Launch of learning outcomes for health workers

Launch of learning outcomes for health workers

At the start of World Breastfeeding Week, Unicef UK Baby Friendly Initiative launched a new set of resources: recommended learning outcomes for several health professional groups.

New Unicef Baby Friendly learning outcomes for health professional training

It had been announced at the Baby Friendly conference in 2018 that learning outcomes and resources were being produced.

Addressing gaps

WBTi UK Indicator 5: Health professional training

The WBTi report in 2016 (see Indicator 5 in Part 1 of the WBTi UK report for the above table, and Indicator 5 in Part 2 for the detailed findings for each UK health profession) showed that for most health professions in the UK, the coverage of infant feeding in pre-registration training was inadequate. In some case only broad standards are given and the individual universities develop their own curricula.

The infant feeding learning outcomes launched by BFI are for a range of newly qualified health professionals so they ‘articulate the minimum knowledge and understanding of infant feeding that it would be reasonable to expect from a health practitioner at the point of qualification’. There are slightly different ones for the following five groups:

  • doctors
  • dietitians
  • pharmacists
  • children’s nurses
  • maternity support workers/nursery nurses.

For each of these professional groups the learning outcomes are grouped into three broad themes:

  1. The value of human milk and breastfeeding.
  2. Supporting infant feeding.
  3. Infant feeding in context, which includes understanding the importance of the International Code. 

They are intended as ‘a stimulus to universities and others to start to consider what should be covered in relevant curricula and training, and then to take action to make that a reality.’ 

One useful recommendation is that ‘A mapping exercise can help the university to assess how far the topics are already covered and assessed in the curriculum, and to identify and plan for any additions to modules or design alternations needed.’ Plans for the resources ‘include a slide pack to help lecturers deliver the content to students, e-learning for students and assessment examples’. 

Specific learning outcomes like these, provided they are taken on board by the training institutions, will surely help to achieve a higher and consistent level of knowledge and skills within and between health professions.

Cover photo licensed by Adobe Stock

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

Breastfeeding and medication: training for pharmacists and counter staff

Breastfeeding and medication: training for pharmacists and counter staff

During World Breastfeeding Week #WBW2019, we are hosting a series of guest blogs exploring how the wider team of health professionals and community breastfeeding support can support breastfeeding families. The WBTi Report found numerous gaps in health professional training in infant feeding, and we are delighted to see a terrific range of resources being developed to address this.

For details of gaps in health professional training, see “Indicator 5” in Part 1 of the WBTi Report for the summary table above and in Part 2 for the detailed findings on each health profession.

In this blog, Wendy Jones MBE discusses gaps in the training of pharmacists (See Indicator 5 in Part 2 of the WBTi report for our detailed findings on pharmacist training) and introduces her new free online educational resources for pharmacists.

On a daily basis I hear that pharmacy staff have advised mothers not to breastfeed whilst taking medication or have refused to sell products such as antihistamines to lactating mothers. This is frustrating for families (and me!) and unnecessary.

We know that there are barriers around breastfeeding and medication:

  1. The patient information leaflet – invariably it says that the product should not be used during lactation. This doesn’t imply risk usually rather that the manufacturer didn’t include breastfeeding when applying for marketing authorisation. For more information see this leaflet on the Breastfeeding Network website.
  2. Understanding of the importance of breastfeeding for the future health of mother and child. Sadly breastfeeding, let alone understanding the pharmacokinetics of transfer of drugs into breastmilk, is not covered currently in most undergraduate training. Most knowledge relies on personal experience (Jones W 2000 Doctoral thesis University of Portsmouth. The role of community pharmacy is supporting mothers requiring medication).
  3. Fear of litigation – to sell a medicine outside of its licence application entails taking responsibility. Pharmacists are concerned, rightly so if they do not access evidence-based information (Hale TW Medications and Mother’s Milk, Jones W Breastfeeding and Medication, LactMed , UKDILAS, Breastfeeding Network factsheets)
  4. Time – frequently counter assistants rather than busy pharmacists are involved in sales of simple medications and do not discuss safety in breastfeeding unless asked by the mother.
  5. Time limitations to consult expert sources.

