Skilled health professionals are a fundamental building block for successful breastfeeding. Parents expect all healthcare professionals to have the knowledge and skills to help them overcome practical challenges and to offer them emotional support. The reality in the UK is that many have not received the training they need to do this, so parents do not always receive the support they need. While improvements have been seen, UK health professional training still shows gaps in training in infant feeding. Relevant, evidence-based training is needed for all those who work with women, infants and young children.
WBTi findings: mapping UK high level health professional training standards in infant feeding against the WHO Educational Checklist
WBTi’s research has found numerous gaps in the pre-registration training in infant feeding in almost all UK health professional specialisms. Only midwifery training covers most of the topics on the WHO’s Educational Checklist on infant and young child feeding.
Alarmingly, the worst gaps are in the high level training standards for nurses, including paediatric nurses. Since the publication of our first report in 2016, there have been a few improvements in the training standards set for paediatricians and GPs, and our upcoming reassessment will be mapping these against the WHO checklist.
What can YOU do?
If you are a health professional,urge your governing body to strengthen the requirements on infant feeding in your professional standards and examinations by:
It takes a village to raise a child – we all have a role to play to support breastfeeding mothers and babies.
We all are the building blocks responsible for supporting new families: partners and family members, health workers, neighbours and community members, religious leaders, employers, academics, governments and policy makers. We can all make a difference. We need to step up to our responsibilities. Everyone needs to understand the importance of breastfeeding – for maternal and infant physical and mental health and wellbeing, for public health, for our economy, and for our planet.
For WBW this year, WABA has produced an extensive suite of materials looking at all these roles and responsibilities. They have outlined the challenges that breastfeeding families face at every stage from conception, through birth, getting breastfeeding off to a good start, and maintaining breastfeeding all the way through starting solids and going back to work, and the solutions we need in each situation – all backed up by links to the latest evidence.
The #WBW2022 Action Folder pulls all this together: it is a useful resource for anyone using evidence to build policies and best practice. You can download it as a PDF and all the links to research and references will be live.
The UK WBTi team will be highlighting just a few of the concepts this week:
Health workers: the importance of relevant, evidence-based. The advertising of follow-on milks, on the media, from 6 months in the UK has led to confusion, resulting in some parents seeing formula milk as equivalent to breastmilk, or that breastfeeding should stop at 6 months. The International Code needs to be adopted by the UK government in full, to reduce this confusion and protect breastfeeding. training for all those who work with women, infants and young children
UNICEF UK Baby Friendly Initiative and the BFHI worldwide sets out ways in which healthcare staff can receive sound, evidence-based, basic training in supporting breastfeeding.
ALSO join a special webinar from the Global Breastfeeding Collective on BFHI, with some added specialist topics on supporting small and underweight breastfeeding infants, and on infant feeding in emergencies. (7-9 AM BST and again at 4-6 PM BST). Register HERE
Community support: Access to skilled, integrated support for all, with a special focus in the GBC webinar on how to support breastfeeding infants who are not gaining well (NICE NG 75,2017). All parents should have easy access to trained healthcare staff- midwives, paediatricians, health visitors and GPs- breastfeeding peer supporters and specialist support (IBCLC, BFCs). Supporting breastfeeding in complex circumstances: Specialist support from IBCLCS, BFCs, or infant feeding leads, integrated with specialist healthcare teams
Protecting infants and young children in emergencies. National policies should guide Local Resilience Forums but these do not exist at present.
The impact of misleading marketing: The International Code. The advertising of follow-on milks, on the media, from 6 months in the UK has led to confusion, resulting in some parents seeing formula milk as equivalent to breastmilk, or that breastfeeding should stop at 6 months. The International Code needs to be adopted by the UK government in full, to reduce this confusion and protect breastfeeding.
Governments with national and local policy makers need to protect all families and support them to make informed feeding decisions free of commercial influence.
What can YOU do?
