We are delighted to have been invited to present an overview of the WBTi UK project to the 2023 Breastfeeding Network Conference!
Check back on our blog, or sign up to the blog for notifications, to get all the advocacy links we talk about.
See you there!
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
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:
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
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
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.
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.
CONTACT: wbti@ukbreastfeeding.org
WHERE TO START? Watch this 4 minute introductory video from Save the Children
Aid worker or emergency planner? Short video here: how can you incorporate best practice into your support for Ukrainian families?
GET INFORMED: Read the first 25 pages of the Guidance for an overview of best practice.
Resources from the Global Breastfeeding Collective, led by WHO and UNICEF
It is important to continue breastfeeding if you are COVID positive: your milk can pass antibodies to your baby! More resources HERE.
UNICEF UK Baby Friendly resources
Guidance for local authorities on infant feeding during COVID19 (from BFI, First Steps Nutrition Trust, and NIFN). First line guidance for UK local authorities responsible for supporting families
The provision of formula in food banks (November 2020)
Statement on infant formula in food banks (November 2020) – signposting
See also the response to Question 11 on formula donations and distribution in their FAQ here
International humanitarian guidelines and operational guidance
Operational Guidance on Infant feeding in Emergencies
for Emergency Relief Staff and Programme Managers
Available in numerous languages
Media Guide and Guide on writing/ talking about infant feeding in emergencies
These are extremely useful for humanitarian aid organisations and for the media in framing the situation
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
Rapid Feeding Assessment Key Phrases in multiple languages (including Ukrainian, Russian, Romanian, Polish and English – scroll down the page)
Simple Points for Helpers – infant feeding in emergencies in multiple languages (including Ukrainian, Russian, Romanian, Polish and English – scroll down the page)
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
Posters and booklets in Ukrainian hosted by the Lithuanian IBCLC Association
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 resources in multiple languages including Ukrainian, Romanian, Russian. (From the Missouri Department of Health and Senior Services, USA)
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
Translations of key phrases, breastfeeding infographics in many languages, and more: Safely Fed European resources
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
Global Health Media: Videos on childbirth and breastfeeding topics.
Infant Feeding in Emergencies Social Media resources:
Infant Feeding Support for Refugee Children Facebook Page: Memes/ graphics in multiple languages, with appropriate captions
La Leche League International Facebook page: Memes/ graphics in multiple languages, aimed at mothers and parents
Safely Fed UK Facebook page – volunteers welcome to create graphics in Canva and to monitor the page! Contact WBTi UK: wbti@ukbreastfeeding.org
For policy makers, emergency planners, media and humanitarian aid workers
Policy resources, media guide, training materials: Infant Feeding in Emergencies Core Group
IYCFE Hub: global hub of resources
Background information on breastfeeding in Ukraine: WBTi 2015 Ukraine Assessment Report
Policy resources, translations of key phrases, and more: Safely Fed European resources
Please do contact us if you are interested in volunteering or have some useful resources to share!!
CONTACT: wbti@ukbreastfeeding.org
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.
UNICEF UK Baby Friendly resources
Guidance on infant feeding during COVID19 (from BFI, First Steps Nutrition Trust, and NIFN)
First line guidance for local authorities responsible for supporting families
The provision of formula in food banks (November 2020)
Statement on infant formula in food banks (November 2020) – signposting
See also the response to Question 11 on formula donations and distribution in their FAQ here
International humanitarian guidelines and operational guidance
Operational Guidance on Infant feeding in Emergencies
Operational Guidance for Emergency Relief Staff and Programme Managers
Available in numerous languages
Guides on writing/ talking about infant feeding in emergencies and Media Guide
These are extremely useful in framing the situation
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
Infant Feeding flyer for families in transit (English, Arabic, Farsi, Kurdish)
Developed by the volunteer team from Infant Feeding Support for Refugee Children/ Safely Fed
Email us for more languages
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 resources in multiple languages (Missouri Department of Health and Senior Services, USA)
Infant Feeding in Emergencies Social Media resources:
Support for Refugee Children Facebook Page
Memes/ graphics in multiple languages, with appropriate captions
Safely Fed UK Facebook page – volunteers welcome to create graphics in Canva and to monitor the page! Contact WBTi UK: wbti@ukbreastfeeding.org
Resources in Afghan languages: Dari and Farsi
Background information on breastfeeding in Afghanistan: WBTi 2019 report on Afghanistan
Pictorial counselling cards for Afghanistan, in Dari
Infant Feeding flyer for families in transit: versions in Farsi and English
Developed by the volunteer team from Infant Feeding Support for Refugee Children/ Safely Fed
Breastfeeding Confidence booklet by the Australian Breastfeeding Association, in Dari
Breastfeeding Matters – An Important Guide to Breastfeeding for Women and their Families (from best Start, Ontario Canada) can be downloaded free in Farsi
Breastfeeding information in Farsi and other languages (Missouri Department of Health and Senior Services, USA)
Please do contact us if you are interested in volunteering or have some useful resources to share!!
