We are delighted to have been invited to present an overview of the WBTi UK project to the 2023 Breastfeeding Network Conference!
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August 1-7th marks the World Breastfeeding Week. The theme is ‘Let’s make breastfeeding and work, work!’ The benefit of breastfeeding to health, the economy, work and the environment is widely documented. However, the UK remains one of the countries in the world with the lowest breastfeeding rate. Although 81% of mothers set out to breastfeed, only 1% of babies in the UK are still exclusively breastfed at 6 months. The question has always been why is breastfeeding rate so low in the UK?
Return to work is one of the key barriers to breastfeeding especially where the workplace is not breastfeeding friendly. A study published in 2007 by the Cohort Group found that mothers employed part-time or self-employed were more likely to breast-feed for at least 4 months than those employed full-time. The longer a mother delayed her return to work postpartum, the more likely she was to breast-feed for at least 4 months. Mothers were more likely to breastfeed for at least 4 months if their employer offered family-friendly or flexible work arrangements, or they received Statutory Maternity Pay plus additional pay during their maternity leave rather than Statutory Maternity Pay alone. This demonstrated that return to work could have a negative impact on breastfeeding if the mother is not properly supported.
Currently the UK does not have a legal framework that protects and promote breastfeeding in the workplace. The 1001 critical days strategy is there but does not have a legal backing to ensure that mothers are properly supported to continue breastfeeding should they choose to return to work early. A general assumption is made that mothers would take the full 52 weeks of maternity leave even though the leave is not properly paid. Mothers returning to work find it challenging to understand what they can and cannot do.
Though many employers are quick to showcase how family friendly they are in supporting working parents, breastfeeding remains an area in need of significant improvement. This is predominantly because the government has failed to recognise the benefits of breastfeeding and has failed to embed it in the current family friendly rights. Ideally, maternity leave should naturally go with a workplace breastfeeding policy. Other family friendly policies such as shared parental leave is not achieving its desired impact partly because of the lack of breastfeeding support in the workplace.
Mothers who intend to breastfeed for long may not share their maternity leave with their partners if support is not in place in the workplace.
These challenges were clearly articulates in the breastfeeding documentary titled ‘Breastfeeding: Not on the Agenda’which was followed by a call to action for the government to include breastfeeding in the family friendly rights to Make Breastfeeding and Work, Work.
NOTE from the WBTi team:
This petition incorporates many of the WBTi recommendations for action:
Dr Ernestine Gheyoh Ndzi is the Associate Dean for Law and Police Studies at York St John University. Her research interest lies in Company Law and Employment Law. Ernestine has in the past four years been researching on shared parental leave and breastfeeding. Ernestine is a member of the Board of Trustees for The Breastfeeding Network. She is the producer of the breastfeeding documentary titled ‘Breastfeeding: Not on the Agenda. She is running a 9-webinar series exploring the benefits and challenges of breastfeeding. She is also leading on the campaign for change to support breastfeeding in the UK.
When you think of the UK Armed Forces, many of our minds will go to an infantry soldier fighting stoically on the battlefield, or perhaps bearskins guarding the King at the palace. Not many people think of breastfeeding mother. But we do have them.
The Defence Breastfeeding Network launched in June 2020, to support breastfeeding soldiers during their maternity and return to work phase. Initially, we started with a Facebook group for some community support. We then created a partnership with Families and Babies Lancashire, who train members of the DBN to become level 2 breastfeeding peer supporters. As a network, we have currently trained over 60 peer supporters who give back to our members but also in their own communities. A project the DBN is currently working on is the establishment of breastfeeding/ wellness rooms within our infrastructure. These rooms all have a lockable door, comfortable seating, access to fridge space, access to clean running water and electricity. Many of the rooms are made comfortable with extra facilities such as tea and coffee stations, TV’s/radios, microwaves and more, with credit to the individuals within units that set these rooms up for all to benefit from. These rooms are more than just set up for those that need it now, they’re set up for when they are needed in the future. As an organisation, the Armed Forces are setting an example that I would encourage every employer to follow.