Conflicts of interest

It has come to my attention recently that continued professional development (CPD) materials on infant feeding are being provided free of charge to make pharmacists and staff “Infant Feeding Champion”. Sadly, these are provided by the formula companies and the support of breastfeeding is considerably less than what I would describe as evidence based and full of advertisements for products ranging from nipple shields to nipple creams and specialist formulas.

New free training materials

I decided that I wanted to provide training materials for pharmacists and counter staff free of charge using the knowledge that I have gained over the past 31 years as a qualified, registered breastfeeding supporter as well as pharmacist with a specialist interest in the safety of drugs in breastmilk. The first module can be found here. More modules are underway looking at the pharmacokinetics of drug transfer and the treatment of common conditions.

In the meantime, my message is #DontSayStopLookItUp

I’m happy to be contacted:

and I will send detailed information to mothers and professionals.

 Dr Wendy Jones  MBE

Wendy was one of the founder members of a UK charity the Breastfeeding Network. In her employed life she was a community pharmacist and also worked in doctor surgeries supporting cost effective, evidence-based prescribing. She qualified as a pharmacist prescriber using her knowledge to reduce the risk of heart attacks and strokes in clinics to help patients stop smoking, weight optimisation and control of blood pressure and cholesterol. She feels she was best described as the conscience of the village. Her aim was to run clinics for breastfeeding mums needing medication but never managed it. 

Wendy left paid work to concentrate on writing her book Breastfeeding and Medication (Routledge 2013,  2nd edition 2018), developing information and training material on drugs in breastmilk as well as setting up her own website http://www.breastfeeding-and-medication. She has also published Breastfeeding for Dads and Grandmas (Praeclarus Press) and Why Mothers Medication Matters (Pinter and Martin).

Wendy is known to many from her work on providing a service on the compatibility of  drugs in breastmilk and has been a breastfeeding supporter for 30 years. She is passionate that breastfeeding should be valued by all and that medication should not be a barrier. She has 3 daughters and 5 grandchildren ranging in age from 6 years to 6 weeks. All her family seem as passionate about breastfeeding as she is and currently all 3 of her daughters are breastfeeding. 

She was awarded a Points of Light award by the Prime Minister in May 2018 and was delighted to be nominated for an MBE in the New Year’s Honours List 2018 for services to mothers and babies. She received her award at Windsor Castle in May 2019 from Her Majesty the Queen. 

Hospital Breastfeeding 3: Posters from HIFN

Hospital Breastfeeding 3: Posters from HIFN

During World Breastfeeding Week #WBW2019, we are hosting a series of guest blogs exploring how the wider team of health professionals and community breastfeeding support can support breastfeeding families. The WBTi Report found numerous gaps in health professional training in infant feeding, and we are delighted to see a terrific range of resources being developed to address this.

For details of gaps in health professional training, see “Indicator 5” in Part 1 of the WBTi Report for the summary table above and in Part 2 for the detailed findings on each health profession.

Following on from previous blogs about the launch of the Hospital Infant Feeding Network website and the “Don’t Say Stop Look it Up” campaign, today’s blog looks at another set of resources provided by the Hospital Infant Feeding Network.

As a reminder, the Hospital Infant Feeding Network is a place for hospital health professionals to find out more about facilitating and supporting breastfeeding in a hospital setting. It provides a highly referenced, practical website on relevant topics, and a closed Facebook group for discussion and sharing best practice. For National Breastfeeding Celebration weeks in June, HIFN produced a set of A3 posters aimed at hospital staff in different settings to summarise useful, evidence-based information. These can be downloaded here.

The first two posters look at the reasons for health professionals to support breastfeeding, in term babies and in the neonatal unit setting. Families who are finding breastfeeding difficult are unlikely to find this type of messaging useful so it is important that these are placed to be staff-facing only.

The next three posters look at what is normal, common breastfeeding problems and the non-nutritional aspects of breastfeeding:

The final poster is designed for hospital settings where lactating women might be seen or admitted:

More information about all of these topics is available on the HIFN website.

 Ilana Levene is a paediatric doctor planning to sub-specialise in neonatal medicine and interested in research relating to neonatal nutrition. She lives in Oxford with her husband, an environmental consultant, and two children. She is a trustee of Oxfordshire Breastfeeding Support, a local grassroots network of free weekly breastfeeding drop-ins and online support. She likes cross-stitching and making patchwork quilts.

