WBTi UK report – first anniversary celebration – a Forum

WBTi UK report – first anniversary celebration – a Forum

It’s a year since the first WBTi UK report was launched in November 2016 at the Houses of Parliament, giving the first snapshot of the state of breastfeeding support in the UK across the indicators. The report has been used as a basis to advocate for improvements in legislation, in strategy, and in training. It has been shared with MPs, with government ministers, as well as shared widely throughout the breastfeeding community through our website.

During the year, we have hosted monthly blogs on our website, focussing on the various indicators in turn. We have an active social media planning group that publicises the WBTi findings, our blog and activities. The team have also produced numerous journal articles, posters and conference presentations in the UK and beyond. Our talented team of volunteers have also developed a video  about our findings. We continue to contribute to ongoing consultations about improving health professional training in infant feeding

OLYMPUS DIGITAL CAMERA

Policy Forum: Protecting Infants in UK Planning for Emergencies

On November 28th 2017, we will be holding a policy forum at the Houses of Parliament, in collaboration with Ruth Stirton of the University of Sussex and hosted by Alison Thewliss MP: “Protecting Infants in UK Planning for Emergencies.” This event both celebrates the anniversary of the report and aims to achieve change in Indicator 9, “Infant and young child feeding during emergencies,” which is the policy with the lowest scores across the UK. At present, there are no UK-wide or national strategies addressing the issue and it is not explicitly mentioned in local planning.

Unicef UK Baby Friendly Initiative

The jewel in the crown of breastfeeding support in the UK is the Unicef Baby Friendly Initiative. All maternity units in Scotland and Northern Ireland are accredited and most in England and Wales are working towards it. Many community NHS trusts and boards are also on the ladder towards accreditation. Some neonatal units, university midwifery and health visiting/specialist community public health nursing courses are also involved. All are helping to raise the standards of infant support provided by these health professionals.

Cuts to breastfeeding support around the country

Sadly, the WBTi assessment found that cuts in infant feeding lead posts, drop-ins and peer support programmes as well as specialist services were occurring and this has continued. For example, Blackpool’s service was decommissioned in June and the service in Kent is under threat. It appears that there is an assumption by some commissioners that health visitors can provide a sufficient service. Health visitors do have a responsibility to provide effective support with infant feeding, and should do so at statutory visits and other contacts. However, a significant number of mothers also require specialist support, which needs time as well as skill, and all mothers can benefit considerably from the social support that trained peer supporters can provide. It seems it is not well understood how challenging some breastfeeding situations are and the amount of training required to help effectively in those situations.

Ask YOUR MP to join the Call to Action!

These cuts in services for women and babies are likely to have a negative impact on Baby Friendly accreditations. Unicef UK is holding an event for MPs at the Houses of Parliament on December 5th, asking them to pledge their support for breastfeeding. How would it be if every current MP were contacted? Are you willing to contact your MP?

 

 

 

Using data to help all children reach their potential

Using data to help all children reach their potential

Indicator 10: Mechanisms of Monitoring and Evaluating Systems:

Are monitoring and evaluation data regularly collected and used to improved infant and young child feeding practices?

In last month’s blog Patricia Wise explained how monitoring and evaluating breastfeeding rates is the 10th and final indicator of any World Breastfeeding Trends Initiative report, including the UK one . This blog shows how the data can be used as a tool to inform decision-making, especially for commissioning services, to reduce inequalities in child health.

Public Health datasets

Public Health England Early Years Profiles  allow for measures of infant health based on International Classification of Diseases codes (ICD10) to be tracked over time and compared with statistically similar areas across England. It needs local knowledge to interpret findings as you are looking for patterns, or signals, in amongst the noise of coding and other errors. Decision-making is hard when there are gaps or significant errors in the data so it is worth spending time with all involved to improve the quality of the data.

As an example, Northumbria Healthcare NHS Foundation Trust recently received the first Health Visiting Baby Friendly Achieving Sustainability Gold Award, demonstrating a long term commitment to implementing the Unicef UK Baby Friendly Initiative. The Trust is in the 4th most deprived decile (a decile is 1/10 of the population) in England (IMD2010) so a good example of what can be achieved in communities with areas of disadvantage.