In 2021, the Defence Breastfeeding Policy was launched, providing clear and concise information for line managers on how to effectively manage and support breastfeeding mothers in the workplace, from risk assessments to medical gradings and through to deploying into a field environment which can mean living outside for extended periods of time. This does not mean we are sending breastfeeding mothers away from their children for months on end with little notice but takes into account the fact that we are soldiers, aviators and sailors. Gone are the days where women were dismissed from the military for being pregnant, and now as an organisation we are aiming to be proactive with breastfeeding support rather than reactive. Service life isn’t always easy on the service person or their immediate family, and as a network, the DBN is there to be as much of a village as possible. Education is really important, and the DBN attends unit health events and gives briefings across the UK to raise awareness of policy and the networks existence, in order to create more allies within the Armed Forces.
I have personally been on a field exercise (in the UK) with a manual breastpump in my bergen. It was handled wonderfully, I was able to take a small fridge to store my milk and was able to be transport it back to a freezer too. I was given the time, space and respect to express milk comfortably and was treated with dignity. I went on to feed my son for 2.5 years.
So how do we make breastfeeding work? We need support. We need employers that are proactive and view mothers as an asset and not a hindrance. We need support from everyone else; our families, friends, and strangers in the street. And I’m proud to say that the Armed Forces is a great champion.
LCpl Natasha Day MBE joined the British Army in 2014 as a Combat Medical Technician, deploying to South Sudan and Kenya before studying to become a Paramedic in 2021. After the birth of her son Charlie, she established the Defence Breastfeeding Network (DBN) in 2020 to support members of the Armed Forces and their families in their breastfeeding journey. The DBN supports over 1300 families and has collectively opened 83 breastfeeding and wellness rooms across Defence infrastructure. Natasha is currently posted to the NHS as a Paramedic.
Shared parental leave is a policy that was introduced in the UK in 2014 with the aim of giving parents more choice and flexibility in how they care for their child in the first year. However, it means that the mother would have to share part of her maternity leave with her partner. This would reduce the time a mother can spend on maternity leave. While the shared parental leave policy is great in encouraging fathers to take a more active role in the early days of the child’s life and enabling mothers to return early to the labour market, it presents a unique challenge to mothers who choose to breastfeed.
Barriers in the workplace are some of the key challenges to breastfeeding mothers who choose to return to work early after childbirth. Returning to work often means mothers must constrain their breastfeeding, which sometimes results to mothers ceasing breastfeeding.
The lack of a legal framework on what employers are expected to do to support breastfeeding mothers makes shared parental leave unattractive to parents who desire to exclusively breastfeed for six months and to continue according to the WHO breastfeeding recommendations. While there is ACAS guidance and the Health and Safety Policy on what employers should be doing to support breastfeeding mothers returning to work, employers are not obliged to follow it and there are no consequences where they do not follow the guidance. Furthermore, flexible working remains a request not a right and does not go far enough to protect breastfeeding mothers in the workplace.
Shared parental leave policy has been criticised as not fit for purpose for reasons such as financial constraints, the complexity of the policy, societal perception, childcare responsibilities, lack of workplace support and breastfeeding. While the recent evaluation report recognised that there are challenges with the shared parental leave policy, it failed to identify breastfeeding as a challenge. The study that informed the report did not consider breastfeeding as a factor to evaluate its impact on the policy. It is extraordinary that a policy that is meant to provide parents with flexibility on how they care for their child, do not consider breastfeeding as a key factor.
A study with mothers that were breastfeeding and took shared parental leave demonstrated that shared parental leave only worked well where the workplace was supportive and made provision for the mother.
It is important that mothers are supported in how they decide to feed their babies. Breastfeeding need to be part of the family friendly rights in the UK. This would ensure that breastfeeding is factored into policies that concerns nursing mothers such as maternity leave and shared parental leave.
Dr Ernestine Gheyoh Ndzi is the Associate Dean for Law and Police Studies at York St John University. Her research interest lies in Company Law and Employment Law. Ernestine has in the past four years been researching on shared parental leave and breastfeeding. Ernestine is a member of the Board of Trustees for The Breastfeeding Network. She is the producer of the breastfeeding documentary titled ‘Breastfeeding: Not on the Agenda. She is running a 9-webinar series exploring the benefits and challenges of breastfeeding. She is also leading on the campaign for change to support breastfeeding in the UK.
