Category: Community

Infant Feeding in Emergencies – Resources for supporting families from #Ukraine #IYCFE

Infant Feeding in Emergencies – Resources for supporting families from #Ukraine #IYCFE

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.

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

Sphere Handbook

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

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.

Infant Feeding in Emergencies – Resources for supporting #Afghan families #IYCFE

Infant Feeding in Emergencies – Resources for supporting #Afghan families #IYCFE

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

Sphere Handbook

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

Video from UNICEF 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

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.

#WBW2021 Protect Breastfeeding: A Shared Responsibility – Holding Time exhibit by Lisa Creagh

#WBW2021 Protect Breastfeeding: A Shared Responsibility – Holding Time exhibit by Lisa Creagh

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

Follow online on #BreastfeedingBuddy

Holding Time Cheshire and Merseyside: https://holdingtime.org/cam/

https://www.lisacreagh.com/holding-time-1

www.youtube.com/c/HoldingTime

@TheHoldingTimeProject

@holdingtimeproject

Improving Me https://www.improvingme.org.uk/about-us/

Improving Me

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:

http://www.holdingtime.org/CAM

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

#WBW2021 Protect Breastfeeding: A Shared Responsibility – Communities

#WBW2021 Protect Breastfeeding: A Shared Responsibility – Communities

‘Creating breastfeeding Communities’.

The Harrow Example.

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:

https://www.wearebesideyou.co.uk/Swindon

Harrow was featured in the UK WBTi report in 2016, as an example of good practice

Email us at wbti@ukbreastfeeding.org

Sign up to our mailing list HERE


Dr Alison Spiro -Specialist health visitor (rtd) is a member of the WBTi UK Steering Group.

[1] ‘national-maternity-review-report.pdf’ (2016). Available at: https://www.england.nhs.uk/wp-content/uploads/2016/02/national-maternity-review-report.pdf

#WBW2021 Protect Breastfeeding: A Shared Responsibility – Peer Support

#WBW2021 Protect Breastfeeding: A Shared Responsibility – Peer Support

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:

Who’s Who in Breastfeeding Support and Lactation in the UK, from Lactation Consultants of Great Britain

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.

Case studies of two breastfeeding services providing integrated support, 2016.
In Part 2 of our WBTi UK Report

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!

Email us at wbti@ukbreastfeeding.org

Sign up to our mailing list HERE

Banner photo credit: Pixabay

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.

Seeing the world through babies’ eyes

Seeing the world through babies’ eyes

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

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

Shocking gaps in emergency preparedness for Europe’s babies

Shocking gaps in emergency preparedness for Europe’s babies

The Covid-19 pandemic has shown how important it is for countries to protect their citizens from illness.

Yet a new WBTi regional report shows gaps in support for families across Europe, with the poorest overall scores in national leadership and, shockingly, emergency preparedness, where the UK scored 0/10. This pandemic is an emergency for infants and young children and only North Macedonia was found to have an adequate strategy.

Babies who are breastfed have better health and resistance to infection, and most mothers want to breastfeed. Yet many European mothers stop or reduce breastfeeding in the early weeks and months, and bottle feeding is prevalent, due to inadequate support from health systems and society.

Launched today, the first European report on infant and young child feeding policies and practices, Are our babies off to a healthy start?, compares 18 countries and identifies the considerable improvements they need to make in supporting mothers who want to breastfeed. A summary report has been published today in the International Breastfeeding Journal .

The full report can be downloaded from the World Breastfeeding Trends Initiative global website.    

The new report, Are our babies off to a healthy start?, compares the  implementation of WHO’s Global Strategy for Infant and Young Child Feeding across 18 European countries. The comparisons show clearly that inadequate support and protection for breastfeeding mothers is a Europe-wide problem. The health of babies, mothers and whole populations  lose out as a result. However, countries do differ considerably. Turkey rates highest overall; the five countries with the lowest scores belong to the European Union. 

     ‘Nutrition is key to achieving the Sustainable Development Goals related to health, education, sustainable development, reduction of inequalities and more.’

Joao Breda, Head, WHO European Office for Prevention and Control of Noncommunicable Diseases

The scope of the assessment is wide-ranging, with ten policy and programme indicators, including national leadership, Baby Friendly hospital and community practices, marketing controls on breastmilk substitutes, health professional training, emergency preparedness and monitoring. There are also five feeding practices indicators, such as exclusive breastfeeding for 6 months, a WHO recommendation. 

The original assessments were all carried out using the World Breastfeeding Trends Initiative (WBTi), a tool first developed in 2004 by the International Baby Food Action Network (IBFAN) but only launched in Europe in 2015. It requires collaboration with relevant organisations within a country on assessment scores, gaps identified and recommendations for improvements. The Report highlights good practice, enabling countries to learn from one another.