CONTACT: wbti@ukbreastfeeding.org
This week (7- 12 June) is Infant Mental Health Awareness Week and the theme is ‘20:20 vision: Seeing the world through babies’ eyes’. The Week is led by the Parent-Infant Foundation (PIF) and the First 1001 Days Movement, a collaboration of relevant organisations with the PIF as secretariat, which is being launched during the week.
What is infant mental health? It is the emotional wellbeing of babies. The Movement’s vision is that ‘every baby has loving and nurturing relationships in a society that values emotional wellbeing and development in the first 1001 days, from pregnancy, as the critical foundation for a healthy and fulfilling life.’
What babies want is what they need and these needs are basic. As obstetrician Grantly Dick-Read wrote in the mid 20th century:
“The newborn has only three demands. They are warmth in the arms of its mother, food from her breasts, and security in the knowledge of her presence. Breastfeeding satisfies all three.”
They do also need to receive attention from other humans. If their needs are usually met, babies can form secure relationships (attachment) with their caregivers. Usually, there is one primary caregiver, most commonly the mother. Attachment theory was developed by the psychoanalyst John Bowlby in the 1950s. An attachment figure who cares responsively for the infant provides a secure base. It is believed that behaviours by the infant to stay close when separated, like screaming and clinging, have been reinforced by natural selection (see What is attachment theory).
Babies are vulnerable – as Donald Winnicott, paediatrician and psychoanalyst, among his other insightful quotes, stated:
‘There is no such thing as a baby, there is a baby and someone’.
However, infants are not passive as they communicate by giving cues to their needs, such as the rooting reflex when hungry. If their needs are not responded to quickly, they become upset. Dr. Edward Tronick’s ‘still face’ experiments in the 1970s showed the importance of human connection for an infant. If the parent’s face is still and unresponsive to her baby, the baby looks confused and then becomes distressed. The experiments also showed that ruptures in a relationship like this are easily repaired. Parents do not need to respond perfectly.
However, when there is repeatedly no response to a baby’s distress, as in sleep training where the baby is left alone and expected to adapt, it was found that the babies’ behaviour changed so that by the third night they were no longer crying but their cortisol (stress hormone) levels were still high so there was a mismatch between behaviour and physiology; instead of learning to self-soothe it seems as though they were giving up so in despair.
The significance of the care babies receive is that their experiences, starting before birth, influence the neural connections that are formed in the developing brain – the ‘wiring’. A parent who is emotionally not really available to the baby (so not attuned to their needs) will find it difficult either to respond or to respond appropriately, providing an unintentional ‘still face’ or angry face. The parents could be ill, depressed, addicted, suffering domestic abuse, desperately worried about their financial situation, overloaded with responsibilities………It is therefore crucial for a society to care for parents so that they can be emotionally available to their children.