In the Northumberland PHE area (which includes Northumbria NHS Trust), breastfeeding prevalence rates at 6-8 weeks have increased 2 percentage points between 2010/11 and 2014/15. Opportunities for assessing wider measures of child health from the Early Years Profiles are limited so Northumberland is unusual in having data available for gastroenteritis hospital admissions for two consecutive years. These reduced from 29 per 1,000 babies under one in 2014/15 to 19 per 1,000 in 2015/16. Other factors will also contribute but there is good evidence that breastfeeding reduces the incidence of gastroenteritis  and associated NHS cost savings have been calculated .

Comparing Northumberland to neighbouring trusts in the graph below, its hospital admission rate for gastroenteritis sits on the regression line. Darlington and North Tyneside have more admissions (32/1,000 and 31/1,000) while Gateshead has similar admissions to Northumberland at 20/1,000. However, all these four areas have similar breastfeeding rates. Local knowledge is key though to trying to understanding differences as South Tyneside has a low admission rate at 11/1,000 with lower breastfeeding rates.

 

Breastfeeding prevalence at 6-8 weeks compared with hospital admissions for infants with gastroenteritis in the North East Region

Gastro_plain
Figure 1:
X axis =Breastfeeding prevalence at 6-8 weeks – previous method
Y axis = Admissions for gastroenteritis in infants under 1 year
https://fingertips.phe.org.uk/profile-group/child-health/profile/child-health-early-years/data#page/10/gid/1938132986/pat/6/par/E12000001/ati/102/are/E06000057/iid/20202/age/170/sex/4 [accessed 13 November 2017]
(Link defaults to A&E attendances so Y-axis needs resetting each time to ‘admissions for gastroenteritis under 1 year’. You can vary the Area on the interactive chart, as in the table below, to see each of them highlighted as a black diamond. Areas mentioned in the blog are highlighted in bold in the table.)

Using the Public Health England data

The graph on the PHE site is interactive. Comparing breastfeeding rates at 6-8 weeks with gastroenteritis rates for under 1 year olds shows the prevalence of gastroenteritis decreases as breastfeeding rates increase, as seen by the regression line. However, the variations in hospital admission rates also reduce and stabilise as the breastfeeding prevalence rates exceed approximately two thirds of the population. The reason for this is not clear. It could be an indication of a longer average duration of breastfeeding, or more exclusive breastfeeding within the population or other factors. The differences between similar communities indicate these admissions can be reduced. Since October 2015 the breastfeeding data have been obtained via interim reporting arrangements to collect health visiting activity at a local authority resident level. This new method is not comparable with the previous method so it will take some time to understand any future trends (PHE Definitions for indicator 2.02ii, Indicator ID 20202).

 

“In health care, geography is destiny”

Reducing these unnecessary variations in breastfeeding improves child health, helping to reduce inequalities (WBTi report p4). The impact of cuts to peer support, health visiting teams and Children’s Centres may be demonstrated within the PHE data through increasing demand for hospital services. Where children grow up influences their health.

“In health care, geography is destiny” (Wennberg, 2010).

 

 

North East Area Breastfeeding Prevalence Rate 6-8 weeks previous method (%) Admissions for gastroenteritis in infants under 1 year / per 10,000 Admissions for gastroenteritis in infants under 1 year / per 10,000
                 2014/15 2014/15 2015/16
County Durham 28.9 339.6 312.7
Darlington 34.2 515.0 316.8
Gateshead 37.2 227.2 204.3
Hartlepool 20.2 300.5 364.5
Newcastle 46.2 348.6 201.1
Northumberland 38 292.7 185.5
North Tyneside 38.5 393.3 307.6
South Tyneside 24.4 244.3 108.8
Stockton-on-Tees 29.6 230.6 300.5
Sunderland 26.2 355.3 259.8
*Middlesbrough and Redcar and Cleveland have been omitted from the table as the previous method of collecting breastfeeding data was not available.
Data on gastroenteritis and explanation on definitions available at
https://fingertips.phe.org.uk/profile-group/child-health/profile/child-health-early-years/data#page/4/gid/1938132994/pat/6/par/E12000001/ati/102/are/E06000003/iid/92517/age/170/sex/4

 

References

Renfrew, MJ, Pokhrel S, et al. Preventing disease and saving resources: the potential contribution of increasing breastfeeding rates in the UK. Unicef UK BFI

https://www.unicef.org.uk/babyfriendly/wp-content/uploads/sites/2/2012/11/Preventing_disease_saving_resources.pdf

Accessed 16 November 2017-11-16.