     ˝Success …rests first and foremost on achieving political commitment at the highest level and assembling the indispensable human and financial resources.’

WHO Global Strategy 2003

If governments, other policymakers, hospitals and community services, public health departments, institutions that train health professionals, and others, adopt the report recommendations, it will enable more mothers to initiate and continue breastfeeding, strengthening the health of the population for the future.

The WBTi European Working Group, led by Dr. Irena Zakarija-Grkovic of Croatia, produced the Report and comprises coordinators from European countries which have carried out a WBTi assessment. The production of the report was supported by the Croatian Ministry of Health and UNICEF Croatia.

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UK media contact: wbti@ukbreastfeeding.org

We want the new government to invest in the health of women and children by supporting and protecting breastfeeding.

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.

Download the PDF HERE

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:

  • To appoint a permanent, multi-sectoral infant and young child feeding strategy group and develop, fund and implement a national strategy to improve infant and young child feeding practices. 
  • To include actions to promote, protect and support breastfeeding in all policy areas where breastfeeding has an impact.
  • To implement the Unicef UK Baby Friendly Initiative across community and paediatric services, building on the recommendation for maternity services in the NHS Long Term Plan.
  • To protect babies from harmful commercial interests by bringing the full International Code of Marketing of Breastmilk Substitutes into UK law and enforcing this law.
  • To commission, and sustainably fund, universal breastfeeding support programmes delivered by specialist/lead midwives and health visitors or suitably qualified breastfeeding specialists, such as IBCLC lactation consultants and breastfeeding counsellors, alongside trained peer supporters with accredited qualifications.
  • To maintain and expand universal, accessible, affordable and confidential breastfeeding support through the National Breastfeeding Helpline and sustaining the Drugs in Breastmilk Service.
  • To deliver universal health visiting services and the Healthy Child Programme by linking in with local specialist and support services.
  • To establish/re-establish universal Children’s Centres with a focus on areas of deprivation, offering breastfeeding peer support.
  • To make it a statutory right of working mothers and those in education to work flexibly as required and to access a private space and paid breaks to breastfeed and/or express breastmilk and manage its safe storage.
  • To commit to resourcing for charitable organisations who play a key role within the health agenda working at a national and local level to support families and communities with infant feeding.
  • To support the commitment to undertake an Infant Feeding Survey which builds on the data previously collected in the Infant Feeding Survey 2010 (now discontinued). 
  • To implement the recommendations of the Becoming Breastfeeding Friendly (BBF) study.

CASE FOR ACTION

  1. Breastfeeding benefits all babies, and studies have shown that just a small increase in breastfeeding rates could cut NHS expenditure considerably.  It is vital to invest in breastfeeding support in the early months and this will reap rewards in the future that are likely to exceed the initial cash flows associated with putting proper support in place.
  2. A UNICEF report states that “no other health behaviour has such a broad-spectrum and long-lasting impact on public health. The good foundations and strong emotional bonds provided in the early postnatal period and through breastfeeding can affect a child’s subsequent life chances”. 
  3. Evidence has also demonstrated that a child from a low-income background who is breastfed is likely to have better health outcomes than a child from a more affluent background who is formula-fed. Breastfeeding provides one solution to the long-standing problem of health inequality.
  4. Research into the extent of the burden of disease associated with low breastfeeding rates is hampered by data collection methods. This can be addressed by investment in good quality research.

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

4. https://www.brunel.ac.uk/research/News-and-events/news/Breastfeeding-for-longer-could-save-the-NHS-40-million-a-year

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       

Empowering communities through integrated sustainable solutions #WBW2019

Empowering communities through integrated sustainable solutions #WBW2019

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:

  • Basic: universal services such as midwives, health visitors, and support workers are trained to BFI standards
  • Additional: a network of trained local peer supporters and support groups
  • Specialist: a referral pathway to specialist help at IBCLC level, for complex cases that cant be resolved by “Basic” and “Additional” support

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.

Prevention intention

Prevention intention

A Vision for Prevention

Matt Hancock, UK Secretary of State for Health and Social Care since July 2018, launched his prevention vision on 5 November.

His other priorities are to advance health technology and provide better support for the health and social care workforce. He sees prevention as having two aspects. Partly it is about keeping well physically and mentally, to prevent ill health, but  also about the environment around people, their lifestyle choices and how existing health conditions are managed. The aims are for the average person to have 5 more years of healthy independent living by 2035, and to reduce the gap between the richest and poorest. At present there is a large discrepancy in spending with £97 billion (public money) spent on treating disease and £8 billion on prevention across the UK!