It is time for a reassessment of the UK’s national infant feeding policies and programmes. YOU could help! Volunteers are welcome with knowledge in any of the ten policy areas (Indicators 1-10), or with skills such as research, writing, graphics, social media and more – feel free to contact us for a chat!
WBTi Key Indicators:
Indicator 1: National policy, programme and coordination Indicator 2: Baby Friendly Initiative Indicator 3: International Code of Marketing of Breastmilk Substitutes
Indicator 4: Maternity protection Indicator 5: Health professional training Indicator 6: Community-based support Indicator 7: Information support Indicator 8: Infant feeding and HIV
Indicator 9: Infant and young child feeding during emergencies
Indicator 10: Monitoring and evaluation
Which one will YOU choose?
Contact us: wbti@ukbreastfeeding.org
Helen Gray MPhil IBCLC is Joint Coordinator of the WBTi UK Steering Group.
The Week runs from June 27th to July 2nd and the theme is ‘Everyone has a part to play in helping mums to breastfeed’. The early weeks with a new baby are hard for most mothers and some find that time very challenging but support can make a huge difference. Some people around the mother, particularly partners, can offer practical help in looking after the home and the mother so that she can recuperate after the birth and focus on nurturing the baby, which primarily means feeding.
Sometimes skilled support is needed to enable breastfeeding to work better, which often means improving the latch. This can be from health professionals, such as midwives and health visitors, and specialists – breastfeeding counsellors and IBCLCs (International Board-Certified Lactation Consultants); the specialist services include national helplines*. Trained breastfeeding peer supporters are available in many areas and can offer invaluable mother-to-mother support. They often work in volunteer or paid roles in local support groups, where mothers can give each other confidence and build self-reliance through sharing their stories.
Everyone having contact with the mother can be emotionally supportive, indicating that they value what she is doing and respect her decisions, helping to build her confidence that she can make breastfeeding work. These includes friends, relatives, neighbours, GPs, pharmacists, shop staff…
However, alongside these personal contacts, society’s infrastructure and attitudes can also influence a mother’s experiences with infant feeding. A World Breastfeeding Trends Initiative assessment demonstrates the extent to which a country’s support for breastfeeding implements the Global Strategy on Infant and Young Child Feeding, by scoring ten policy and programme indicators:
1. National policy and funding
2. Baby Friendly in maternity settings
3. WHO International Code of Marketing of Breastmilk Substitutes (the Code)
4. Maternity protection in workplaces
5. Health professional training
6. Support services for pregnant and breastfeeding mothers
7. Accurate and unbiased information
8. Infant feeding and HIV
9. Infant and young child feeding during emergencies
10.Data – monitoring and evaluation
The UK assessment in 2016 showed the variability between indicators, particularly as an assessment identifies gaps and makes recommendations.
2016 UK report
Carrying out a WBTi assessment in a country around every 5 years monitors the progress, or lack of it, in a country. It is time for a reassessment in the UK.
If you would like to be involved in collecting data, please do contact us, and let us know which of the indicators above YOU are interested in?
Our WBTi work has revealed that in the UK we have no national guidance on the support and feeding of infants and young children, or pregnant or breastfeeding mothers, during emergencies. There is currently a postcode lottery of Local Resilience Forums who include a few details in their advice to the public such as “Remember to pack formula and nappies for your baby”, but there is no national guidance for LRFs and local authorities that they should include infants and young children in their planning.
This page will serve as a repository for resources for those planning services and those providing feeding support for Ukrainian families with infants and young children.
Breastfeeding provides infants with food security, immune protection, and emotional comfort during disasters. Basic priorities in an emergency:
1) Support new mothers to hold their babies skin to skin and begin breastfeeding within the first hour.
2) Support mothers who are breastfeeding, partially or fully breastfeeding, to continue breastfeeding and increase their milk supply if needed: provide access to skilled feeding support.
