‘Let’s make breastfeeding work – optimal maternity leave and workplace accommodations support an environment that enables breastfeeding’

August 1-7^th marks the World Breastfeeding Week. The theme is ‘Let’s make breastfeeding and work, work!’ The benefit of breastfeeding to health, the economy, work and the environment is widely documented. However, the UK remains one of the countries in the world with the lowest breastfeeding rate. Although 81% of mothers set out to breastfeed, only 1% of babies in the UK are still exclusively breastfed at 6 months. The question has always been why is breastfeeding rate so low in the UK?

Return to work is one of the key barriers to breastfeeding especially where the workplace is not breastfeeding friendly. A study published in 2007 by the Cohort Group found that mothers employed part-time or self-employed were more likely to breast-feed for at least 4 months than those employed full-time. The longer a mother delayed her return to work postpartum, the more likely she was to breast-feed for at least 4 months. Mothers were more likely to breastfeed for at least 4 months if their employer offered family-friendly or flexible work arrangements, or they received Statutory Maternity Pay plus additional pay during their maternity leave rather than Statutory Maternity Pay alone. This demonstrated that return to work could have a negative impact on breastfeeding if the mother is not properly supported.

Currently the UK does not have a legal framework that protects and promote breastfeeding in the workplace. The 1001 critical days strategy is there but does not have a legal backing to ensure that mothers are properly supported to continue breastfeeding should they choose to return to work early. A general assumption is made that mothers would take the full 52 weeks of maternity leave even though the leave is not properly paid. Mothers returning to work find it challenging to understand what they can and cannot do.

Though many employers are quick to showcase how family friendly they are in supporting working parents, breastfeeding remains an area in need of significant improvement. This is predominantly because the government has failed to recognise the benefits of breastfeeding and has failed to embed it in the current family friendly rights. Ideally, maternity leave should naturally go with a workplace breastfeeding policy. Other family friendly policies such as shared parental leave is not achieving its desired impact partly because of the lack of breastfeeding support in the workplace.

Mothers who intend to breastfeed for long may not share their maternity leave with their partners if support is not in place in the workplace.

These challenges were clearly articulates in the breastfeeding documentary titled ‘Breastfeeding: Not on the Agenda’which was followed by a call to action for the government to include breastfeeding in the family friendly rights to Make Breastfeeding and Work, Work.

NOTE from the WBTi team:

This petition incorporates many of the WBTi recommendations for action:

Embed breastfeeding in the school curriculum and relevant health professionals training.
- See WBTi recommendations for Indicator 5 “Health Professional training” and our related blogs:
- Recommendations on health professional training: WBTi Report Part 1: indicator 5
- WBTi Report Part 2: Indicator 5 for details of each health profession’s training standards in infant and young child feeding
- WBTi blog on “What does your doctor know about breastfeeding? and our 2020 Eevent on “Doctors and Breastfeeding”
Provide a policy on breastfeeding in the workplace which will protect the rights of breastfeeding mothers in the workplace.
- Our WBTi 2016 findings and recommendations on Indicator 4, maternity protection in the workplace
- Our other WBTi blogs on maternity protection and breastfeeding breaks in the workplace HERE and HERE
Mandate all large public places like shopping malls, community centres, public libraries, museums, etc to provide breastfeeding rooms or spaces.
Fully adopt The Code of Marketing of Breastmilk Substitutes to protect babies and their families from harmful commercial influences and undermining of breastfeeding for commercial profit; and to protect families who formula feed from the escalating costs of premium brands.
- Our WBTi 2016 findings and recommendations on Indicator 3: The International Code that the UK government implement the full Code and subsequent relevant WHA Resolutions in UK law and regulations, and also monitor and enforce these regulations.
- Further examples of Code violations in the UK in WBTi 2016 Report Part 2: Indicator 3
Provide adequate 24/7 specialist lactation support in maternity services to actively counteract the culture of formula top-ups in hospitals; and to enable human donor milk to be more accessible as an option when mother’s milk is not immediately available.
Guarantee a sustained funding support to breastfeeding organisations who play a key part in supporting mothers.
- Our WBTi 2016 findings and recommendations on Indicator 6: community-based support
- Additional findings in Part 2 including an audit of UK third sector breastfeeding support, and a list of cuts to community services
Include breastfeeding support on the Net Zero Environmental Agenda.