Rollins N, Bhandari N et al (2016) ‘Why Invest, and What It Will Take to Improve Breastfeeding Practices?’ The Lancet 387: 491–504.

http://www.thelancet.com/series/breastfeeding

Accessed 15 November 2017

Victora CG, Bahl R et al (2016) ‘Breastfeeding in the 21st century: Epidemiology, Mechanisms, and Lifelong Effect’ The Lancet Series: Breastfeeding 1 387(10017): 475–490

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)01024-7/fulltext

Accessed 15 November 2017

Wennberg, J. E. (2010). Tracking medicine: a researcher’s quest to understand health care, Oxford, Oxford University Press.

 

 

Phyll_photo_IMG_4794-1

Phyll Buchanan is a Breastfeeding Network Supporter, tutor and trustee.

Phyll has completed her MSc in Evidence-based Health Care.

Data matters: How do we know what’s happening with breastfeeding?

Data matters: How do we know what’s happening with breastfeeding?

Indicator 10 of any World Breastfeeding Trends Initiative report is about that country’s monitoring and evaluation systems. It may not seem an exciting topic but it’s essential to collect robust data on infant feeding to know what the breastfeeding rates are and how mothers are experiencing services. Without having monitoring data how can services be evaluated and then improvements planned?

For small projects, feedback from mothers may be the most effective evaluation but for larger projects and sizeable areas, the percentages of babies being breastfed (called prevalence) at particular ages help to monitor what is happening. Figures don’t capture the ripple effect of support, though, such as a mother who’s been helped on her breastfeeding journey then supporting friends or being more likely to breastfeed a subsequent baby or deciding to train as a peer supporter.

The WBTi UK report in 2016  found that data collection and analysis had reduced considerably since the ending of the 5-yearly infant feeding survey. There is variation between the four nations with England collecting the least data.

Changing systems in England

In England, record level data on infant feeding is currently submitted by service providers to NHS Digital as part of the Maternity Services Dataset (initiation/first milk feed) and the Children and Young People’s Health Services Dataset (6-8 weeks). Whilst these new datasets are reaching full maturity, NHS England and Public Health England are publishing official statistics on an interim basis for breastfeeding initiation and breastfeeding at 6-8 weeks respectively. Both sets of data are assembled from aggregate data submitted on a voluntary basis by service commissioners. These two breastfeeding indicators are included in the Health Improvement part of the Public Health Outcomes Framework (https://fingertips.phe.org.uk/profile/public-health-outcomes-framework).

Data on infant feeding at birth are submitted by maternity units. Babies were previously counted as breastfeeding if they went to the breast at least once in the first 48 hours. However, this is now changing to a record of the baby’s first milk feed. This is captured as part of the Maternity Services Dataset and NHS Digital publishes monthly reports on the statistics of all the indicators in the data set: as well as annual data.

Local authorities have responsibility for ensuring that their commissioned providers of the universal health visiting service submit infant feeding data for babies aged 6-8 weeks as part of the Children and Young People’s Health Services Dataset (which is about to be renamed the Community Services Dataset). As this data collection is not yet mature, aggregate infant feeding data is submitted to PHE on a quarterly basis. Official statistics are produced annually and quarterly

The Early Years part of PHOF, including these indicators, is maintained by the National Child and Maternal Health Intelligence Network.

In theory, the information at 6-8 weeks provides a picture of what is happening for the whole population but, disappointingly, there are quite a number of gaps. In most cases the local authority submits data to PHE but it cannot always be published as official statistics as a result of validation failures. This is most often due to too many records of ‘unknown’ breastfeeding status.

In one area, the health visiting service has found a solution to this by including a mandatory field on infant feeding in the electronic record of the questions about maternal mood at 6-8 weeks.

There needs to be information on at least 95% of the eligible population of babies (called coverage) to be valid and thus included. This results in some gaps in the published statistics even though the underlying data is available.

