materials were also published in response to the need for quick educational updates for staff, including return-to-practice nurses, HV students who have been fast-tracked to practice, or healthcare assistants redeployed into postnatal care within community settings.

As the pandemic continued, it was clear that further support for communities was needed. In partnership with the First Steps Nutrition Trust and the NIFN, Unicef UK produced guidance for local authorities highlighting the need for a clear pathway for the protection of breastfeeding and infant formula distribution as part of the local authority emergency food provision system.

What next?

The Baby Friendly team are conducting a follow-up survey of the NIFN to learn from the adaptations made during the pandemic, to identify promising practices, to understand the impact of changes and to predict how services might look when we come out of the pandemic and into the ‘new normal’. In addition, virtual Baby Friendly courses and remote-based Baby Friendly assessments will be launched in the autumn alongside online webinars, seminars, lectures, podcasts and case studies sharing good practice.    

Francesca Entwistle is the policy and development officer for the Unicef UK Baby Friendly Initiative. 

Since 1994, the Baby Friendly Initiative has set evidence-based  standards for health services to ensure babies, their mothers and families receive the best care possible around infant feeding and developing a close and loving relationship with their baby so that all babies get the best possible start in life. 



Victora CG, Bahl R, Barros AJD, França GVA, Horton S, Krasevec J, Murch S, Sankar MJ, Walker N, Rollins NC. (2016) Breastfeeding in the 21st century: epidemiology, mechanisms and lifelong effect. The Lancet 387: 475-90. See:  https://www.bpni.org/Article/Breastfeeding-in-the-21st-century-epidemiology-mechanisms.pdf (accessed 16 June 2020).

WHO. (2020) Frequently asked questions: breastfeeding and COVID-19 for health care workers. See: https://www.who.int/docs/default-source/maternal-health/faqs-breastfeeding-and-covid-19.pdf?sfvrsn=d839e6c0_1&fbclid=IwAR1mi_truhdeeI9i7ejiSWmBf5SQRppTBbf5EVBdZEs5L-uCFsCBOVd7rNo (accessed 16 June 2020).

WHO, Unicef, IBFAN (2020) Marketing of breast milk substitutes: national implementation of the international code, status report 2020. See: https://www.who.int/publications/i/item/9789240006010 (accessed 16 June 2020).

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