Dr Ernestine Gheyoh Ndzi is the Associate Dean for Law and Police Studies at York St John University. Her research interest lies in Company Law and Employment Law. Ernestine has in the past four years been researching on shared parental leave and breastfeeding. Ernestine is a member of the Board of Trustees for The Breastfeeding Network. She is the producer of the breastfeeding documentary titled ‘Breastfeeding: Not on the Agenda. She is running a 9-webinar series exploring the benefits and challenges of breastfeeding. She is also leading on the campaign for change to support breastfeeding in the UK.

Shared Parental Leave policy failing to make Breastfeeding and Work, Work

Shared parental leave is a policy that was introduced in the UK in 2014 with the aim of giving parents more choice and flexibility in how they care for their child in the first year. However, it means that the mother would have to share part of her maternity leave with her partner. This would reduce the time a mother can spend on maternity leave. While the shared parental leave policy is great in encouraging fathers to take a more active role in the early days of the child’s life and enabling mothers to return early to the labour market, it presents a unique challenge to mothers who choose to breastfeed.

Barriers in the workplace are some of the key challenges to breastfeeding mothers who choose to return to work early after childbirth. Returning to work often means mothers must constrain their breastfeeding, which sometimes results to mothers ceasing breastfeeding.

The lack of a legal framework on what employers are expected to do to support breastfeeding mothers makes shared parental leave unattractive to parents who desire to exclusively breastfeed for six months and to continue according to the WHO breastfeeding recommendations. While there is ACAS guidance and the Health and Safety Policy on what employers should be doing to support breastfeeding mothers returning to work, employers are not obliged to follow it and there are no consequences where they do not follow the guidance. Furthermore, flexible working remains a request not a right and does not go far enough to protect breastfeeding mothers in the workplace.

Shared parental leave policy has been criticised as not fit for purpose for reasons such as financial constraints, the complexity of the policy, societal perception, childcare responsibilities, lack of workplace support and breastfeeding. While the recent evaluation report recognised that there are challenges with the shared parental leave policy, it failed to identify breastfeeding as a challenge. The study that informed the report did not consider breastfeeding as a factor to evaluate its impact on the policy. It is extraordinary that a policy that is meant to provide parents with flexibility on how they care for their child, do not consider breastfeeding as a key factor.

A study with mothers that were breastfeeding and took shared parental leave demonstrated that shared parental leave only worked well where the workplace was supportive and made provision for the mother.

It is important that mothers are supported in how they decide to feed their babies. Breastfeeding need to be part of the family friendly rights in the UK. This would ensure that breastfeeding is factored into policies that concerns nursing mothers such as maternity leave and shared parental leave.

New Toolkit for Employers supporting breastfeeding mothers

Maternity Action have produced a new resource for employers which aims to help manage pregnant women and new parents at work, including breastfeeding mothers. Our in-house legal team have developed the Employers Toolkit, drawing on the extensive knowledge of potential workplace issues that we have gained through our advice work. With this resource, we are aiming to encourage employers to support women to have healthy pregnancies and to improve women’s experiences at work during pregnancy, maternity leave and on their eventual return.

The resource is also based on feedback that we have had from employers – for example, we know that many smaller employers don’t have HR capacity and cannot get the right information at the right time, which leads to uncertainty of their legal obligations. The toolkit is designed to make life easier for employers – there are checklists for different stages of pregnancy, maternity leave and return to work so that employers can be confident that they have done everything they are required to do.

In addition to this, the toolkit also contains a template for risk assessment and a number of model policies, including on maternity leave and pay and on breastfeeding. The model breastfeeding policy comprises best practice examples, information about Health and Safety protection and suggestions for possible adjustments. The toolkit builds on our previous work with the UK breastfeeding organisations to develop a Maternity Action resource for employers, and with Acas in 2013, developing their guidance on accommodating breastfeeding on return to work.

Many employers want to do the right thing for their employees and indeed many already do, recognising that supporting the transition back to work for their women employees is a small, short-term investment that has longer term benefits such as loyalty and staff satisfaction. With this toolkit, we aim to provide employers with answers to common questions about managing pregnancy, maternity, adoption, paternity and other family leave provisions in the workplace. We hope that this will help inform good employment practices.

