Breastfeeding – what does it take?

Beautiful African mother kissing her babyBreastfeeding is in the news – with World Breastfeeding Week starting this week on August 1st, a new survey has revealed the severity of cuts to the breastfeeding support that UK mothers rely on – 44% of local authority areas in England are affected by recent recent cuts. The UK leads the world – with the lowest breastfeeding rates anywhere by one year.

So what? Does that really matter?

Just ask the 80% of mothers who have had to stop breastfeeding in the first 6 weeks before they wanted to, because they were struggling and no one knew how to help, according to the 2010 Infant Feeding Survey.,

Just ask public health departments, struggling to deal with rapidly rising obesity, and with a significant percentage of mothers struggling with poor mental health – their risk of postnatal depression doubled by the lack of skilled breastfeeding help according to Borra et al’s research published in 2015.

Just ask the NHS, struggling to cope with over £40 million costs of more GP appointments, antibiotics, and even hospitalisation for just a few of the diseases that breastfeeding could help prevent in women and children (Renfrew: 2012).

Ask the economists, who see overall costs to the economy in the billions, with overall productivity and cognitive ability costs 0.53% of GDP across the population, as described in the 2016 Lancet series on breastfeeding by Rollins et al.

Just ask that one mother, who struggled though sleepless nights, painful nipples, and a crying baby – who was just told “just keep feeding” as her baby’s weight dropped until she was told to “just give a bottle”, who had no friendly and knowledgable circle of experienced breastfeeding mums to support her, who had no access to a skilled lactation specialist to resolve her problems. Once her baby was formula fed, there was no one to advise her on that either. Did it matter to her?

Yes, how we feed our babies matters. It matters for our health and our baby’s health, it matters for our society’s overall wellbeing, it matters for our planet.

What does it take to create a society where feeding babies is valued and supported?

The UK government signed up long ago to a Global Strategy for Infant and Young Child Feeding, developed by the World Health Organisation and UNICEF.

This outlines the kinds of policies and programmes that are proven to support healthy infant nutrition.

The WBTi (World Breastfeeding Trends Initiative) helps each country to find the gaps in their own services, and to make recommendations to improve support for families along the whole feeding journey, from birth to home and community support, from health professional training to maternity protection at work. You can see the full UK report (Part 1) and supplementary material (Part 2) on the website.

Key findings

Below are some key WBTi findings in the UK, listed by indicator.

These are among the most urgent issues to address in order to improve support for all families in the UK.

Please contact your local public health department, your council and commissioners, and your MP to let them know what families in YOUR area need!

Indicator 1: National policy, programme and coordination

There is no dedicated strategic or clinical infant feeding leadership or strategy in England, and although Scotland and Northern Ireland have strategic leadership, there is no formal joint working or communications across nations. The governments and public health agencies of England, Scotland and Wales have however now committed to a national review of breastfeeding policies and programmes through the Becoming Breastfeeding Friendly project, in order to scale up breastfeeding interventions.

Indicator 2: Baby Friendly Initiative (BFI)

The Baby Friendly Initiative is not mandated across maternity settings in England, although Scotland has now reached 100% BFI accreditation, in both community and maternity services.

Indicator 3: International Code of Marketing of Breastmilk Substitutes

The World Health Assembly International Code is still only partially enacted in UK law, and hardly enforced. Marketing of baby milks and baby food, bottles and teats remains pervasive.

Indicator 4: Maternity protection

Although parents in the UK generally have paid maternity leave, new mothers have no rights to flexible breaks or facilities to breastfeed or express milk. Maternity Action is highlighting this issue in its campaign to reduce maternity discrimination.

Indicator 5: Health professional training

High level universal standards for most health professions in the UK have many gaps with regard to infant feeding (both breastfeeding and bottle feeding). Work is going on to update standards over time. If you are a health professional, please support your regulatory council or Royal College to address these gaps.

What does your doctor know about breastfeeding?
Mapping of pre-registration health professional training against the WHO Education Checklist

Indicator 6: Community-based support

In 2016, the WBTi report was the first to map out the provision of trained breastfeeding support by the UK voluntary organisations, along with cuts that were happening in community breastfeeding support (see Part 2 of the WBTI report, pages 28-32). An updated survey of cuts to community breastfeeding support has been released this week by Better Breastfeeding.

Indicator 7: Information support

Some parts of the UK have started to observe a national breastfeeding week or World Breastfeeding Week, although not all NHS information on breastfeeding is accurate or up to date

Indicator 8: Infant feeding and HIV

The UK is one of few developed countries to have HIV policies that incorporate the most recent WHO guidance, although many health professionals are not trained in them.

Indicator 9: Infant and young child feeding during emergencies

There is currently no central guidance on caring for infants in emergencies, and many local areas lack specific plans. The WBTi team is producing a policy brief and recommendations with the University of Sussex Law School.

Indicator 10: Monitoring and evaluation

Current data collection is weak and there are still many gaps in the new datasets on maternal and infant health. It is essential to include not only breastfeeding initiation and rates at 6-8 weeks, but also continued breastfeeding at 6 months and beyond.

‘Success in breastfeeding is not the sole responsibility of a woman – the promotion of breastfeeding is a collective social responsibility.’ 

Rollins, The Lancet



Credit: banner photo Adobe Stock


Helen Gray IBCLC photo

Helen Gray IBCLC is Joint Coordinator of the World Breastfeeding Trends Initiative (WBTi) UK Working Group. She is on the national committee of Lactation Consultants of Great Britain, and is also an accredited La Leche League Leader. She represents LLLGB on the UK Baby Feeding Law Group, and serves on the La Leche League International special committee on the International Code.

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