Maternity Action have produced a new resource for employers which aims to help manage pregnant women and new parents at work, including breastfeeding mothers. Our in-house legal team have developed the Employers Toolkit, drawing on the extensive knowledge of potential workplace issues that we have gained through our advice work. With this resource, we are aiming to encourage employers to support women to have healthy pregnancies and to improve women’s experiences at work during pregnancy, maternity leave and on their eventual return.
The resource is also based on feedback that we have had from employers – for example, we know that many smaller employers don’t have HR capacity and cannot get the right information at the right time, which leads to uncertainty of their legal obligations. The toolkit is designed to make life easier for employers – there are checklists for different stages of pregnancy, maternity leave and return to work so that employers can be confident that they have done everything they are required to do.
In addition to this, the toolkit also contains a template for risk assessment and a number of model policies, including on maternity leave and pay and on breastfeeding. The model breastfeeding policy comprises best practice examples, information about Health and Safety protection and suggestions for possible adjustments. The toolkit builds on our previous work with the UK breastfeeding organisations to develop a Maternity Action resource for employers, and with Acas in 2013, developing their guidance on accommodating breastfeeding on return to work.
Many employers want to do the right thing for their employees and indeed many already do, recognising that supporting the transition back to work for their women employees is a small, short-term investment that has longer term benefits such as loyalty and staff satisfaction. With this toolkit, we aim to provide employers with answers to common questions about managing pregnancy, maternity, adoption, paternity and other family leave provisions in the workplace. We hope that this will help inform good employment practices.
Maternity Action is working with Greater Manchester Good Employment Charter to engage employers in the region. Acas North West hosted the launch of the resource and we are working together to promote the resource more widely. We are also looking at other ways to get the resource out to the employers who need it. Please get in touch if you would like to get involved in this.
The toolkit is funded by the VCSE Health and Wellbeing Fund, part of a partnership programme between Department of Health & Social Care, NHS England and UK Health Security Agency.
Get in touch: info@maternityaction.org.uk
Annah Psarros is Senior Policy Officer at Maternity Action. Annah is particularly interested in health inequalities and the social factors contributing to maternal health and wellbeing. She is currently working on a research project about the cost of living crisis and its effects on mothers and families, due in the autumn.
Imagine if every mother was entitled to the paid maternity leave, breastfeeding breaks and flexible return to work options she needed to enable her to combine breastfeeding with earning an income.
Please join the Global Breastfeeding Collective at a webinar to celebrate World Breastfeeding Week. Maternity leave and workplace accommodations are critical features of environments that enable breastfeeding. Hear from mothers about their experiences combining work and breastfeeding, get new ideas from countries who have used evidence-based policies to make breastfeeding work, learn about updated maternity leave recommendations, and find resources to support advocacy.
Free, registration required: https://www.globalbreastfeedingcollective.org/lets-make-breastfeeding-work
The webinar, Let’s Make Breastfeeding Work, will be held:
Thursday, 03 August 2023
1 PM British Summer Time
Simultaneous interpretation will be available in Arabic, Chinese, English, French, Russian & Spanish.
REGISTER HERE: https://www.globalbreastfeedingcollective.org/lets-make-breastfeeding-work
The Global Breastfeeding Collective is a partnership of more than 20 prominent international agencies, including the World Health Organization and UNICEF, calling on donors, policymakers, philanthropists and civil society to increase investment in breastfeeding worldwide.
#WBW2023 #WorldBreastfeedingWeek2023 #Breastfeeding #EnablingBreastfeeding #MakingADifference
‘Breastfeeding: Not on the Agenda’ Webinar series: ‘Ready for Disaster? Infant and young child feeding in emergencies in the UK and Europe’ will be presented today by Helen Gray, WBTi Joint Coordinator.
NOTE: this presentation is now available on YouTube
This week’s topic in the “Breastfeeding: Not on the Agenda” series of webinars is the importance of planning for the protection of infant and young child feeding in emergencies, right here in the UK.
Infants, young children, pregnant and breastfeeding women are among the most vulnerable in any emergency situation, but they are almost invisible in our national resilience planning.