Maternity Action is working with Greater Manchester Good Employment Charter to engage employers in the region. Acas North West hosted the launch of the resource and we are working together to promote the resource more widely. We are also looking at other ways to get the resource out to the employers who need it. Please get in touch if you would like to get involved in this.

The toolkit is funded by the VCSE Health and Wellbeing Fund, part of a partnership programme between Department of Health & Social Care, NHS England and UK Health Security Agency.

Get in touch: info@maternityaction.org.uk

Annah Psarros is Senior Policy Officer at Maternity Action. Annah is particularly interested in health inequalities and the social factors contributing to maternal health and wellbeing. She is currently working on a research project about the cost of living crisis and its effects on mothers and families, due in the autumn.

World Breastfeeding Week 2023 “Enabling Breastfeeding: Making a Difference for Working Parents”

August 1-7 will once again be World Breastfeeding Week. This year, the theme “Enabling Breastfeeding: Making a Difference for Working Parents” is all about combining working and breastfeeding.

One of the key findings from our first WBTi assessment of UK breastfeeding policies and programmes was that although the UK does provide paid maternity leave, and some paid paternity leave, and although there is some guidance on good practice from ACAS and from HSE, there is no statutory right in the UK to breastfeeding breaks or facilities in the workplace.

WABA produces regular snapshot Parents at Work reports on each country’s status on implementing International Labor Organization (ILO) conventions and recommendations on maternity protection at work, including maternity leave, paternity leave, and protected breaks for breastfeeding or expressing milk.

The ILO report Care at Work: Investing in Care Leave Policies and Care Services for a More Gender- Equal World of Work provides a global overview of national laws and policies such as maternity protection, paternity, parental and other care-related leave policies, as well as childcare and long-term care services.

Breastfeeding-friendly workplaces provide time, income security and space to enable positive nutrition and health outcomes

All women should have the right to paid working time for breastfeeding, as called for by ILO Convention No. 183. In 2021, 138 countries provide a right to time and income security for breastfeeding. These provisions potentially benefit 8 in 10 potential mothers across the world. Since 2011, seven countries have introduced paid nursing breaks. However, breastfeeding breaks remain unpaid in four high-income countries. In 2021, at least four pathfinder countries recognize men’s supporting role by offering breastfeeding breaks to fathers.

Almost 5 in 10 potential mothers live in countries that grant two daily breastfeeding breaks; while 109 countries offer the right to daily nursing breaks for six months or more. This would support exclusive breastfeeding in line with World Health Organization (WHO) recommendations for 7 in 10 potential mothers across the world. However, only ten countries provide a right to breastfeeding breaks for at least two years, compromising mothers’ ability to continuing breastfeeding.

Workplace nursing facilities are a key ingredient of breastfeeding-friendly workplaces. However, only 42 countries offer the right to workplace nursing facilities, covering roughly 6 in 10 potential mothers globally. While small- and medium-sized enterprises (SMEs) are often exempted from these requirements, research shows that the economic and well-being benefits of breastfeeding for the new-born, the mother and the employer outweigh the limited costs of these measures. Only 13 countries offer a right to workplace nursing facilities irrespective of the number and sex of workers, with only 5 in 100 potential mothers worldwide living in these countries. Conditionalities for nursing facilities based on sex are discriminatory and remain in place in 19 countries.

WBW Action Folder

Details for campaigning for improved policies and support for breastfeeding in the workplace can be found in the World Breastfeeding Week Action Folder.

WBW Pledge Map

Organising a WBW2023 celebration? Add it to the pledge map!

WBTi UK’s WBW outline of the week

Tuesday 1 August

Introduction

Wednesday 2^nd August at 12 noon

‘Breastfeeding: Not on the Agenda’ Webinar series: ‘Ready for Disaster? Infant and young child feeding in emergencies in the UK and Europe’ by Helen Gray MPhil IBCLC, WBTi Joint Coordinator

Previous webinars in the series and the documentary are available on YouTube.

Thursday 3^rd August at 1pm

‘Let’s make breastfeeding work – optimal maternity leave and workplace accommodations support an environment that enables breastfeeding’. Free webinar from the Global Breastfeeding Collective, led by WHO and UNICEF.