Feeding is a crucial part of nurturing care and breastfeeding facilitates the process.There is considerable evidence that not being breastfed is linked to poorer physical health in infants (Lancet, 2016). Breastfeeding provides personalised nutrition. Antibodies and other components in breastmilk reduce the chance and severity of infections. Oligosaccharides in breastmilk feed and thus favour beneficial bacteria in the infant’s gut and this helps the development of a healthy immune system. It is difficult to allow for confounding factors in studies on breastfeeding but reviews show it is linked with better cognitive performance, which is likely to be due to the fatty acids in breastmilk. But what about any impact on emotional development? There are studies which suggest that being breastfed is associated with paying more attention to positive emotions in others. Breastmilk contains the calming hormone oxytocin, which stimulates social interactions, and which is further released through touch and suckling, so the moods of both mother and baby benefit. Several studies indicate that mothers who are breastfeeding tend to touch their babies more, are more responsive and tend to gaze at them more, all of which will help the infant’s emotional wellbeing. The Unicef UK Baby Friendly Initiative leaflet, Building a Happy Baby, provides practical suggestions for parents to support their baby’s brain development and addresses myths and realities.
Jones found that breastfeeding helps to protect infants from the harmful effects of maternal depression.
Mothers who stop breastfeeding before they want to are at greater risk of postnatal depression (Borra et al 2014) so mothers need easy access to breastfeeding support to help them continue, thereby benefitting their babies physically and emotionally. Sadly, there are barriers to breastfeeding throughout society, as outlined in the WBTi UK report.
Parents and carers urgently need more support, especially during the stresses and isolation of lockdown and the COVID19 pandemic. We call on government to make infants and their families a high priority during the pandemic and in our plans to rebuild a stronger society.
Photo used with permission
Maternal Mental Health Day is on the first Wednesday in May, which this year was 6th May. A group of organisations has launched a new survey to try to capture parents’ experiences in the context of a global pandemic and social distancing. If the survey can be distributed widely to parents with a baby/child under 2 year, or are pregnant, to gather the views of parents of a range of ages, ethnicities and experiences, the data will be particularly useful.
The collaborating organisations include members of the First 1001 Days Movement, which is coordinated by the Parent-Infant Foundation, Home-Start UK, Best Beginnings, and the Maternal Mental Health Alliance. The WBTi UK Steering Group have also signed up to support the First 1001 Days Movement.
Do you know anyone who is pregnant or has a child under 2 years who might be interested in completing the survey? Please pass on the survey link. The survey is expected to be open for about 3 weeks, so until late May.
Headline results of the survey are due to be released in Infant Mental Health Awareness Week (7-12 June).
Photo courtesy of Paul Carter, We Do It In Public (wdiip.co.uk)
The WBTi UK team are proud to be part of producing this joint statement calling for our next government to make breastfeeding a priority in setting the agenda to prioritise the early years of life.
The new government needs to prioritise the first 1001 days of a child’s life, from conception to age two, to enable children to survive and thrive. How an infant is fed and nurtured strongly influences a child’s future life chances and emotional health. Importantly, if a woman breastfeeds there are substantial health benefits for her – having impacts onher future long after breastfeeding has stopped.
Independent, practical, evidence-based information and support is essential for every family. Supporting women with breastfeeding can go a long way to protecting children and mothers from a wide range of preventable ill health, including obesity and mental health problems.
This window of opportunity cannot be missed for the future health outcomes of mothers and the next generation. In addition to well documented health outcomes, supporting breastfeeding will also contribute to a stronger economy – potential annual savings to the NHS are estimated at about £40 million per year from just a moderate increase in breastfeeding rates.
Support for breastfeeding is also an environmental imperative and recognition of the contribution breastfeeding can make to avoiding environmental degradation should be a matter of increasing global and political attention.
In the UK, the majority of women start to breastfeed but breastfeeding rates drop rapidly – our continuation rates are some of the lowest in the world and are even lower amongst women living in deprived areas, where increasing rates could make a real difference to health inequalities. Support for all women, parents and families with breastfeeding falls short of what is wanted and needed.
Women tell us they encounter difficulties with the public perceptions of breastfeeding out of the home. Families tell us they are still regularly exposed to conflicting messaging and marketing for formula milks that drowns out advice from healthcare professionals.
Women tell us they receive little to no help with infant feeding and that their health visitors, midwives and doctors often have little training or knowledge about breastfeeding and limited time to support them.
Recent cuts in health visitor numbers and breastfeeding peer support services mean many women may be left without the support they need however they choose to feed their infants.