3) Protect infants who are not breastfed: Trained infant feeding / nutrition support teams from trusted NGOs like UNICEF will provide access to safe supplies of appropriate infant formula for babies that need it, and support with safe preparation under hazardous conditions.
4) Protect all infants: breastmilk substitutes and feeding equipment (infant formulas and other milks, bottles, teats, breast pumps and also donor human milk) will be provided by trusted NGOs like UNICEF; the public should AVOID sending donations of these into high risk settings, but send donations of funds to trusted NGOS instead. This will enable them to provide families with what is needed on the ground.
These organisations are members of the Infant Feeding in Emergencies Core Group and have created the international Operational Guidance on Infant Feeding in Emergencies. Please consider supporting their work with families with infants and young children.
We have collected links to infant feeding resources in Ukrainian, and also in the languages of countries housing refugee families, for breastfeeding helpers and aid workers in those countries.
Please send us any suggestions for additional resources
We have a few other resources not included here; please email us any enquiries.
NOTE: we will continue to add links and resources to this page, and these organisations are continuing to add further translations into more languages – please make sure that you clear your cache, or ‘refresh’ the page, each time you open any of these links to ensure that you find the most up to date page.
NOTE: We are providing these resources as a public service, but we cannot read the resources in other languages ourselves, so we cannot always vouch for the accuracy of the contents. Please have someone fluent in the language read it for you.
Guidance for helpers not trained in supporting infant feeding
This short leaflet was written for local authorities and those supporting Afghan refugee families but could be useful for those supporting Ukrainian refugees in the UK. It sets the context, lists some useful resources for parents, provides information about making up powdered infant formula correctly and describes useful actions in some possible scenarios.
Infant feeding support resources – multiple languages
Pictorial counselling cards in many languages including Russian, adapted to include COVID19 recommendations. Some are full pictorial sets, while some are simply the translation matrix.
Infant Feeding flyer for families in transit (including English, Ukrainian, Polish, Russian, updated for COVID19). Developed by the volunteer team from Infant Feeding Support for Refugee Children/ Safely Fed
Pictorial book about breastfeeding (no words) from La Leche League Netherlands. The PDF is free to use for all. Printing and sharing is allowed, as long as the original file (including credits) is unaltered. Price listed on website is for printed version.
Breastfeeding Matters – A Guide to Breastfeeding for Women and their Families (from best Start, Ontario Canada) can be downloaded free in Russian and other languages
La Leche League International: Variety of resources and infographics in infant feeding in emergencies translated into multiple languages – most are directed at mothers and parents
Please do contact us if you are interested in volunteering or have some useful resources to share!!
CONTACT: wbti@ukbreastfeeding.org
Helen Gray MPhil IBCLC is Joint Coordinator of the WBTI UK Steering Team, and Policy and Advocacy Lead at Lactation Consultants of Great Britain. Her research interests include human rights and infant and young child feeding in emergencies.
A shocking new report on formula marketing which was commissioned by the World Health Organisation and Unicef has been launched. Called ‘How the marketing of formula milk influences our discussions on infant feeding’, it is a large scale and thorough report in which women’s voices are a key part. The report can be downloaded from this page.
Eight countries were included (Mexico, Bangladesh, UK, Vietnam, S. Africa, Nigeria, China and Morocco) and it involved 8500 mothers talking about their experiences of being targeted and also interviews with health professionals and marketing executives. The survey was conducted by M&C Saatchi World Services, which states on its website: “Our aim is to harness the power of cutting-edge marketing, communications and creativity, so that they become key tenets of behaviour change activity throughout the International Development sector.”
The conclusions of the report are that the marketing is highly targeted, pervasive and exploitative, uses misleading scientific claims and incorporates appeals to aspiration. It therefore backs up robustly what has been known about infant formula marketing for many years. Industry invests more in marketing each year than the funds WHO has available!
‘Marketing the $55 billion formula milk industry’, the webinar of the launch of the report on 23 February is available here.