In the UK, the 2016 WBTi report found that while there is national guidance on the care of farm animals, pets, zoo animals and circus animals in emergencies, but there is no mention of infants or young children. There is an assumption that parents will take all responsibility for their own family – but too often there are no guidelines or recommendations to help them to prepare or handle an emergency.
Breastfeeding is a vital element in resilience and food security for families with infants: it provides immune protection and safe nutrition and fluids at any time, while providing both mother and child with comfort and resilience against stress. Skilled breastfeeding support is essential during emergencies, to enable breastfeeding dyads to continue.
In the UK, many infants are dependent on formula, which brings its own risks in an emergency. Infants who are not breastfed have reduced immunity to infections, in a situation where pathogens may be significantly increased due to contaminated water, or the crowding of evacuated families in rest centres. These infants depend on access to clean water, to a supply of suitable formula, and to hygienic preparation facilities and feeding equipment, and suitably trained support from responders and staff.
Local emergency planning in England and Wales is devolved to Local Resilience Forums (LRF). A recent study of LRF guidance for the public on emergency “grab bags,” by WBTi team member Patricia Wise, found that out of 42 LRF websites in England and Wales, only 27 even mention infant supplies, and 18 of those give only generic information rather than specific advice on what to pack for infants in an emergency. Northern Ireland included a generic ‘special equipment for children’ in its grab bag recommendations.
It is not difficult to include these supplies, facilities and training in every local resilience plan – there are resources and model operational guidance on the Infant Feeding in Emergencies Core Group website.
The climate crisis is contributing to increased frequency and severity of natural disasters. The Australian Government recently funded a large research project, Babies and Young Children in the Black Summer (BiBS) Study, into the impact of the Black Summer Bushfires on families with infants and young children, conducted by the Australian Breastfeeding Association, Dr Michelle Hamrosi and Dr Karleen Gribble from Western Sydney University. One of the findings from this study was that parents with young children felt that they did not have the right information in time, that they needed extra preparation and extra time to evacuate. In fact, the title of the BiBS report is “Want to help the children? Help the parents.”
The recent global COVID-19 emergency also had a disproportionate impact on families with infants and young children. Despite consistent guidance from WHO emphasising the importance of breastfeeding to infant health, and supporting mothers to maintain breastfeeding or at least their milk supply if possible, many countries routinely separated mothers and newborns, despite disrupting breastfeeding with the risks that would entail to maternal and infant health and wellbeing (Vu et al. 2020).
In the UK, families are also experiencing long term crises of food insecurity, especially during the current cost of living crisis. UNICEF Baby Friendly UK, NIFN and First Steps Nutrition have produced important guidance for local authorities on how to support these families. First Steps Nutrition have produced several related reports on food security for families with infants and on the impact of the cost of living crisis.
ACTION! contact your local authority and ask them
This webinar is part of the documentary and webinar series “Breastfeeding: Not on the Agenda” on breastfeeding, hosted by Dr Ernestine Ndzi from York St John University.
You can register for upcoming webinars here.
Previous webinars in the series and the documentary are available on YouTube.
Helen Gray is Joint Coordinator of the World Breastfeeding Trends Initiative (WBTi) project in the UK.
She is the Policy and Advocacy Lead for Lactation Consultants of Great Britain. She represents La Leche League of Great Britain on the UK Baby Feeding Law Group (BFLG), which works to bring the International Code of Marketing of Breastmilk Substitutes into UK law.
Helen’s background in anthropology and human evolution has influenced her interest in how breastfeeding, and the way we nurture our babies, are influenced by both human biology and culture.
Her current advocacy focus is the need for strong policies to protect infant feeding in emergencies. She has written several articles and chapters on the subject and served on the Advisory Panel for a London Food Resilience research project. She now represents BFLG on the global Infant Feeding in Emergencies Core Group.
August 1-7 will once again be World Breastfeeding Week. This year, the theme “Enabling Breastfeeding: Making a Difference for Working Parents” is all about combining working and breastfeeding.
