Improving UK support for breastfeeding – using a river metaphor

I was very pleased to have the opportunity at the 9 May iHV conference to present the broad findings of the World Breastfeeding Trends Initiative (WBTi) 2016 UK assessment of the state of support for breastfeeding, using the metaphor of a river. The WBTi UK Steering Group is keen to raise awareness of its 2016 report so that the findings can be used locally and nationally for change. National Breastfeeding Celebration Week provides an opportunity to be proud of what has been achieved but it is also important to be mindful of what still needs improving in supporting and protecting breastfeeding.

Any efforts to improve a situation require a thorough assessment of the current situation first. A WBTi assessment considers ten policy and programme indicators, drawn from the 2003 WHO Global Strategy on Infant and Young Child Feeding. Each indicator is scored on how well it is implemented, and gaps and recommendations are identified. The Steering Group collaborates with a core group of representatives of relevant organisations, such as professional organisations, charities and government departments, to achieve consensus on the various elements of the report. Nearly 100 countries have carried out this process so far.

	Indicator name	UK score out of 10
1	National policy, programme and coordination	1
2	Baby Friendly Initiative	7.5
3	Implementation of the International Code of Marketing of Breastmilk Substitutes	6
4	Maternity Protection	6.5
5	Healthcare systems (primarily health professional training)	5.5
6	Community-based support	7
7	Information support	5.5
8	Infant feeding and HIV	6.5
9	Infant feeding during emergencies	0
10	Monitoring and evaluation system	5

In the metaphor, the mother’s breastfeeding journey is represented by stepping stones across the river. The stepping stones stand for the people who provide the mother with direct support, such as family and friends, midwives, maternity support workers, health visitors, peer supporters, breastfeeding counsellors, and lactation consultants. The Health Visitor’s role is crucial as the service is universal and she can both signpost as well as give direct support.

The river itself is the flow of intermingling influences on the mother’s infant feeding decisions – these start in her infancy at the head of the river and include the later factors categorised as the WBTi indicators. A dam represents the legal protections – in the UK these include protection from formula advertising for babies under 6 months (Indicator 3) and maternity leave and protected breastfeeding/ expressing rights at work (Indicator 5).

The riverbanks represent other Indicators, such as the extent of national leadership (Indicator 1), health professional training (Indicator 5) and data collection on breastfeeding rates (Indicator 10). A weak riverbank that looks stable is particularly risky and is like a trusted health professional with inadequate knowledge and skills.

Strengthening the dam and riverbanks would mean that the mother is much less likely to be knocked off the stepping stones, so much more likely to achieve her breastfeeding goals. To have greatest impact, there needs to be concurrent improvement on the different Indicators, otherwise there will still be too great a flow of negative influences over the stepping stones.

#CelebrateBreastfeeding

June 2019

Patricia Wise is an NCT breastfeeding counsellor and a member of the WBTi Steering Group.