What needs to happen:
1. Invest in mothers and families (e.g. good maternity legislation)
2. Protect the integrity of science and medicine (including strong conflict of interest policies)
3. Urgently legislate, regulate and enforce regulations in order to protect all families.
The launch was hosted by Kathriona Devereux, science communicator and Cuidhu breastfeeding counsellor, on behalf of WHO, Unicef, Save the Children and two other organisations. Dr. Nigel Rollins gave a brief history of infant formula marketing and presented the key findings. Anu Narayan of Unicef framed the issue – it’s about marketing, the right to accurate and impartial information, and public health v commercial interests, not about breastfeeding v bottle feeding or limiting access or rights. The study questions were:
What are women’s experiences of and attitudes towards formula marketing?
What are health professionals’ experiences of and attitudes towards formula marketing?
The presentation was followed by comments from a panel that comprised Helen Clark (former Prime Minister of New Zealand), Rebone Ntsie, dietitian from South Africa, Duong Vu from Alive and Thrive in Vietnam, Professor Caroline Homer, specialist in maternal and infant nutrition, and Katie Gilbert, Managing Director at M&C Saatchi World Services. Recommendations for action from the panel included: framing the issues as supporting the right to health, engaging political leaders, recognising the scale and urgency of the problem, improving national regulations and checking imports comply with regulations. It was also suggested that public health needs both to provide the services that mothers need and to demonstrate empathy in its communications, as breastfeeding counsellors are trained to do, indicating understanding of what it’s like to be a mother; formula marketing conveys that impression of understanding.
Worryingly, updating the International Code to address marketing through social media better was also suggested; however, the Code has been updated by 19 subsequent resolutions since 1981 to close loopholes and it does cover all marketing. Governments need to have strong enforceable regulations to implement the Code and resolutions, including addressing digital marketing, and thus protect infants and young children.
What wasn’t mentioned was the significant negative environmental impact of formula feeding. Protecting and supporting families who want to breastfeed to do so will reduce that negative impact.
In addition there is a petition to stop unethical formula research on babies, and particularly a new study in Africa in which low birthweight exclusively breastfed babies will randomly be allocated formula.
If you’d like to check the content of the current UK Laws, the Baby Feeding Law Group (BFLG) has information and links on its website.
Author
Patricia Wise is an NCT Breastfeeding Counsellor and a member of the WBTi UK Steering Group
Our WBTi work has revealed that in the UK we have no national guidance on the support and feeding of infants and young children, or pregnant or breastfeeding mothers, during emergencies. There is currently a postcode lottery of Local Resilience Forums who include a few details in their advice to the public such as “Remember to pack formula and nappies for your baby”, but there is no national guidance for LRFs and local authorities that they should include infants and young children in their planning.
This page will serve as a repository for resources for those planning services and those providing feeding support for families in crisis in the UK.
Currently there are many gaps in the support for families who have been evacuated from Afghanistan, so resources in Afghan languages are collected here.
Please send us any suggestions for additional resources
We have a few other resources not included here, including Rapid Assessment Tools and Simple Phrases about feeding, and a Peer Counsellor Training Curriculum in Dari; please email us any enquiries.
CONTACT: wbti@ukbreastfeeding.org
NOTE: We are providing these resources as a public service, but we cannot read the resources in other languages ourselves, so we cannot always vouch for the accuracy of the contents. Please have someone fluent in the language read it for you.
Guidance for helpers not trained in supporting infant feeding
This short leaflet sets the context, lists some useful resources for parents, provides information about making up powdered infant formula correctly and describes useful actions in some possible scenarios.
Infant feeding resources – multiple languages
Rapid Assessment tools in various languages – contact wbti@ukbreastfeeding.org
Infant Feeding Counselling resources Pictorial counselling cards in many languages, adapted to include COVID19 recomendations
The PDF is free to use for all. Printing and sharing is allowed, as long as the original file (including credits) is unaltered. Price listed on website is for printed version.