 

Try it yourself!

There is now a facility to compare different sets of the annual data, such as comparing gastrointestinal or respiratory infection rates with breastfeeding rates. §If there is sufficient correlation between two datasets, a red line appears. It doesn’t prove there’s a causal link though. You can try this for yourself here:
You select the Region, Area and Indicator you are interested in and then another Indicator for the Y-axis. You need to tick ‘add regression line’ to see if there is a correlation.

Using data to advocate for services

However, even if a service is well-evaluated, that does not guarantee its continued existence, as occurred with the Blackpool peer support Star Buddies programme, although this can be a useful tool in challenging actual or proposed cuts. Zoe Walsh, in her speech to Blackpool council (at 4mins 30s in the recording) in September 2017 used data as part of her clear explanation of why the service needs to be reinstated.

Data collection counts!

 

Cover photo credit: Paul Carter

30. Photo for WBTi MAINN presentation

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

Protecting all infants in emergencies: Indicator 9 in the WBTi report

Protecting all infants in emergencies:  Indicator 9 in the WBTi report

The World Breastfeeding Trends Initiative (WBTi) assessment looks at the state of national policy, programmes and planning around infant and young child feeding (IYCF) in each country.

Indicator 9 focuses on national planning for the protection of infants and young children in case of emergency: is there a strategy in place to ensure that suitable nutrition and support is quickly put in place for families in the event of a disaster?

Infants and young children are our most vulnerable citizens in any emergency situation. They need protection, as their immune systems are immature, they have specific nutritional requirements, and they can’t wait several days for an emergency response to meet their needs, especially in a high-risk setting.

Disasters and emergencies in the UK

The UK is not immune from disasters. These can range from storms and flooding, to catastrophic fires and terrorist incidents. 

Ind 9 Trickey Gray

Helen Gray from the WBTi team has co-written, with Heather Trickey, a blog on the need for the protection of infants and young children in emergency situations

 

 

 

More recently, in response to the arrival of Hurricane Ophelia in Ireland and the UK, the WBTi team has joined in setting up a social media awareness campaign on protecting infants and young children in emergencies, using memes like the one below to communicate key concepts on the Safely Fed UK Facebook page.

Safely Fed UK Power Outage

Ind 9 global

 

Gaps in policies worldwide

Yet around the world, the WBTi global report has found that planning for infants in emergencies is one of the weakest policy areas in infant feeding in many countries.

 

 

 

 

 

Global guidance and recommendations

The World Health Assembly (WHA), composed of delegations from all our countries, has recognized the importance of including planning for infants and young children in all disaster-preparedness planning. WHA Resolution 63.23 calls on all nations to incorporate the international standards outlines in the Operational Guidance on Infant Feeding in Emergencies

Ops Guidance IFE 2017

 

The newest update of the Operational Guidance has just been published by the international Infant Feeding in Emergencies Core Group, which brings together leading humanitarian organisations and experts working in this field.

 

 

 

Planning for the protection of infants in emergencies in the UK

The WBTi assessment of UK policy in 2016 found that there is no central national strategy on infant and young child feeding in emergencies, but that emergency planning is devolved to local areas.

(See Indicator 9 on UK policy on planning for infants in emergencies here ) 

Our first Anniversary Forum, to be hosted by Alison Thewliss MP, chair of the All Party Parliamentary Group on Infant Feeding and Inequalities, at the Houses of Parliament in November, will bring together emergency planners, members of Local Resilience Forums, government agencies, researchers and infant nutrition specialists to explore how protecting infants and young children can be woven into the UK emergency-preparedness system.

In December, the Lactation Consultants of Great Britain will be hosting a specialist training on infant feeding in emergencies in developed countries, led by the Safely Fed Canada team, aimed at public health officials, emergency planners, specialist health visitors working with vulnerable populations and refugees, and infant feeding leads.

Disasters can and do occur in the UK, and we need to be prepared.

Banner illustration:
Created by Michelle Pensa Branco from Safely Fed Canada for Safely Fed UK: Infant and Young Child Feeding in Emergencies Facebook page 

 

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.

