More on Indicator 1 – National Policy, Programme and Coordination

Two weeks ago representatives of the key organisations involved in breastfeeding sat round a table to begin the first UK assessment using the World Breastfeeding Trends initiative tool.

In the first presentation, this graphic popped up, and a collective “ooh” and then an “aah” went round the room. You may be forgiven for wondering why it generated such a response – it doesn’t look particularly inspiring!


gear model
Credit: Pérez-Escamilla et al, Advances in Nutrition, Nov 2012

It’s because this picture demonstrates what happens when there is a strong national strategy on breastfeeding – and also what happens when there isn’t.

In the late 1990s, Brazil made a concerted effort to improve infant health through a drive to increase breastfeeding rates in the country. They put in place legislation to protect mothers, training for health professionals, breastfeeding promotion – along with the money to pay for it all. And they had a national coordinated breastfeeding strategy to make it happen.

At the same time, Mexico had no such national strategy. Half-hearted efforts were made in some areas, such as training for health professionals and public promotion of breastfeeding.

As the graphs show, Brazil was able to significantly increase breastfeeding rates over that period while in Mexico they stagnated.

Without a strong, national, coordinated breastfeeding strategy to drive things forward, everything else is just wheels turning in the wind.

That’s the metaphor – what does this all mean in practice for the UK?

Let’s imagine a mother, who has her baby in a Baby Friendly hospital [1] and breastfeeding gets off to a good start. But then she arrives home and starts to experience some problems. Her health visitor suggests she gives the baby some formula [2]. She’s seen some adverts on television and buys a particular brand of formula because it’s “closer to breastmilk” [3]. She lives in a rural area, and the nearest breastfeeding support group is 10 miles away and she doesn’t drive [4]. Her husband has seen the adverts too so he knows that “good dads do the night feeds” [5]. After a couple of weeks the baby is getting more and more formula and is breastfeeding less and less. Her husband suggests she’s given breastfeeding a good go but maybe she should stop now [7]. She had wanted to breastfeed for longer but she gives up [8].

  1. Indicator 2 of the WBTi asks – are babies born in Baby Friendly hospitals?
  2. Indicator 5 asks – do health professionals have adequate breastfeeding training?
  3. Indicator 3 asks – is the International Code of Marketing of Breastmilk Substitutes fully implemented?
  4. Indicator 6 asks– do all mothers have access to breastfeeding support in the community?
  5. (see Indicator 3)
  6. Indicator 7 asks – do parents have access to good information about breastfeeding and the risks of using formula?
  7. Indicator 12 asks – what percentage of babies are exclusively breastfed for the first six months?

Without this central cog (Indicator 1) driving all the other cogs (Indicators 2-10) things cannot move forward. This point is also made clear in a new report from Save the Children, which looked at breastfeeding policies and practices in six countries, including the UK.

The WHO Global Strategy on Infant and Young Child Health (which the UK is signed up to) states that each country should have:

  • a national breastfeeding policy
  • a plan of action based on that policy
  • that plan must be adequately funded
  • there needs to be a National Breastfeeding Committee
  • that committee must meet on a regular basis to review progress
  • that committee needs to link effectively with public health bodies
  • that committee must have a coordinator who communicates national policy at regional and local levels

Indicator 1 of the WBTi assessment asks whether a country has each of the above and gives a total score out of 10. How well do you think the UK as whole will score? How would the countries of the UK score individually? What do we need to do to improve that score? How can policies be turned into actions at a local level?

Post your comments below or on our Facebook page.

In the next blog post we will be talking about Indicator 2 – Baby Friendly care and Baby-Friendly Hospital Initiative and will be asking for your thoughts about how things can be improved.

3 thoughts on “More on Indicator 1 – National Policy, Programme and Coordination

  1. This article completely reflects my experience with regards breastfeeding, had it not been for my stubborn streak I definitely would not still be exclusively breastfeeding my 6 month old son. I found there was a huge gap in the knowledge of health care workers with regards breastfeeding and dealing with problems That I encountered. I had recurrent mastitis and was repeatedly given incorrect medication from doctors. My son had a tongue tie and s lip tie which were contributing to our problems neither of which were picked up by health care workers. In our community there is a breastfeeding support group which has been very helpful to meet like minded mums, but I fully agree that the knowledge base is not ingrained across the board and I found doctors saying things like “some of us weren’t meant to breastfeed ” This really upset me as a first time mum who wanted to do the best for her son. I even had a midwife in the hospital slip my husband some formula “just in case” . This message of expected failure will definitely be having a huge impact on the number of infants that are being exclusively breastfed and in undermining the confidence new mothers who want to do the best for their infants. Let’s hope there can be progress within the UK.

    Liked by 1 person

  2. Great post.

    But to make this happen, we need money: And not just money on “more health visitors” (although we need that too) – but specifically, money on people who work behind the scenes. The back-office staff whom Cameron is so keen for us to sack. The “co-ordinator” posts. The people with a wealth of experience in health promotion strategies who attend conferences and meet regularly to discuss and disseminate information. A national strategy, co-ordinated with international leaders.

    The politicians could enable all this to happen, if they funded it. The political will has to support this; it’s a resolvable issue, but it needs serious support if it’s going to happen.

    £££ on leadership in breastfeeding will save £££££££££££££. Are the politicians willing to support it?


    1. Couldn’t agree more! We were talking about this very topic today at the meeting of the WBTi UK partners. We hope that our report will spur this action, but we will need help from people like you, Melanie to push it through and make sure their MPs are arguing the case.


Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s