Friday 4^th August

Maternity Action’s Senior Policy Officer Annah Psarros, on their new Toolkit for Employers, including a model Breastfeeding Policy

Saturday 5^th August

Dr Ernestine Ndzi on Shared Parental Leave

Sunday 6^th August

LCpl Natasha Day MBE, founder of the Defense Breastfeeding Network

Monday 7^th August

Final blog from Dr Ernestine Ndzi on the need for “Family-Friendly Policies at Work”, and a Call to Action

Petition

And finally, everyone is encouraged to sign and share this petition from Dr. Ernestine Ndizi, calling for the government to:

Embed breastfeeding in the school curriculum and relevant health professional training.
Provide a policy on breastfeeding in the workplace which will protect the rights of breastfeeding mothers in the workplace.
Mandate all large public places like shopping malls, community centres, public libraries, museums, etc to provide breastfeeding rooms or spaces.
Fully adopt The Code of Marketing of Breastmilk Substitutes to protect babies and their families from harmful commercial influences and undermining of breastfeeding for commercial profit; and to protect families who formula feed from the escalating costs of premium brands.
Provide adequate 24/7 specialist lactation support in maternity services to actively counteract the culture of formula top-ups in hospitals; and to enable human donor milk to be more accessible as an option when mother’s milk is not immediately available.
Guarantee a sustained funding support to breastfeeding organisations who play a key part in supporting mothers.

– Include breastfeeding support on the Net Zero Environmental Agenda.

Sign the petition HERE

#StepUpForBreastfeeding: We are the Building Blocks #WBW2022

It takes a village to raise a child – we all have a role to play to support breastfeeding mothers and babies.

We all are the building blocks responsible for supporting new families: partners and family members, health workers, neighbours and community members, religious leaders, employers, academics, governments and policy makers. We can all make a difference. We need to step up to our responsibilities. Everyone needs to understand the importance of breastfeeding – for maternal and infant physical and mental health and wellbeing, for public health, for our economy, and for our planet.

For WBW this year, WABA has produced an extensive suite of materials looking at all these roles and responsibilities. They have outlined the challenges that breastfeeding families face at every stage from conception, through birth, getting breastfeeding off to a good start, and maintaining breastfeeding all the way through starting solids and going back to work, and the solutions we need in each situation – all backed up by links to the latest evidence.

The #WBW2022 Action Folder pulls all this together: it is a useful resource for anyone using evidence to build policies and best practice. You can download it as a PDF and all the links to research and references will be live.

The UK WBTi team will be highlighting just a few of the concepts this week:

Health workers: the importance of relevant, evidence-based. The advertising of follow-on milks, on the media, from 6 months in the UK has led to confusion, resulting in some parents seeing formula milk as equivalent to breastmilk, or that breastfeeding should stop at 6 months. The International Code needs to be adopted by the UK government in full, to reduce this confusion and protect breastfeeding. training for all those who work with women, infants and young children

UNICEF UK Baby Friendly Initiative and the BFHI worldwide sets out ways in which healthcare staff can receive sound, evidence-based, basic training in supporting breastfeeding.

ALSO join a special webinar from the Global Breastfeeding Collective on BFHI, with some added specialist topics on supporting small and underweight breastfeeding infants, and on infant feeding in emergencies. (7-9 AM BST and again at 4-6 PM BST). Register HERE

Community support: Access to skilled, integrated support for all, with a special focus in the GBC webinar on how to support breastfeeding infants who are not gaining well (NICE NG 75,2017). All parents should have easy access to trained healthcare staff- midwives, paediatricians, health visitors and GPs- breastfeeding peer supporters and specialist support (IBCLC, BFCs). Supporting breastfeeding in complex circumstances: Specialist support from IBCLCS, BFCs, or infant feeding leads, integrated with specialist healthcare teams

Protecting infants and young children in emergencies. National policies should guide Local Resilience Forums but these do not exist at present.

The impact of misleading marketing: The International Code. The advertising of follow-on milks, on the media, from 6 months in the UK has led to confusion, resulting in some parents seeing formula milk as equivalent to breastmilk, or that breastfeeding should stop at 6 months. The International Code needs to be adopted by the UK government in full, to reduce this confusion and protect breastfeeding.