 

 

Sustaining breastfeeding together: Partnerships for the Goals

Sustaining breastfeeding together: Partnerships for the Goals

The theme for this year’s World Breastfeeding Week  is all about the importance of building multi-level partnerships to work together to support and protect breastfeeding and achieve the UN’s Sustainable Development Goals.

The final Sustainable Development Goal, number 17, calls for cross sectoral and innovative multi-stakeholder partnerships to achieve sustainable development.

Research has shown that the most effective way to improve breastfeeding rates is to implement policies and programmes at every level, from hospital to home and community, with support available from health professionals, peer supporters, friends, families and society.

One of the main WBTI recommendations outlines how this could be led from the top in the UK:

A national sustainable Strategy Board, including representatives from all the voluntary groups, health professional organisations, and NGOs to share best practice between devolved nations coordinated by a high level funded lead specialist.

A good breastfeeding journey for a family begins with birth in a Baby Friendly accredited hospital, and continues at home, surrounded by supportive family and friends, with easy access to skilled health professionals and mother support groups in the community. Once they return to work, mothers are supported by their employers to continue to breastfeed as long as they wish. Legislation protects families from misleading marketing by the baby feeding industry, and ensures safe and high quality breastmilk substitutes are available for those babies who need them.

A strong partnership between all sectors is essential to supporting families throughout their journey. The WBTi project was centred around building a strong partnership between organisations and agencies involved in maternal and infant health in order to monitor and assess the UK’s implementation of key infant feeding policies and programmes. The decision-making Core Group was responsible for determining the gaps and recommendations for the WBTi report and its member organisations had to be free from conflict of interest with regard to funding from the formula, baby food, bottle and teat industries. Organisations covering the full spectrum of maternal and infant health were invited to participate in the wider WBTi consultation.

Together, we can build a better future for Britain’s babies.

 

The WBTi Core Group

Association of Breastfeeding Mothers   https://abm.me.uk/

Baby Feeding Law Group    www.babyfeedinglawgroup.org.uk/

Baby Milk Action www.babymilkaction.org/

Best Beginnings   www.bestbeginnings.org.uk/

Breastfeeding Network   www.breastfeedingnetwork.org.uk/

Child and Maternal Health Observatory   www.herc.ox.ac.uk/downloads/health_datasets/browse-data-sets/child-and-maternal-health-observatory-chimat

Department of Health   www.gov.uk/government/organisations/department-of-health

First Steps Nutrition   www.firststepsnutrition.org/

Institute of Health Visiting ihv.org.uk/

Lactation Consultants of Great Britain   www.lcgb.org/

La Leche League GB   www.laleche.org.uk/

Maternity Action www.maternityaction.org.uk/

Northern Ireland infant feeding lead

NCT   www.nct.org.uk/

National Infant Feeding Network www.unicef.org.uk

Public Health England  www.gov.uk/government/organisations/public-health-england

Scotland Maternal and Infant Nutrition Coordinator www.gov.scot/

Start4Life www.nhs.uk/start4life/

Unicef UK Baby Friendly Initiative www.unicef.org.uk/babyfriendly/

 

Other organisations who participated in the WBTi consultation

British Dietetic Association. https://www.bda.uk.com

Cabinet Office https://www.gov.uk/government/organisations/cabinet-office

Department of Health http://www.gov.uk

General Medical Council  http://www.gmc-uk.org

General Pharmaceutical Council   https://www.pharmacyregulation.org

Nursing and Midwifery Council   https://www. nmc.org.uk

Public Health Agency Northern Ireland www.publichealth.hscni.net/

Public Health Scotland   http://www.gov.scot/

Public Health Wales http://www.wales.nhs.uk/

Royal College of General Practitioners http://www.rcgp.org.uk

Royal College of Midwives http://www.rcm.org.uk

Royal College of Paediatrics and Child Health https://www.rcpch.ac.uk

Royal College of Obstetricians and Gynaecologists http://www.rcog.org.uk

Unite, the Union of Community Practitioners and Health Visitors Association www.unitetheunion.org/

U K Standing Conference on Specialist Community Public Health Nurse Education

 

Relevant quotes:

The Lancet Series on Breastfeeding concluded that breastfeeding is the responsibility of all of society, not just the individual woman. http://www.thelancet.com/series/breastfeeding

It takes a village to raise a child………so says the African proverb.