Don’t Say Stop Look it Up – A New Breastfeeding Campaign for HCPs (HIFN): 2

Don’t Say Stop Look it Up – A New Breastfeeding Campaign for HCPs (HIFN): 2

During World Breastfeeding Week #WBW2019, we are hosting a series of guest blogs exploring how the wider team of health professionals and community breastfeeding support can support breastfeeding families. The WBTi Report found numerous gaps in health professional training in infant feeding, and we are delighted to see a terrific range of resources being developed to address this.

For details of gaps in health professional training, see “Indicator 5” in Part 1 of the WBTi Report for the summary table above and in Part 2 for the detailed findings on each health profession.

Following on from yesterday’s blog about the launch of the Hospital Infant Feeding Network website, today we are looking in more detail at the joint GPIFN, Breastfeeding Network and HIFN campaign “Don’t Say Stop Look It Up”.

DontStopLookItUp

This campaign, started by the GP Infant Feeding Network in 2017, aims to make sure healthcare professionals know how to check whether specific medicines can be taken by breastfeeding women. Most healthcare professionals know that with regard to breastfeeding and medication they should check what the British National Formulary (BNF) says. The BNF is a phenomenal resource, respected around the world, with comprehensive information about medication doses, side effects and cautions. However, in some cases it takes a very cautious line on breastfeeding – for example, for the antidepressant sertraline, recommended by specialist services as a preferred option in breastfeeding, the BNF says “not known to be harmful but consider discontinuing breastfeeding”. For ibuprofen, accepted by specialist services as appropriate during lactation, the BNF says “use with caution during breastfeeding. Amount too small to be harmful but some manufacturers advise avoid”. It isn’t hard to see that well-meaning healthcare professionals are nervous about recommending medicines for breastfeeding women when seeing these descriptions in a trusted source of information, and why they may advise that breastfeeding should be stopped, or that the medication cannot be taken.

The #Don’tSayStopLookItUp campaign seeks to highlight the position of the National Institute for Health and Care Excellence (NICE), which states “Ensure health professionals who prescribe drugs to a breastfeeding mother… seek guidance from the UK Drugs in Lactation Advisory Service… the ‘British National Formulary’ should only be used as a guide as it does not contain quantitative data on which to base individual decisions… Health professionals should recognise that there may be adverse health consequences for both mother and baby if the mother does not breastfeed. They should also recognise that it may not be easy for the mother to stop breastfeeding abruptly – and that it is difficult to reverse”. The campaign poster set can be downloaded, and covers common classes of drugs such as antibiotics, antidepressants, painkillers and anaesthetics. The rest of the blog will cover in more detail how health professionals can effectively use the UK Drugs in Lactation Advisory Service (UKDILAS).

UKDILAS is an NHS service specifically set up to help health professionals make informed decisions about the use of medicines during breastfeeding. It is provided by a team of highly specialised pharmacists. The website is not the easiest one to navigate so we’ll go through the three particularly useful services they provide, step by step.

Using UKDILAS

Firstly, UKDILAS provides thorough lactation-specific information on individual medications. When a health professional wants to check a single medication, where they would normally look it up in the BNF, they can go to www.sps.nhs.uk (or Google UKDILAS) and use the search box at the top of the page:

Searching for codeine, for example, will bring up first the individual drug name and any lactation (and other specialist service) factsheets as well:

Clicking on the individual drug name codeine brings the reader to a long list of articles and other specialist information so the last step is to click on the “Lactation Safety Information” link under the medication name to go straight to the relevant section.

In this case, the final result is “Use when breastfeeding – No” with useful comments about how much data this is based on and what effects are seen. This will also link you through to any other relevant lactation safety information held about this medicine:

The other two UKDILAS services are the factsheets and the ability to ask specific questions. Question & Answer factsheets are available via a link from the UKDILAS part of the SPS website (www.sps.nhs.uk/ukdilas) and cover general topics like “which oral antihistamines are safe to use while breastfeeding?”. There are also general “safety in lactation” articles covering specific classes of medication – these will come up when you search for an individual medication, as shown above with codeine, which is an opioid analgesic.