Despite robust evidence showing that investment in breastfeeding support and protection makes sense, politically breastfeeding has been viewed by governments as a lifestyle choice and so left to parents to work out for themselves. For too many women, trying to breastfeed without support, or stopping before they want to, is deeply upsetting and the situation is made worse by fragmented care, and poor and often conflicting advice from those they are seeking to support them. To ensure an increase in breastfeeding rates, to help reverse obesity rates and to reduce widening health inequalities will require significant investment in breastfeeding.
It is essential that our new government prioritises breastfeeding and invests in its support and protection.
We call on all political parties to commit to the following actions, if elected:
CASE FOR ACTION
References
1. Laurence M. Grummer‐Strawn Nigel Rollins, (2015), Impact of Breastfeeding on Maternal and Child Health. https://onlinelibrary.wiley.com/toc/16512227/2015/104/S467
2. Borra C, Iacovou M, Sevilla A (2015) Maternal Child Health Journal (4): 897-907. New evidence on breastfeeding and postpartum depression: the importance of understanding women’s intentions.
3. Brown, A, Rance J, Bennett, P (2015) Understanding the relationship between breastfeeding and postnatal depression: the role of pain and physical difficulties. Journal of Advanced Nursing 72 (2): 273-282
5. Li R, Fein SB, Chen J, Grummer-Strawn LM, (2008) Why mothers stop breastfeeding: mothers’ self-reported reasons for stopping during the first year. Pediatrics 122: S60-S76
6. Support for breastfeeding is an environmental imperative. (2019) BMJ 2019;367:l5646 https://www.bmj.com/content/367/bmj.l5646
7. McAndrew F et al (2012) Infant Feeding Survey 2010
8. NHS (2019) NHS Long term Plan https://www.longtermplan.nhs.uk/
9. National Institute for Health and Care Excellence (2013) Postnatal Guideline NICE, London https://www.nice.org.uk/guidance/cg37
10. National Institute for Health and Care Excellence (2012) Improved access to peer support NICE, London
11. Rollins N, Bhandari N, Hajeebhoy N, et al (2016) Why invest, and what it will take to improve breastfeeding practices? The Lancet 387 491-504
12. Wilson AC, Forsyth JS, Greene SA, Irvine L, Hau C, Howie PW. 1998 Relation of infant diet to childhood health: seven year follow up of cohort of children in Dundee infant feeding study. BMJ. Jan 3;316(7124):21-5.
13. Brown, A, Finch, G, Trickey, H, Hopkins, R (2019) ‘A Lifeline when no one else wants to give you an answer’ – An Evaluation of the BFN’s drugs in breastmilk service. https://breastfeedingnetwork.org.uk/wp-content/pdfs/BfN%20Final%20report%20.pdf
I’m a lactation consultant and writer who has just finished a Masters degree in Health Promotion at Leeds-Beckett University. This blog touches on some of the insights that my studies have given me, not least how data, like WBTi’s reports, can help health promoters create integrated, sustainable solutions that make health a resource to be shared by everyone.
In 1986, the World Health Organization (WHO) Ottawa Charter for Health Promotion defined Health Promotion as “the process of enabling people to increase control over, and to improve, their health.” Whether the focus be on breastfeeding, preventing obesity, supporting mental health or any of the complex (so called ‘wicked’) problems that challenge our societies, it is health promotion’s recognition of the social determinants of health that has most affected my thinking. All too often our society is quick to blame the individual for unhealthy behaviours; my increased awareness of the social determinants of health, that is, how socio-economic, cultural and environmental conditions determine individuals’ well-being, has changed my perception. It’s given me a heightened awareness of how prevailing political ideologies influence the way we think about society, and how this plays out into how likely (or not) individuals are to be able to make healthy choices throughout the course of their lives.
“This unequal distribution of health-damaging experiences is not in any sense a ‘natural’ phenomenon but is the result of a toxic combination of poor social policies, unfair economic arrangements …and bad politics.” WHO[1]
To give an example, indicator 6 of the WBTi looks at community-based support, so key to women continuing to breastfeed.[2]In the UK, the recent NHS Long Term Plan’s recommendation of UNICEF UK Baby Friendly accreditation is cause for celebration and will boost the capacity of midwives and health visitors to support breastfeeding in the community.