One of the key findings from our first WBTi assessment of UK breastfeeding policies and programmes was that although the UK does provide paid maternity leave, and some paid paternity leave, and although there is some guidance on good practice from ACAS and from HSE, there is no statutory right in the UK to breastfeeding breaks or facilities in the workplace.
WABA produces regular snapshot Parents at Work reports on each country’s status on implementing International Labor Organization (ILO) conventions and recommendations on maternity protection at work, including maternity leave, paternity leave, and protected breaks for breastfeeding or expressing milk.
The ILO report Care at Work: Investing in Care Leave Policies and Care Services for a More Gender- Equal World of Work provides a global overview of national laws and policies such as maternity protection, paternity, parental and other care-related leave policies, as well as childcare and long-term care services.
Breastfeeding-friendly workplaces provide time, income security and space to enable positive nutrition and health outcomes
All women should have the right to paid working time for breastfeeding, as called for by ILO Convention No. 183. In 2021, 138 countries provide a right to time and income security for breastfeeding. These provisions potentially benefit 8 in 10 potential mothers across the world. Since 2011, seven countries have introduced paid nursing breaks. However, breastfeeding breaks remain unpaid in four high-income countries. In 2021, at least four pathfinder countries recognize men’s supporting role by offering breastfeeding breaks to fathers.
Almost 5 in 10 potential mothers live in countries that grant two daily breastfeeding breaks; while 109 countries offer the right to daily nursing breaks for six months or more. This would support exclusive breastfeeding in line with World Health Organization (WHO) recommendations for 7 in 10 potential mothers across the world. However, only ten countries provide a right to breastfeeding breaks for at least two years, compromising mothers’ ability to continuing breastfeeding.
Workplace nursing facilities are a key ingredient of breastfeeding-friendly workplaces. However, only 42 countries offer the right to workplace nursing facilities, covering roughly 6 in 10 potential mothers globally. While small- and medium-sized enterprises (SMEs) are often exempted from these requirements, research shows that the economic and well-being benefits of breastfeeding for the new-born, the mother and the employer outweigh the limited costs of these measures. Only 13 countries offer a right to workplace nursing facilities irrespective of the number and sex of workers, with only 5 in 100 potential mothers worldwide living in these countries. Conditionalities for nursing facilities based on sex are discriminatory and remain in place in 19 countries.
WBW Action Folder
Details for campaigning for improved policies and support for breastfeeding in the workplace can be found in the World Breastfeeding Week Action Folder.
WBW Pledge Map
Organising a WBW2023 celebration? Add it to the pledge map!
WBTi UK’s WBW outline of the week
Tuesday 1 August
Introduction
Wednesday 2nd August at 12 noon
‘Breastfeeding: Not on the Agenda’ Webinar series: ‘Ready for Disaster? Infant and young child feeding in emergencies in the UK and Europe’ by Helen Gray MPhil IBCLC, WBTi Joint Coordinator
Previous webinars in the series and the documentary are available on YouTube.
Thursday 3rd August at 1pm
‘Let’s make breastfeeding work – optimal maternity leave and workplace accommodations support an environment that enables breastfeeding’. Free webinar from the Global Breastfeeding Collective, led by WHO and UNICEF.
Friday 4th August
Maternity Action’s Senior Policy Officer Annah Psarros, on their new Toolkit for Employers, including a model Breastfeeding Policy
Saturday 5th August
Dr Ernestine Ndzi on Shared Parental Leave
Sunday 6th August
LCpl Natasha Day MBE, founder of the Defense Breastfeeding Network
Monday 7th August
Final blog from Dr Ernestine Ndzi on the need for “Family-Friendly Policies at Work”, and a Call to Action
Petition
And finally, everyone is encouraged to sign and share this petition from Dr. Ernestine Ndizi, calling for the government to:
– Include breastfeeding support on the Net Zero Environmental Agenda.
Do YOU want to be part of driving change for our children’s future?
The second assessment is now underway. It will run throughout this year and be launched in 2024.
What is the WBTi?
The World Breastfeeding Trends Initiative (WBTi) is a human rights-based, evidence-informed, collaborative and participatory national assessment of the implementation of key policies and programmes from the WHO’s Global Strategy for Infant and Young Child Feeding, and is a project developed by the International Baby Food Action Network (IBFAN). Currently nearly 100 countries are taking part.