To ask UKDILAS a specific question, health professionals can telephone (9am-5pm Mon to Fri) or email – full details are on the website. The team will answer any breastfeeding and medicine-related question, but particularly specialise in highly complex areas such as multiple medications and premature infants.

Other sources of information on drugs in breastmilk

As lactation professionals know, there are many other ways to access information about medications in lactation – for example the wonderful Drug Factsheets put together by Wendy Jones at the Breastfeeding Network, American national resource LactMed and textbooks such as Medications and Mothers’ Milk (Hale). This blog has focused on UKDILAS because it is an NHS source, which is reassuring to busy UK health professionals who may not have time to check the credentials of other sources.

So, in summary, health professionals naturally use the BNF to check information about lactation, but by using the Don’t Say Stop Look It Up campaign, we can help them find out about specialist sources of information to help families make informed decisions.

 Ilana Levene is a paediatric doctor planning to sub-specialise in neonatal medicine and interested in research relating to neonatal nutrition. She lives in Oxford with her husband, an environmental consultant, and two children. She is a trustee of Oxfordshire Breastfeeding Support, a local grassroots network of free weekly breastfeeding drop-ins and online support. She likes cross-stitching and making patchwork quilts.

Strengthening breastfeeding support through a new hospital network (HIFN): 1

Strengthening breastfeeding support through a new hospital network (HIFN): 1

During World Breastfeeding Week #WBW2019, we are hosting a series of guest blogs exploring how the wider team of health professionals and community breastfeeding support can support breastfeeding families. The WBTi Report found numerous gaps in health professional training in infant feeding, and we are delighted to see a terrific range of resources being developed to address this.

For details of gaps in health professional training, see “Indicator 5” in Part 1 of the WBTi Report for the summary table above and in Part 2 for the detailed findings on each health profession.

There is exciting progress to strengthen breastfeeding education and policy in a hospital setting in the UK, with the launch of a comprehensive website resource for hospital health professionals this week www.hifn.org. Co-chair Ilana Levene tells us more about the Hospital Infant Feeding Network (HIFN).

“HIFN was set up in 2018 and consists of a network of health professionals interested in supporting and facilitating breastfeeding in a hospital setting in the United Kingdom. I’m a paediatric trainee with a special interest in neonatal nutrition and my co-chair Vicky Thomas is a consultant paediatrician with a special interest in complex nutritional difficulties in infancy and childhood. Our steering committee includes a parent, a nurse practitioner, a dietitian and doctors from other specialities such as anaesthetics, endocrinology and emergency medicine. All health professionals and those who have a strong interest in hospital breastfeeding are welcome to become active within HIFN – if you would like to join, please search for the closed Facebook Group “Hospital Infant Feeding Network” and follow us on Twitter @HIFN12. To understand more about HIFN, just dive right into our new website www.hifn.org, launching this week to mark World Breastfeeding Week. It covers our principles and goals, general background issues of infant feeding in the UK and specific topics relevant to health professionals looking after both mothers and children in a hospital setting. If you’re not a hospital health professional, signpost those you know to the website as a source of expert, referenced, practical breastfeeding-friendly knowledge.

Why did we decide to form a new network for hospital health professionals? In 2016, the GP Infant Feeding Network (GPIFN) was set up in order to improve infant feeding support by General Practitioners, and this arena showed that there was a significant appetite and unmet need not only from GPs, but also hospital professionals. A recent survey of paediatric doctors in a large UK hospital found that 30% did not agree that breastfeeding is the most beneficial form of nutrition in the first 6 months of life, and over 50% felt inadequately trained to manage breastfeeding when they encounter it. WBTi has documented the many gaps in undergraduate and postgraduate training (see Indicator 5 in both Part 1 and Pat 2 of the WBTi report) , and sources like the parent-led Hospital Breastfeeding campaign have clearly shown the poor practice families experience on the ground every day as a result. With this pressing need in mind, a group of hospital professionals active in GPIFN decided to form a sister network. From the moment of inception, we have reached out to families, the lay organisations active in the breastfeeding field, and lactation professionals, in order to work in partnership.