However, cuts to peer-support services, and the closure of over 1000 Sure Start centres have disproportionately affected poorer members of society. If a mother in the community has persistent nipple pain, no car, no public transport, no money for a lactation consultant and her nearest breastfeeding group is 20 miles away, even with the support of the hard-working volunteers on the National Breastfeeding Helpline, her capacity to protect the health of her family through breastfeeding will be limited.
Incidentally, the discipline of Health Promotion, while focusing on the up-stream causes of health inequalities, is also focused on empowering communities to participate in the creation of healthier societies. The UK’s WBTi report, under Indicator 6, points out that in England and Wales there is often little coordination between NHS services and peer-supporters, who can offer so much to new mothers. It recommends a range of integrated postnatal services that include voluntary sector breastfeeding support, meet local needs and provide clear access to specialist support.
Integrated breastfeeding support is outlined in the criteria for UNICEF Baby Friendly accreditation for community services:
The guidance and standards on community breastfeeding support from NICE, Baby Friendly and Public Health England are summed up in this “Breastfeeding Support Within Maternity Transformation Plans: Guide to the Guidance” by Better Breastfeeding.
As an individual health promoter, the scale and complexity of the social determinants of health can feel overwhelming. Nonetheless, recognising them sets the challenge to health promoters (in all disciplines, not just those who work in traditional health services or policy) to work empathetically, creatively and collaboratively. After all, ‘Success in breastfeeding is not the sole responsibility of a woman – the promotion of breastfeeding is a collective societal responsibility’ (The Lancet).
[1]Commission on Social Determinants of Health (2008). Closing the Gap in a Generation: Health Equity Through Action on the Social Determinants of Health (PDF). World Health Organization.
[2]Dennis C (2002) The Effect of Peer Support on BreastFeeding Duration among Primiparous Women: A Randomized Controlled Trial. Canadian Medical Association Journal 166(1):21-8.
Alice Allan is a lactation consultant, writer and communication specialist who has worked in Ethiopia and Uzbekistan on maternal and child health. Her novel, Open My Eyes, (Pinter and Martin) set in an Addis Ababa NICU, recently won The People’s book Prize for Fiction. She currently lives near London with her family and an Ethiopian street dog called Frank.
The theme for World Breastfeeding Week this year is “Empower parents, enable breastfeeding,” which fits the philosophy of our WBTi work very well. The WBTi recommendations have been produced by a Core Group of 18 of the UK’s key government agencies, health professional organisations and charities working in infant and maternal health. The 46 recommendations, across ten areas of policy and programmes, parallel many of the recommendations of previous national breastfeeding initiatives such as the UNICEF Baby Friendly Call to Action, the Becoming Breastfeeding Friendly project (completed in Wales and Scotland so far), and the Breastfeeding Manifesto.
The WBTi assessment and recommendations for action are all about providing the structures, policies and programmes that families need in order to support mothers and infants to be able to breastfeed successfully. It is not a woman’s responsibility on her own, it is the responsibility of ALL of us, across society, to provide the support that mothers and babies need.
This has been echoed by the UN Human Rights experts, who have stated that breastfeeding is a human right of the breastfeeding dyad, and that states/ society is responsible for providing the structural support they need. Likewise this is the key message of the Lancet 2016 Series on Breastfeeding.
Our UK report found many gaps and barriers in ten areas of policy and programmes across the UK:
There are several bright spots, however, and in the two years since the WBTi report and recommendations were published, there have been improvements in several areas
So we are in interesting times – we still face budgetary and cultural challenges, and families still face many barriers.
However change is clearly happening!
For World Breastfeeding Week, we are hosting a number of guest blogs detailing some exciting innovations:
The launch of the Hospital Infant Feeding Network, with a website and a collection of posters and resources for health professionals working with mothers, infants and young children in hospital.
A new set of educational resources on breastfeeding and medications for pharmacists, from the wonderful Wendy Jones.
And a blog looking at some of the public health issues around breastfeeding support in the community, from Alice Allan IBCLC MPH.
Sign up HERE for WBTi’s email list, and don’t forget to sign up to follow our blog!
Breastfeeding trends (UK) 