WBTI Indicators of Policy and Programmes
- National policy, programme, and coordination
- Baby Friendly Initiative
- International Code of Marketing of Breastmilk Substitutes
- Maternity protection in the workplace
- Health professional training
- Community based support
- Information support and communications
- Infant feeding and HIV
- Infant and young child feeding during emergencies
- Monitoring and evaluation
In 2016, the UK scored just 50.5/ 100 on these ten key policy indicators.
WBTi brings together the main government agencies, health professional bodies, and civil society organisations involved in infant and maternal health and nutrition in each country to work together to collect information, identify gaps and generate recommendations for action. This Core Group must be free of conflicts of interest from the baby feeding industry (all infant or toddler milks up to 3 years, baby foods, bottles or teats).
The Global Breastfeeding Collective, led by WHO and UNICEF, recommend that the WBTi process be repeated, at least every 5 years, to monitor implementation of key policies, and include this in each country’s score on the Global Breastfeeding Scorecard.
Volunteers wanted
Many volunteers contributed to the success of the first UK WBTI assessment in 2016.
Your contribution is valuable, large or small:
- Writing
- Social media
- Graphic design
- Advocacy
- Freedom of Information requests.
- Fundraising
- Mapping infant feeding training standards
- Auditing numbers of breastfeeding counsellors and peer supporters
- Project management
- Virtual assistant skills
- Parliamentary research
- and more
You can find the main WBTi UK 2016 Report Part 1, and Part 2 with supplementary material, with Report Cards for each of the four nations and for the UK overall, here: https://ukbreastfeeding.org/wbtiuk2016/
Twitter: @wbtiuk
Facebook: Breastfeeding – WBTi
Facebook page on emergencies: Safely Fed UK – Infant Feeding in Emergencies
Contact us! wbti@ukbreastfeeding.org
WHO and UNICEF launched the Baby Friendly Initiative (BFHI) over thirty years ago; three years later, UNICEF UK Baby Friendly Initiative (BFI) was born. The original BFHI framework of Ten Steps was created to improve maternity and hospital practices that undermined breastfeeding, such as separating mothers and their newborns or routine formula supplements, as well as implementing the International Code of Breastmilk Substitutes in maternity settings, in order to eliminate conflicts of interest with the baby feeding industry (companies that manufacture or distribute infant formula/milks, baby foods, feeding bottles and teats) such as promotion of formula milk in healthcare settings, or direct contact by companies with parents.
The Baby Friendly Initiative has changed the face of maternity practices and midwifery training in the UK – breastfeeding initiation has gone up about 20% since UNICEF UK BFI was founded in 1994. In this country, BFI has grown beyond maternity settings to create standards for infant feeding support programmes in the community and for universities training the next generation of midwives and health visitors. The BFI standards were revised in 2012, based upon the twin pillars of breastfeeding and the UN Convention on the Rights of the Child.
BFI standards in the community call for the integration of several levels of breastfeeding care:
A good example of how the BFI community standards work is Harrow. Read more HERE about how WBTi UK Steering Team member and specialist health visitor Alison Spiro led Harrow’s local community health services through BFI accreditation, to develop a well integrated services and become
“the only local authority in the UK where breastfeeding was the ‘normal’ way to feed babies”
UNICEF assessment
More recently, UNICEF UK BFI have produced Learning Outcomes for a wider range of health professions: medical students, paediatricians, pharmacists, paediatric/ children’s nurses, maternity support workers and nursery nurses. These will help to address the gaps in high level health professional training standards found in WBTI’s 2016 report. Every health professional who works with women, infants and children should understand the basics of lactation and breastfeeding management, prescribing during lactation, and how to refer parents on to local breastfeeding support.
#WBW2022 Webinar
The entire webinar runs from 7-9 AM BST and again from 4-6 PM BST, and will be recorded.
Register HERE
Our WBTi #WBW2022 blog will cover these additional topics later in the week.
See you there!
Helen Gray MPhil IBCLC is Joint Coordinator of the WBTi UK Steering Group.
Breastfeeding trends (UK) 