Breastfeeding Matters – An Important Guide to Breastfeeding for Women and their Families (from best Start, Ontario Canada) can be downloaded free in Farsi
Please do contact us if you are interested in volunteering or have some useful resources to share!!
CONTACT: wbti@ukbreastfeeding.org
Helen Gray MPhil IBCLC is Joint Coordinator of the WBTI UK Steering Team, and Policy and Advocacy Lead at Lactation Consultants of Great Britain. Her research interests include human rights and infant and young child feeding in emergencies.
We are thrilled to have a guest blog from artist Lisa Creagh, illustrated with her powerful photographs, to wrap up #WBW2021 Her work focusing on mothers and breastfeeding brings out the importance of everyone in society understanding, supporting and protecting breastfeeding.
Holding Time is an ongoing work designed to create greater cultural awareness of the needs of breastfeeding mothers. The work has a conceptual framework as the central theme is motherhood and time. The centerpiece is a three screen installation of animated portraits of mothers alongside a timepiece which grows as time passes.
The project is multi-channel, multi platform and operates city to city. By working with academics, health professionals and grassroots networks it is a large piece of socially engaged feminist art that is intended to bring about meaningful change in UK breastfeeding policy.
In Coventry I was commissioned by Warwick University to create a piece combining a grid of mothers with audio about their breastfeeding experiences. It was understood that I may not manage to actually capture Coventry mothers, given the extraordinary circumstances of 2020. So i devised a project that could run without human contact, hoping that the conditions would eventually change. Mothers were recruited via social media and through a network of partners from the Coventry Family Health and Lifestyle Services. I met the infant Feeding Team in August 2018 and received great enthusiasm from them and one of their partners, a project called MAMTA that works with BAME mothers who wish to breastfeed.
When the call for participants went out, we had an overwhelming response! In February I interviewed sixteen mothers via zoom, suggesting the storytelling workshops (also zoom) to those I felt would benefit. Not everyone took up this offer but those that did reported great benefits from having the chance to discuss openly with other mothers the issues they had faced in establishing breastfeeding. Rachel New, the radio producer and writer who devised and ran the workshops on behalf of Creative Lives did an amazing job of really getting the group to face each other and themselves, to pull out the wealth of experience they had between them and craft this into written pieces.
Breastfeeding is such a complex issue and so poorly understood. Mothers came from a wide range of backgrounds – young, older, experienced, new, British, South Asian, and African, reflecting the incredible diversity and cultural richness found in Coventry which has been welcoming people from across the world for many decades. I was hoping to bring out the contrast between mothers who had inherited an unbroken cultural inheritance of breastfeeding vs those, like me who had needed to start from scratch.
I waited hopefully for the restrictions to lift and finally on April 12th 2021 it was legal again to set up a photo studio. With the help of some local talent and the support of a wonderful arts organisation, Artspace, I was finally able to set up a temporary photo studio in Coventry in early May. Now all the mothers I had met only virtually started to appear every day at the door in 3D! it was a wonderful experience to meet them all finally, albeit under strict Covid safety conditions.
By now the Storytelling group had a WhatsApp group and were organizing park meetups. We quickly set up a WhatsApp group for everyone and once the week was over I went into a supercharged post production period. My commission and proposal to Arts Council England had not included new animation but I felt it would be a travesty to the mothers who had shown such support and commitment to the project, to show mothers form another city in the final show. On my last night in the Premier Inn (I spent a lot of time in the Premier Inn) I decide I could make a new piece in time for the show.
It as an ambitious plan but I feel tremendously proud of the work that came out of Coventry: 12 new animated portraits, one large group portrait, sixteen VLOGS still being released onto Youtube channel and a legacy of seven still images hanging permanently in the labour ward where each mother gave birth, at UHCW in Coventry to inspire new mothers in the city to listen to their stories and if they can, follow them on the journey of breastfeeding.
