Leadership and collaboration – WBTi actions, Indicator 1

The World Breastfeeding Trends Initiative (WBTi) is a tool to help countries assess their implementation of key policies and programmes. These are drawn from the WHO Global Strategy for Infant and Young Child Feeding, which was adopted by the World Health Assembly, including the UK. The first UK World Breastfeeding Trends Initiative report was published in November 2016 and launched at the Houses of Parliament. Its ten policy and practice indicators address the extent to which there is an infrastructure in a country to support breastfeeding. The process brought together organisations and agencies working in maternal and infant health to monitor progress, identify gaps and generate joint recommendations for action to address those gaps.

What is Indicator 1 about?

Indicator 1 asks if there is a national infant feeding policy, supported by a government programme, with a coordinating mechanism such as a national infant feeding committee and coordinator. The UK assessment found:

key-gaps-and-recommendations

Women have autonomy over their own bodies so decide for themselves how to feed their babies but it can be very hard to carry a specific intention when the environment is unsupportive. It’s similar to the situation faced by someone who wants to avoid becoming overweight in an environment where tempting food is heavily advertised and easily available. A UK mother who wishes to breastfeed is likely to face barriers to achieving her goal throughout her breastfeeding journey.

National leadership

How can the situation be changed? An efficient way that can help to achieve consistency across the country is to have national leadership – a national coordinator with sufficient authority, a representative high level committee and a plan or strategy for change, as described in Indicator 1. Breastfeeding Policy Matters in 2015 highlighted the importance of this and the processes needed [1].

Scotland and Northern Ireland have national leadership in place but England does not. Yet the rhetoric is there. The 2016 government guidance from Public Health England, Health matters: giving every child the best start in life explains why the early years are so crucial [2]. It lists some of the health benefits and states that ‘creating the right environment to promote and support breastfeeding is crucial’. It highlights the importance of good maternal mental health so that the mother can be sensitive to the baby’s emotions and needs, helping the baby to develop secure attachment. Breastfeeding enhances a mother’s mental health while mothers who want to breastfeed but stop before they planned to are at greater risk of postnatal depression [3]. However, instead of increasing the support available to mothers, many support services were cut in 2016 because of reduced funds available. Such preventative services were not seen as a priority.

Freedom to choose how to feed one’s baby is valued in the UK and some people are concerned that mothers might feel pressured to breastfeed if it is encouraged. Ironically, advertising of follow on formula milks that might persuade mothers to switch from breastfeeding seems to cause less concern. Yet thousands of mothers make the often upsetting decision to stop breastfeeding before they wanted to. Where is the focus on these mothers and their suffering? Supporting breastfeeding is not about persuasion but about providing the infrastructure to enable them to continue; since some three quarters of mothers already opt to start breastfeeding, persuasion is irrelevant for them. If more mothers continued as long as they wished to, the proportion starting may well increase as expectant mothers will be less likely to hear negative messages.

Unicef UK’s widely endorsed Call to Action in 2016 included developing a national infant feeding strategy board in each nation [4]. What would a strategic plan encompass? The other WBTi indicators offer key points to include, such as Baby Friendly status being a universal goal, legislation in line with World Health Assembly recommendations, adequate protection for breastfeeding in the workplace, local support that is of high quality and integrated, and health professionals who have adequate training is supporting breastfeeding. If representatives of the four UK nations meet regularly they can also share ideas. Back in 2003 the World Health Organisation produced the Global Strategy for Infant and Young Child Feeding, which includes recommendations for national leadership, and this was followed in 2008 by the European Blueprint document [5,6]. Thus there are plenty of ideas available for developing a plan. The challenge is then implementation.

Alongside national leadership by governments, as described above, the breastfeeding support charities, relevant royal colleges and other similar professional bodies, campaigning organisations and interested individuals can both amplify calls for change and help to bring it about by collaborating. The infant feeding coalition meeting in June 2016, reinvigorating the idea of the former Breastfeeding Manifesto Coalition, demonstrated the keenness there is to work together [7]. Unicef UK’s Baby Friendly consultation on developing an inclusive Foundation provides an urgent opportunity to influence this – urgent because the deadline is 31 January 2017 [8].

Please read the consultation document and respond to the survey, thus helping to influence the future.

Also, check out our campaigning guidance for you to contact your MP and discuss issues highlighted in our report [9].