Governments with national and local policy makers need to protect all families and support them to make informed feeding decisions free of commercial influence.

What can YOU do?

It is time for a reassessment of the UK’s national infant feeding policies and programmes. YOU could help! Volunteers are welcome with knowledge in any of the ten policy areas (Indicators 1-10), or with skills such as research, writing, graphics, social media and more – feel free to contact us for a chat!

WBTi Key Indicators:

Indicator 1: National policy, programme and coordination
Indicator 2: Baby Friendly Initiative
Indicator 3: International Code of Marketing of Breastmilk Substitutes

Indicator 4: Maternity protection
Indicator 5: Health professional training
Indicator 6: Community-based support
Indicator 7: Information support
Indicator 8: Infant feeding and HIV

Indicator 9: Infant and young child feeding during emergencies

Indicator 10: Monitoring and evaluation

Which one will YOU choose?

Contact us: wbti@ukbreastfeeding.org

Helen Gray MPhil IBCLC is Joint Coordinator of the WBTi UK Steering Group.

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.

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

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.
A UNICEF reportstates 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”.
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.
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

#WBW2019: Empower parents, enable breastfeeding

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.

Gaps and barriers

Our UK report found many gaps and barriers in ten areas of policy and programmes across the UK:

Lack of national leadership and national strategy on infant feeding, except in Scotland.
Areas where maternity settings still do not meet the minimum UNICEF Baby Friendly standards, in particular in England.
Weak regulations governing marketing by baby milk companies, no regulations governing bottle and teat marketing, and little enforcement of existing provisions.
Lack of provisions to support new mothers to continue breastfeeding when they return to work.
Gaps in health care professional training in infant and young child feeding (See both Part 1 and Part 2 of the WBTi report for full details)
Cuts to peer support and other community breastfeeding support.
No national communications strategy on breastfeeding.
Lack of understanding of current guidance on breastfeeding for HIV+ mothers.
No national guidance on planning for the care of infants and young children in emergencies or disasters.
Poor data collection and monitoring of breastfeeding rates.

Highlights of progress

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

National policy work: Scotland already had strong national policy leadership. Scotland, Wales and England have taken part in the Becoming Breastfeeding Friendly project on scaling up breastfeeding interventions, with a government commitment to act on recommendations.
With the latest NHS England Long Term Plan, all of the UK has now pledged to reach full UNICEF Baby Friendly accreditation in all maternity settings.
Increased awareness of International Code issues in the UK include a relaunch of the UK Baby Feeding Law Group, a coalition of UK organisations working in infant and maternal health, to advocate for implementation of the International Code in UK law.
The Alliance for Maternity Rights has included the protection of flexible breastfeeding/ expressing breaks and suitable facilities in their Action Plan.
Several health professional councils have begun to review their training standards on infant feeding, and a working group led be UNICEF Baby Friendly has launched a new set of learning outcomes for the training of medical students, paediatric nurses, dietitians, pharmacists and maternity support workers/ nursery nurses.
Continued cuts to local authority and public health budgets has continued to severely impact community breastfeeding support such as trained peer support. The WBTi team organised a conference on the public health impact of breastfeeding with the Institute for Health Visiting, exploring in particular the UNICEF Baby Friendly community requirements for “basic” health professional BFI training, “additional” local trained support such as peer support groups, and a “specialist” referral pathway at IBCLC level. The BFI, NICE and Public Health England guidance are clearly explained in the “Guide to the Guidance” by Better Breastfeeding. However there is potential for strengthening the commissioning of integrated breastfeeding services, through the increased profile of breastfeeding in England in the NHS Long Term Plan, breastfeeding representation now being included in the NHS England National Maternity Transformation Programme Stakeholder Group, and in Scotland and Wales with renewed national leadership and funding.
Although no national communication strategies on breastfeeding have been developed, the national governments and public health agencies have developed breastfeeding campaigns and have supported national breastfeeding weeks again across all four nations.
New guidance on infant feeding for HIV+ mothers from the British HIV Association has included detailed guidance on how to support mothers who wish to breastfeed (see also our guest blog from Pamela Morrison IBCLC explaining the new guidance here)
Infant feeding in emergencies is still not covered by national guidance or universally in local disaster resilience planning, however a national forum hosted by Alison Thewliss MP, and led by the UK WBTI team and Dr Ruth Stirton from the University of Sussex Law School has kick-started the discussion to improve awareness and standards.
Monitoring of breastfeeding rates remains uneven across the UK; Scotland has continued to conduct robust infant feeding surveys, while, in England, the PHE data on breastfeeding rates still have gaps in reporting. The UK government has now proposed to reinstate the national infant feeding survey in a new consultation on prevention. See also our blog by Patricia Wise on gaps and changes in our data (including how YOU can access the fingertips data), and guest blog by Phyll Buchanan MSc on how we can use the infant feeding data to reveal insights into health inequalities.