Here’s a selection:
Hannah and Jacob, 2021
Hannah had a very premature baby who, at 25 weeks, was lucky to survive. She expressed for many months until finally she was given the go ahead to feed Jacob on the breast. Her story is an epic journey of resilience, stamina and self belief with some real insight into what mothers under this tremendous pressure need to keep going: https://youtu.be/P22EgsAIvJQ
Rayyan and Yusuf, 2021
Rayyan is a typical Coventry mother, although she would point out she was actually born in Hull…she lives in a tight knit family who supported her through some incredibly dark days after the birth of her first child. She came through it and is now tremendously positive about her experience and the support she received from family and the local maternity team: https://youtu.be/wrfbEAFB2HI
Mel and Harley, 2021
Mel is breastfeeding her third child and talks about finally feeling confident enough go to baby groups. She is very funny and I think we can all relate to her description of herself when she was a new mother and was too embarrassed to feed in public, even when she had the support of her mother by her side: https://youtu.be/vNnmPHN8Jj0
Hema and Devani, 2021
Hema was one of the first mothers I met in Coventry, back in 2018 at a Big Latch event. She is a tremendous role model as someone who came through huge physical challenges to breastfeed and eventually trained as a peer to peer mentor and is now supporting many mothers in the Coventry Gujarati community. It was fascinating hearing about how Hema sought help when she needed it and is now there to help others: https://youtu.be/5Ku97-Vig3k
Emilie and Jean, 2021
Emilie is not alone in finding herself surprised to be ’still’ feeding her child aged three. I found it really sweet how she says that it wasn’t the plan (but there never really was a plan….). I meet so many mothers who have fed full term doing this work and I’m always fascinated to hear their insights as it really is a journey of self discovery, as much as learning about your child and their needs: https://youtu.be/i4rsRJBy3wg
The NHS Cheshire and Merseyside’s Women and Children’s Partnership proudly announce the Holding Time Project launch and call for participants
Women are invited to express an interest in any of the following:
1. Mother-talk with Lisa: Interview with the artist about your breastfeeding experience for a 5 minute VLOG to be distributed on social media channels and Youtube. 16th September through to 28 October 2021 For examples see www.youtube.com/c/holdingtime
2. Group Mother-speak: Zoom storytelling workshops led by the experienced BBC Producer, Rachel New over six weeks starting on 16th September through to 28 October 2021. These collaborative writing workshops will be delivered in partnership with BBC Radio Merseyside’s community broadcast team. For previous examples listen here: https://www.bbc.co.uk/sounds/play/p09g27bg
3. A Breastfeeding portrait:Feed your baby whilst being photographed by the artist in a Covid safe temporary photographic studio during a 1.5 hour session. These portraits will be the basis of animations and stills for a permanent display. January 2022
Mothers who wish to participate should fill out the form at:
Open to all mothers who have breastfed for any amount of time
Lisa Creagh studied Fine Art and Art History at Goldsmiths College, London. She received a Masters in Photography from Brighton University in 2009. Her work is collaborative in nature: as a producer and curator she has delivered large-scale photographic projects. ‘The Instant Garden’, begun in 2008 was awarded a development grant by The Arts Council of England in 2010 and is still exhibited widely.
Holding Time is a Feminist art piece, which evolved from Lisa’s own difficulties in breastfeeding documented on the project website. Lisa created Holding Time in 2016 to examine the cultural barriers to breastfeeding, listen to the experiences of other mothers and drive change.
Holding Time is a co-created, participatory arts project comprising of videos of conversations and portraits of breastfeeding women, to confront and breakdown the structural and cultural barriers many women face, including stigma about body image. www.lisacreagh.com/about
How can communities change to give parents consistent support with breastfeeding?
Our Harrow model of integrated working across hospital and community services showed that when professionals, lay supporters and specialists worked effectively together under a shared strategy and infant feeding policy, that more parents felt supported to breastfeed their babies. Over two years higher breastfeeding initiation, continuation and exclusivity rates were beginning to be reported. Parents found that they experienced less conflicting advice and breastfeeding gradually began to be seen as the normal way to feed babies in Harrow.