Apart from working on our website content, HIFN has achieved major campaigning wins through advocacy with the Royal College of Paediatrics and Child Health, who recently announced they will no longer accept any funding from breastmilk substitute manufacturers. This has started to ripple out to other associated organisations such as the British Association of Perinatal Medicine. We re-launched a longstanding campaign related to medication in lactation, alongside GPIFN and the Breastfeeding Network, and with support from the UK Drugs in Lactation Advisory Service, called #dontsaystoplookitup. We provided poster resources for National Breastfeeding Celebration weeks – both of these sets of resources are available for download on the website www.hifn.org/dontsaystop and www.hifn.org/posters.

We look forward to continuing to serve UK families moving forward and welcome you to have a look at the new website and get more health professionals involved.”

 Ilana Levene is a paediatric doctor planning to sub-specialise in neonatal medicine and interested in research relating to neonatal nutrition. She lives in Oxford with her husband, an environmental consultant, and two children. She is a trustee of Oxfordshire Breastfeeding Support, a local grassroots network of free weekly breastfeeding drop-ins and online support. She likes cross-stitching and making patchwork quilts.

#WBW2019: Empower parents, enable breastfeeding

#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:

  1. Lack of national leadership and national strategy on infant feeding, except in Scotland.
  2. Areas where maternity settings still do not meet the minimum UNICEF Baby Friendly standards, in particular in England.
  3. Weak regulations governing marketing by baby milk companies, no regulations governing bottle and teat marketing, and little enforcement of existing provisions.
  4. Lack of provisions to support new mothers to continue breastfeeding when they return to work.
  5. 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)
  6. Cuts to peer support and other community breastfeeding support.
  7. No national communications strategy on breastfeeding.
  8. Lack of understanding of current guidance on breastfeeding for HIV+ mothers.
  9. No national guidance on planning for the care of infants and young children in emergencies or disasters.
  10. 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

  1. 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.
  2. 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.
  3. 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.
  4. The Alliance for Maternity Rights has included the protection of flexible breastfeeding/ expressing breaks and suitable facilities in their Action Plan.
  5. 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.
  6. 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.
  7. 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.
  8. 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)
  9. 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.
  10. 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.

Sign up HERE for WBTi’s email list, and don’t forget to sign up to follow our blog! 

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

WBTi’s Twelve Days of Christmas: part 1

WBTi’s Twelve Days of Christmas: part 1

This blog explores links that can be made between the gifts described in “The Twelve Days of Christmas” song and the World Breastfeeding Trends Initiative 2016 report

Day 1 – a partridge in a pear tree

Just as a partridge can find support and protection in the branches of a pear tree, each breastfeeding dyad needs a society that provides a supportive structure; to achieve this needs  coordination at national level through having a national policy, a strategic plan and effective implementation of that plan (WBTi Indicator 1). 

Jeremy Hunt, when Secretary of State for Health, declared that 

“The government is implementing the vision set out in the WBTi UK report. The Maternity Transformation Programme seeks to achieve the vision set out in the report by bringing together a wide range of organisations to work in nine areas… this includes promoting the benefits of breastfeeding by

  • Providing national leadership for breastfeeding celebration week;
  • Publishing breastfeeding initiation data;
  • Publishing breastfeeding profiles; and
  • Improving the quality of data on breastfeeding prevalence at 6-8 weeks after birth.”

A national assessment of UK breastfeeding policies and programmes, “Becoming Breastfeeding Friendly,” has now begun across England, Scotland, and Wales, led by the national governments and public health agencies and the University of Kent. Importantly, this initiative requires government commitment to implementing the resulting recommendations.

Another positive development since the WBTi report in 2016 is that in April 2018 Public Health England created a one-year Midwifery Adviser post for a seconded health professional whose responsibilities include breastfeeding, funded by the National Maternity Transformation Programme.

Day 2 – two turtle doves

This fits very well with Indicator 2 as it assesses the extent to which maternity-related services are Baby-Friendly accredited and the standards support loving relationships. Since the WBTi report, percentages of UK accreditations have increased as follows (2016 figure in brackets):

  • maternity services  62% (58%)
  • health visiting services  67% (62%)
  • universities: 43% (36%) midwifery and 17% (15%) of health visiting courses
  • childrens’ centres  16 (0)
  • neonatal units   6 (0)

Births taking place in fully accredited hospitals:

The WBTi recommendations call for “implementation and maintenance of Baby Friendly standards in all healthcare settings” in England and Wales. New maternity plans in December 2018 from the Department for Health and Social Care include “asking all maternity services to deliver an accredited, evidence-based infant feeding programme in 2019 to 2020, such as the UNICEF Baby Friendly initiative.” 
We would urge the government to extend the expectation of Unicef Baby Friendly accreditation as a minimum in community settings and Health Visiting Services, in neonatal units, and in midwifery and health visitor training programmes.