 

References

  1. McFadden A, Kenney-Muir N, Whitford H, Renfrew M (2015) Breastfeeding: Policy Matters London: Save the Children
    http://www.savethechildren.org.uk/resources/online-library/breastfeeding-policy-matters
  2. https://www.gov.uk/government/publications/health-matters-giving-every-child-the-best-start-in-life
  3. Brown A, Rance, Bennett P (2016) ‘Understanding the relationship between breastfeeding and postnatal depression: the role of pain and physical difficulties’ J Adv Nurs. 2016 Feb; 72(2): 273–282 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4738467/
  4. Unicef UK (2016) Call to action for breastfeeding in the UK.
    https://www.unicef.org.uk/babyfriendly/baby-friendly-resources/advocacy/call-to-action/
  5. WHO (2003) Global Strategy for Infant and Young Child Feeding.
    http://www.who.int/nutrition/topics/global_strategy/en/
  6. European Commission, Directorate Public Health and Risk Assessment (2008) Protection, Promotion and Support of Breastfeeding in Europe: A Blueprint for Action.
    http://www.aeped.es/sites/default/files/6-newblueprintprinter.pdf
  7. Breastfeeding Manifesto The Coalition
    http://www.breastfeedingmanifesto.org.uk/the_coalition.php
  8. Unicef UK Baby Friendly Initiative (2016) Creating a Baby Friendly Foundation: A Consultation Document
    https://www.unicef.org.uk/babyfriendly/baby-friendly-resources/advocacy/foundation-consultation/
  9. Baby Milk Action (2017) Ask your MP to help enable mothers to breastfeed as long as they wish
    http://www.babymilkaction.org/wbtiuk-mps0117

More on Indicator 1 – National Policy, Programme and Coordination

Two weeks ago representatives of the key organisations involved in breastfeeding sat round a table to begin the first UK assessment using the World Breastfeeding Trends initiative tool.

In the first presentation, this graphic popped up, and a collective “ooh” and then an “aah” went round the room. You may be forgiven for wondering why it generated such a response – it doesn’t look particularly inspiring!

 

gear model
Credit: Pérez-Escamilla et al, Advances in Nutrition, Nov 2012

It’s because this picture demonstrates what happens when there is a strong national strategy on breastfeeding – and also what happens when there isn’t.

In the late 1990s, Brazil made a concerted effort to improve infant health through a drive to increase breastfeeding rates in the country. They put in place legislation to protect mothers, training for health professionals, breastfeeding promotion – along with the money to pay for it all. And they had a national coordinated breastfeeding strategy to make it happen.

At the same time, Mexico had no such national strategy. Half-hearted efforts were made in some areas, such as training for health professionals and public promotion of breastfeeding.

As the graphs show, Brazil was able to significantly increase breastfeeding rates over that period while in Mexico they stagnated.

Without a strong, national, coordinated breastfeeding strategy to drive things forward, everything else is just wheels turning in the wind.

That’s the metaphor – what does this all mean in practice for the UK?

Let’s imagine a mother, who has her baby in a Baby Friendly hospital [1] and breastfeeding gets off to a good start. But then she arrives home and starts to experience some problems. Her health visitor suggests she gives the baby some formula [2]. She’s seen some adverts on television and buys a particular brand of formula because it’s “closer to breastmilk” [3]. She lives in a rural area, and the nearest breastfeeding support group is 10 miles away and she doesn’t drive [4]. Her husband has seen the adverts too so he knows that “good dads do the night feeds” [5]. After a couple of weeks the baby is getting more and more formula and is breastfeeding less and less. Her husband suggests she’s given breastfeeding a good go but maybe she should stop now [7]. She had wanted to breastfeed for longer but she gives up [8].

  1. Indicator 2 of the WBTi asks – are babies born in Baby Friendly hospitals?
  2. Indicator 5 asks – do health professionals have adequate breastfeeding training?
  3. Indicator 3 asks – is the International Code of Marketing of Breastmilk Substitutes fully implemented?
  4. Indicator 6 asks– do all mothers have access to breastfeeding support in the community?
  5. (see Indicator 3)
  6. Indicator 7 asks – do parents have access to good information about breastfeeding and the risks of using formula?
  7. Indicator 12 asks – what percentage of babies are exclusively breastfed for the first six months?

Without this central cog (Indicator 1) driving all the other cogs (Indicators 2-10) things cannot move forward. This point is also made clear in a new report from Save the Children, which looked at breastfeeding policies and practices in six countries, including the UK.

The WHO Global Strategy on Infant and Young Child Health (which the UK is signed up to) states that each country should have:

  • a national breastfeeding policy
  • a plan of action based on that policy
  • that plan must be adequately funded
  • there needs to be a National Breastfeeding Committee
  • that committee must meet on a regular basis to review progress
  • that committee needs to link effectively with public health bodies
  • that committee must have a coordinator who communicates national policy at regional and local levels

Indicator 1 of the WBTi assessment asks whether a country has each of the above and gives a total score out of 10. How well do you think the UK as whole will score? How would the countries of the UK score individually? What do we need to do to improve that score? How can policies be turned into actions at a local level?

Post your comments below or on our Facebook page.

In the next blog post we will be talking about Indicator 2 – Baby Friendly care and Baby-Friendly Hospital Initiative and will be asking for your thoughts about how things can be improved.