The proposed actions in the vision  are:

  • “Prioritising investment in primary and community healthcare
  • Making sure every child has the best start in life (our emphasis)
  • Supporting local councils to take the lead in improving health locally through innovation, communication and community outreach
  • Coordinating transport, housing, education, the workplace and the environment – in the grand enterprise to improve our nation’s health
  • Involving employers, businesses, charities, the voluntary sector and local groups in creating safe, connected and healthy neighbourhoods and workplaces”

The Department of Health and Social Care’s (DHSC) paper is called ‘Prevention is better than cure: Our vision to help you live well for longer‘.

It states there is strong evidence that prevention works and recognises that a healthy population is both vital for a strong economy and for reducing pressure on services like the NHS (almost 10% of the national income is spent on healthcare). Average life expectancy is now 81 years, helped by:

  • advances in healthcare
  • changing attitudes so there is less stigma with some conditions
  • improvements in the environment, at home, work and in neighbourhoods
  • antibiotics and mass vaccination
  • public health programmes.

However, there are major challenges in the huge discrepancies between areas – ‘A boy born today in the most deprived area of England can expect to live about 19 fewer years in good health and die nine years earlier than a boy born into the least deprived area.’ (p.7)

Duncan Selbie, Chief Executive of Public Health England, welcomed the change of focus to more emphasis on prevention and pointed out the need for collaborative working – NHS, national government, local government, voluntary and community sector, and industry.  It will be important to monitor industry involvement to ensure that it does not create conflicts of interest, undermining health. Infants, young children, pregnant and breastfeeding mothers are particularly vulnerable, which is why the World Health Organisation developed guidance to protect them from conflicts of interest (WHO 2016 Guidance on the Inappropriate Promotion of Foods for Infants and Young Children) and other inappropriate commercial influence (International Code of Marketing of Breastmilk Substitutes, 1981, and subsequent WHA resolutions).

Improvements will depend both on encouraging individuals to choose healthy lifestyles and manage their own health, and expecting local authorities to take the lead in improving the health of their communities. The challenges of smoking, mental ill health, obesity, high blood pressure and alcolol-related harm are mentioned, along with the benefit of having a more personalised approach to health.

The section on ‘Giving our children the best start in life’ (p.20) mentions healthier pregnancies, improved language acquisition, reducing parental conflict, improving dental health, protecting mental health and  schools involvement, but infant feeding is not mentioned at all! 

However, in the Parliamentary debate on the vision (Prevention of Ill Health: Government Vision) on 5 November, Alison Thewliss MP made the case for supporting breastfeeding by investing in the Baby Friendly Initiative to bring all maternity and community services up to the minimum standard. Matthew Hancock’s reply sounds positive: ‘The earlier that we can start with this sort of strategy of preventing ill health the better, and there is a lot of merit in a lot of what the hon. Lady said.’

 

‘Prevention, Protection and Promotion’ at Public Health England

Earlier in the year (March 2018), Professor Viv Bennett, the Chief Public Health Nurse, and Professor Jane Cummings, the Chief Nursing Officer, came together to launch a campaign on the ‘3Ps –  Prevention, Protection and Promotion’, which is about actions to improve public health and reduce health inequalities. Breastfeeding is mentioned in the Maternity Transformation Campaign and Better Births and there appears to be increased govenment commitment to the key role breastfeeding plays in improving public health.

 

Directors of Public Health have a key role

The DHSC paper expects Directors of Public Health to ‘play an important leadership role’ (p.15). As an example, the Annual Report of Croydon’s Director of Public Health, published in mid-November, We are Croydon: Early Experiences Last a Lifetime, focusses this year on the first 1000 days of a child’s life.

It includes three breastfeeding recommendations:

  • Reset targets for increasing breastfeeding rates at 6 to 8 weeks and 6 months across the Borough and within particular localities
  • Achieve level 3 of the UNICEF Baby Friendly award
  • Turn Croydon into a breastfeeding friendly Borough, so women feel comfortable breastfeeding when they are out and about

 

How can progress on prevention occur unless it starts at the beginning – with infants? Will other Directors come up with similar recommendations?

 

Make London a ‘Baby-Friendly’ city

The Mayor of London, Sadiq Khan, aims to “make London a ‘Baby-Friendly’ city” in the London Food Strategy. This strategy aims to increase the health of all Londoners from infancy onwards, including supporting and normalising breastfeeding across London Transport and across government buildings and workplaces, and encouraging all London boroughs to become Unicef UK Baby Friendly-accredited in maternity and community services.

 

The UK government is due to publish a Green Paper on Prevention in 2019 to set out more detailed plans and, together with the NHS Long Term Plan, which is due to be published soon,  is relevant to a future with better health for all.

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30. Photo for WBTi MAINN presentation
Patricia Wise is an NCT breastfeeding counsellor and a member of the WBTi Steering Group.