This was achieved through joint training sessions involving community and hospital staff. Midwives, midwifery managers, paediatricians, neonatal nurses, paediatric nurses, A&E nurses, health visitors, peer supporters and breastfeeding counsellors all attended the same sessions. Through these, they were able to understand each other’s roles and responsibilities and plan care together.
Peer supporters helped to run daily community drop-in groups with health visitors, and some worked in the antenatal clinic and postnatal wards of the hospital. Specialist, targeted peer support was offered to teenage parents, those with multiples and Somali mothers. A copy of Best Beginning’s ‘Bump to Breastfeeding’ DVD was given to all antenatal parents, who were also invited to a popular Saturday morning breastfeeding workshop.
Over a period of ten years, mothers felt comfortable breastfeeding their babies all over the borough and became visible in shopping centres, cafes, supermarkets, parks, and school grounds.
The National Maternity Review reported in 2016:
‘In Harrow, a multi-ethnic London borough with high infant mortality rates, and areas of deprivation and poverty, the Director of Public Health identified breastfeeding as a top priority for 2006. A multi-professional approach was adopted with Harrow Community Health Services working with the local hospital to improve breastfeeding rates. UNICEF Baby Friendly training was commissioned for midwives, health visitors and support staff in 2007. A peer support training programme began and mothers were recruited from a local support group. A network of breastfeeding support groups was established running from children’s centres, eventually achieving one every day within walking distance for all mothers. In 2008, Bump to Breastfeeding DVDs were given to every pregnant woman by midwives, health visitors and peer supporters. Harrow became accredited as Baby Friendly in 2012 and the local hospital gained the award in 2013. The staff training, peer support programme and free DVDs increased breastfeeding rates, so by 2010 initiation rates had risen to 82% and 6-8 weeks to 73%. By 2013, Harrow had 87% of mothers initiating and 75% breastfeeding at 6-8 weeks (50% exclusively), with one of the lowest drop-off rates in the UK. UNICEF assessed Harrow for its re-accreditation in 2014 and stated that it was the only local authority in the UK where breastfeeding was the ‘normal’ way to feed babies’.[1]
Other examples of Integrated community breastfeeding support:
National governmental leadership in the UK and devolved nations could make a significant difference by making legal, policy and structural changes. These would filter down through every level of society to show ACTION for the shared responsibility of protecting and supporting every child’s human right to have the best start in life.
There have been Calls for Action before with slow or indifferent responses. The new Health Security Agency has an opportunity to fulfil its responsibility to the health of England’s population by making positive changes NOW.
A WBTi report identifies gaps and makes recommendations. The UK report in 2016 reported that, for Indicator 1, which covers National policy and whether there is an associated programme and coordination, the scores from the assessment were:
England 1
N.I. 10
Scotland 10
Wales 4
Sadly, the situation remains unchanged in England. It is TIME to invest and implement recommendations, which are supported by the broad alliance of infant feeding agencies who have come together to speak, with one voice, on behalf for all new families’ futures in this uncertain world.
Establish a structure for monitoring implementation of the Code and that action is taken against violations.
Create a multi-sectorial, funded lead, for Infant Feeding in England with a strategy and route to share best practice.
Ensure full and equitable access to skilled support for every new mother.
Build in improvements to monitoring and collection of data.
All these improvements would help protect the breastfeeding dyad much better and move much closer to the vision of all UK families experiencing a society that is supportive of breastfeeding with ready accessible skilled support available whenever is needed.
Author: Clare Meynell RM (rtd) IBCLC
Clare trained as a child & general nurse before a long career as a midwife and infant feeding lead. more than 25 years. Clare has also led La Leche League peer support training sessions in her local community. Currently, with Helen Gray, Clare jointly coordinates the UK WBTI working group and co presented the first report for the UK in Parliament in November 2016.