So we are in interesting times – we still face budgetary and cultural challenges, and families still face many barriers.

However change is clearly happening!

Coming up on the WBTi blog for #WBW2019

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.

Helen Gray IBCLC is Joint Coordinator of the WBTi UK team, with a special interest in supporting families in emergencies.

International Women’s Day, March 8th

Today is International Women’s Day, which was first held in 1911. The idea had been proposed at the second International Conference of Working Women, held in Copenhagen in 1910. The Day symbolises the struggle for equality, particularly in the workplace, but is also an opportunity to celebrate women’s achievements. You can read more about its history here: https://www.internationalwomensday.com/About

The theme this year is #BalanceforBetter, summarising that a better world has a better gender balance. While considerable progress has been made (for example, it was only in 1948 that women at Cambridge were given formal recognition of their degrees, and the percentage of girls in primary school in the world has risen from 65% in 1970 to 90% in 2015*), there is still a gender pay gap and women are in the minority in business and politics.

Balance requires removing conscious and unconscious bias about people; bias that results from assumptions being made about their capabilities. Alongside removing bias there needs to be support to meet specific needs individuals may have so that opportunities really are accessible – practical support includes items such as ramps and particular computer software. Thus, on the one hand, it’s essential not to assume differences that don’t exist so that women, men and intersex people of equal merit have equal opportunities.

On the other hand, it is important to respect real differences such as biological differences. Female employees who are breastfeeding need breaks for expressing or feeding, a suitable place to do that and facilities such as a fridge for storing expressed milk. If those were a legal requirement in the UK employers would be expected to provide them. Indicator 4 of the World Breastfeeding Trends Initiative is about maternity protection and the 2016 UK report assessed how well the UK is doing and made recommendations.

We’ve also had several blogs focussing on the issue, a blog on breastfeeding and Shared Parental Leave from Ros Bragg at Maternity Action, and a summary of the issue from our own Helen Gray.

With regard to achievements, every mother who nourishes her baby with her own milk is doing something ordinary that millions of women have done before her yet is also extraordinary.

* Rosling H (2018) Factfulness Stodder & Houghton

Photo: iStock.com/Jonas Unruh

Patricia Wise is an NCT breastfeeding counsellor and a member of the WBTi Steering Group.

Breastfeeding and expressing milk at work: What ARE your rights?

The media have been reporting today on the lack of legal protection in the UK for women to express milk or breastfeed when back at work. This is one of the reasons women cited for stopping breastfeeding in the U.K. National Infant Feeding Survey.

Media coverage of WBTi’s findings on gaps in Maternity Protection in the UK

The latest report on women’s rights to expressing breaks and facilities at work can be found in Indicator 4 on Maternity Protection in the WBTi report.

The media seized upon our findings on the lack of maternity protection, in particular the lack of any statutory rights for mothers to breastfeed or express milk at work.
There are resources to support employed mothers, and resources to guide best practice for employers (from Maternity Action and from ACAS), but mothers have no rights in law beyond basic health and safety.

Our findings received coverage by Laura Bates in the Guardian

and by Sophie Borland in the Daily Mail

The Daily Mail even featured a paragraph about how Sarah Willingham from Dragon’s Den balanced breastfeeding with her boardroom responsibilities.

Update on gaps in Shared Parental Leave

Ros Bragg from Maternity Action has also written this blog for WBTi about the current legal rights of breastfeeding mothers in the workplace, with the onset of Shared Parental Leave.

What has YOUR experience been, combining breastfeeding and returning to work?

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