UK Shadow Health Minister Jon Ashworth recently said ‘Children’s health is central to improving wellbeing and economic status of a country’.

 

By Clare Meynell and Helen Gray

Joint Coordinators

WBTi UK Working Group

#KingsBrelfie for World Breastfeeding Week 1– 7August

#KingsBrelfie for World Breastfeeding Week 1– 7August

World Breastfeeding Week (WBW)  (#WBW2017) takes place from 1 – 7 August 2017.  It is an initiative led by The World Alliance for Breastfeeding Action (WABA), supported by UNICEF, the World Health Organisation (WHO), and many breastfeeding organisations worldwide. It is now in its 25th year and it is all about working together for the common good.

In 2016 WABA started the journey to achieving the United Nations’ Sustainable Development Goals  (SDGs) by demonstrating the importance of breastfeeding to each SDG.  However, these goals cannot be achieved without strong partnerships at all levels.  The theme of SDG 17 is “Partnerships for the Goals”, which highlights the vital importance of partnerships between all organisations working towards a sustainable future. This partnership theme echoes  WBTi’s own emphasis on the importance of building partnerships and collaboration. #WBW2017 calls on all those involved to forge new and purposeful partnerships. The objectives for this year’s campaign are Inform, Anchor, Engage and Galvanise.

By Laura Godfrey-Isaacs

Picking up on this year’s campaign themes, a group of midwives at King’s College Hospital in London, including the Director of Midwifery, specialist midwives in Infant Feeding and myself, have come together to devise a campaign to support and celebrate breastfeeding at the Trust, and beyond.

Brelfie1

The “Brelfie”

Our ideas are based around the social media phenomenon of the ‘brelfie’ – a breastfeeding selfie. Celebrities and women of all backgrounds have posted these, often in defiant response to breastfeeding shaming in public. Many have gone viral, and last year WHO declared that the brelfie was a significant tool in normalising and empowering women to breastfeed. This is something that would be highly desirable to see in the UK where we have some of the worst breastfeeding rates in the world, and little acceptance of it in public. This was highlighted recently in a disastrous advertising campaign by the skincare brand Dove (owned by Unilever) which featured posters that appeared to endorse negative public attitudes towards breastfeeding, stating “75% say breastfeeding in public is fine, 25% say put them away, what’s your way?” which received much push back on social media. 

Embarrassment about breastfeeding in public

In addition the TV presenter Jeremy Clarkson outrageously equated breastfeeding in public to urinating, suggesting women should go ‘to a little room to do it’, presumably the toilet, and Claridge’s Hotel famously asked a woman to cover up while breastfeeding in their restaurant. Breastfeeding women have to endure these and many other ‘everyday’ incidences that include negative comments and looks, despite breastfeeding in public being protected in law by the Equalities Act since 2010, and our culture being saturated by women’s breasts being used to sell newspapers, promote music and advertise countless products – an environment, that, as performance poet and birth advocate Hollie McNish puts so well, in her award-winning poem ‘Embarrassed’ is ‘covered in tits’.

What I have also experienced first-hand, as a midwife, is many women telling me they feel nervous about breastfeeding in public, which highlights the lack of cultural support and acceptance that inevitably has a negative impact on women’s ability to sustain the practice, with all the constituent results for both her, the baby and society. More and more evidence points to the importance of breastfeeding on a cultural, public health, psychosocial, ecological and economic level, and the need to support, protect and promote it in all aspects of healthcare and society, as well as asserting breastfeeding as a human right for both babies and women.

The WBTi report identified many barriers along a mother’s breastfeeding journey. Among these there is a disconnect between exhortations to mothers to breastfeed and a prevailing negative attitude towards breastfeeding in public. This can lead to women feeling they are to blame for ‘failing’ to breastfeed, and over 80% give up before they want to. Cultural factors need to be addressed, which is where the power of the brelfie and social media campaigns can – and do – have a really positive effect in shifting attitudes and encouraging activism on the issue.