Working with her colleagues she hopes to create “Actions for Change”, through the WBTi report recommendations, so the next generation of mothers are enabled to achieve their personal breastfeeding goals and that society better values the health giving properties of human milk as the physiologically normal food for babies.
A network of trained peer support is an essential part of high quality integrated breastfeeding services.
Unicef UK Baby Friendly Initiative (BFI) outlines three components that good local breastfeeding services must include, in order to be awarded Baby Friendly accredited status.
Basic, or Routine Care
All health workers who work with new families (health visitors and any allied healthcare assistants in the community services) have been trained to BFI standard (approximately 18 hours of initial in service training, with yearly updates of an hour or more).
Additional services
Here BFI outlines how every health visiting and community service must be embedded in and well supported by a network of trained peer supporters, or other social and trained breastfeeding support. NICE recommends that peer support programmes be externally accredited. Good practice includes not only training, but also regular supervision and updates of skills and knowledge. Typical peer support programmes require peer supporters to be experienced breastfeeding mothers, and often expects them to come from similar communities as the population they are supporting. Training generally is part time, over 16-36 hours. Peer supporters work in a supervised setting, acting as an “informed friend,” and referring complex cases on to health professionals or an advanced breastfeeding practitioner such as an IBCLC or breastfeeding counsellor, using a referral pathway.
Breastfeeding counsellors in the UK are also experienced breastfeeding mothers, so they also provide a type of peer support, or “mother-to-mother” support. Their training typically take around two years, and they are autonomous practitioners, who can be responsible for leading their own local breastfeeding support groups, usually through one of the main UK breastfeeding voluntary organisations.
Mothers who are experiencing breastfeeding challenges often need more than one visit – and they need the time that it requires for skilled listening as well as exploration of possible breastfeeding strategies to resolve the issue. Although many health visitors have additional breastfeeding training and skills, the health visitor workforce is vastly overstretched, and it simply isn’t possible to provide the time and the number of visits that many breastfeeding mothers need.
But peer support programmes can provide this – they offer groups where lonely mothers can meet others and gain confidence in their own mothering, alongside skilled listening and well- informed support. Many mothers will find their own “village” in their local breastfeeding support group, and will return again and again. Some will go on to train as peer supporters or breastfeeding counsellors themselves.
Peer support groups are the beating heart of breastfeeding support
Helen Gray, WBTi Joint Coordinator
WBTi audit of peer support and breastfeeding counsellors provided by the voluntary sector, 2016 In Part 2 of our WBTi UK Report
Specialist support
Every area should have a referral pathway to specialist care at the IBCLC (International Board Certified Lactation Consultant) or similar level, for those complex cases where breastfeeding issues cannot be resolved at the level of basic/ routine care or by additional peer support.
The different roles of breastfeeding support in the UK have been outlined in the chart below:
WBTi’s research: Case studies of best practice The WBTi 2016 Report featured several case studies of areas who showed best practice in providing well joined up, integrated breastfeeding services: Brighton and Harrow.
More recently, our WBTi team has presented posters featuring these and additional case studies of best practices in providing integrated breastfeeding services: Medway, Harrow and Swindon.
WBTi Poster on Integrated Breastfeeding Services.
These examples of best practice in integrated breastfeeding services gave concrete results.
They demonstrated:
– a 2% rise in breastfeeding rates in a socially deprived area in 2018 (Medway),
– a 15% rise in initiation and a 12% rise in continuation of breastfeeding over a six year period (Harrow)
– and a 6% reduction in drop off rates from birth to 6-8 weeks over six years (Swindon).
Our WBTi team are always on the lookout for further examples of best practice in integrated breastfeeding services, and we submit them to Public Health England. Please do contact us if you would like to submit your local services!
Helen Gray MPhil IBCLC is Joint Coordinator of the World Breastfeeding Trends (WBTi) UK Working Group. She is also an accredited Leader (breastfeeding counsellor) with La Leche League of Great Britain.
Breastfeeding trends (UK) 