Day 3 – three French hens

The French hens are believed to symbolise the virtues of faith, hope and charity. Indicator 3 assesses the extent of implementation of the International Code of Marketing of Breastmilk Substitutes and subsequent WHA resolutions. There is faith, that incorporating the Code and resolutions in a country’s laws improves protection for all babies from commercial interests, as the experiences of individual countries like Brazil shows. There is hope that the Code and Resolutions will one day be implemented in UK law. Charity includes helping the vulnerable, such as babies.

Relatively recent changes include the World Health Assembly passing resolution 69.9 in May 2016, welcoming the new World Health Organisation 2016 guidance which clarifies that the Code applies to all milks and commercially produced foods marketed as suitable for infants and young children up to 36 months. A new Implementation Manual for this WHO guidance is also available.

The charity, Save the Children Fund, published its report Don’t Push It: Why the formula milk industry must clean up its act in February 2018.

The Changing Markets Foundation has published two recent exposés of formula company marketing tactics: Milking It and Busting the Myth of Science-Based Formula

The First Steps Nutrition Trust has published numerous reports and statements on topics around the marketing and nutritional composition of infant formula and baby foods 

In addition, the First Steps Nutrition Trust is now taking on the role of secretariat to the Baby Feeding Law Group (BFLG), a coalition of UK organisations working in maternal and infant health who work to bring UK law into compliance with the International Code. The WBTi UK Steering team is a member of the BFLG.

Day 4 – four calling birds

Indicator 4 assesses the protection and support provided by workplaces for employees who are breastfeeding. Four organisations helping to improve the situation include:

Since the publication of the WBTi report, tribunal fees were abolished in 2017

Day 5 – five gold rings

Gold is associated with precious things, and colostrum is known as “liquid gold.”

Indicator 5 assesses both the extent to which care providers are trained in infant and young child feeding and how supportive health service policies are. There are five professions which work most closely with mothers, infants and young children: midwives, obstetricians, paediatricians, health visitors and GPs. If they value breastfeeding and have the training to support mothers effectively they can serve as a golden chain of support.

 However, the WBTi report showed that there are gaps in health professional pre-registration standards in relation to the WHO Education checklist for topics they need to know about. Part 2 of the WBTi report contains further details for each health profession. In 2016, the General Medical Council published its revised Generic Professional Capabilities Framework, which all postgraduate medical curricula must fit. This includes a domain covering capabilities in health promotion and illness prevention. Medical curricula have to be revised to fit the framework and the RCPCH training for paediatricians now includes more about infant feeding at Level 2 (p.31)  Also, the RCPCH made a detailed policy statement on breastfeeding in 2017  and the RCGP developed a position statement on breastfeeding in 2018

The midwifery standards are currently undergoing a thorough review and there will be a consultation in February 2019. 

Members of the WBTi team have been supporting the work of revising and updating professional standards, and a working group led by Unicef Baby Friendly has now formed to take this work forward.

Day 6  – six geese a-laying

In the song the geese symbolise the six days of creation. 

Indicator 6 covers community-based support. So many mothers stop breastfeeding before they want to that it is really important to create an integrated system of support to avoid mothers falling into gaps between services. Six key aspects are:

  • Basic support: Health visitors and other health workers trained to a minimum Baby Friendly standard provide basic but universal help with feeding.
  • Additional: A peer support programme with trained peer supporters provides ongoing social support.
  • Specialist: For more challenging situations, mothers need to be able to access specialist help, for example from certified lactation consultants and breastfeeding counsellors.
  • Ready access to a tongue-tie division service where appropriate.
  • Good data collection is needed to underpin all these services.
  • Families must receive clear information about the services available.

WBTi Indicators 7-12 are covered in part 2

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  • Images from WBTi UK Report and Microsoft ClipArt