Nabilabrelfie2

 

#KingsBrelfie campaign for #WBW2017

The #KingsBrelfie campaign links to Indicator 6 of the World Breastfeeding Trends Initiative Report, which calls for community mother support for breastfeeding, as it will open up discussions with women about their own, and society’s attitudes to breastfeeding. It will help us encourage, support and signpost them to online and healthcare provided sources of information and facilitation, such as our King’s Milk Spot centres in the community. Our campaign will use images of King’s midwives breastfeeding, which also points to our commitment as a community of women together – midwives and women – and hopefully steer away from some of the negative feelings around midwives’ use of ‘advocacy rhetoric’ which women can unfortunately sometimes experience as pressure and judgment. As highlighted in WBTi’s Indicator 7 (communication and information) which calls for a national communications strategy around infant feeding, and for promotional activities including World Breastfeeding Week, we are directly exploring new ways to use communication strategies, that are women-led, to address the cultural barriers to breastfeeding in the UK, through an inclusive social media campaign.

The #KingsBrelfiecampaign is an invitation to all women to post a brelfie on social media during World Breastfeeding Week using the hashtag to help change attitudes, support mothers and assert the right to breastfeed wherever, and whenever women want or need to.

So let’s create a social media storm and celebrate women and breastfeeding together!

LauraGodfrey-Isaacs2017

 

Laura Godfrey-Isaacs

King’s midwife and birth activist

@godfrey_isaacs

 

 

Sustaining Breastfeeding: A Challenge for the UK

Sustaining Breastfeeding: A Challenge for the UK

Position Statement On Breastfeeding From The RCPCH

 Today is the start of World Breastfeeding Week. An open letter was published in The Guardian today, from the Royal College of Paediatrics and Child Health (RCPCH), co-signed by the WBTi team and 17 other organisations working in maternal and infant health. The letter calls for improved social attitudes towards breastfeeding to help reduce the barriers so that women are more able to sustain breastfeeding.

The revised RCPCH position statement on breastfeeding, also launched today, points out the rapid decline in breastfeeding rates (leading to fewer than half of all babies receiving any breastmilk at all by 6-8 weeks after birth), the research evidence on improved health outcomes and intelligence scores, and the economic impact. It lists key messages for health professionals and recommends government action to increase initiation and continuation rates. Roles and responsibilities of paediatricians include:

“All paediatricians should be aware of the RCPCH position on breastfeeding and encourage and support mothers, including those with preterm or sick infants, to breastfeed. They should avoid undermining breastfeeding through the inappropriate use of infant formula “top-ups”, and advise women that the use of infant formula may make it more difficult to establish exclusive breastfeeding.”

While the position statement mentions that the current training curriculum for general paediatricians “requires trainees to understand the importance of breastfeeding and lactation physiology, be able to recognise common breastfeeding problems”, the WBTi assessment found significant gaps in comparison to the WHO Education Checklist for infant and young child feeding topics. However, the curriculum is currently being revised and we very much hope this will improve such training for paediatricians.

Family-centred care

Indicator 5 in the WBTi UK report is about health and nutrition care systems.

Are the services provided by maternity units truly mother- centred? Are health professionals such as health visitors, GPs and relevant hospital staff, with an in-patient mother, baby or young child, really mother centred?

To achieve parent-centredness, the policies and protocols need to incorporate that ethos, and staff training needs to provide the necessary attitudes, knowledge and skills. The crucial element of Indicator 5 is, therefore, health professional training.

Training for health professionals

Our report showed significant gaps in training for most of the relevant professions. Those who support mothers with breastfeeding have much anecdotal evidence between them of extensive variation between health professionals in attitudes and knowledge, from being hugely supportive on the one hand to dismissive of breastfeeding on the other. If all had a positive attitude towards breastfeeding, accompanied by basic knowledge, that would surely help to improve breastfeeding rates, particularly for continuation?

 

Time for action

The recommendations by the WBTi Core Group mirror those of the RCPCH – action is needed at every level, from governments to health professional bodies. from the community to the workplace. Protecting our babies’ future is a responsibility we all share.

 

wbti ind 5 gaps recs
Key gaps and recommendations from the 2016 World Breastfeeding Trends Initiative report on UK infant feeding policies and programmes https://ukbreastfeeding.org/wbtiuk2016/

 

PW Photo for WBTi MAINN presentation

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